by Dr. Louise Newson is a leading menopause specialist and GP. She is the founder of "balance" app the free support application for menopausal women.

I spend my life asking women and healthcare professionals to think about sex hormones. We all know we’ve got them, we might even be able to name a few, but do you know what they do for us and how they change as we age?

The menopause isn’t about a grumpy woman who’s put on 10lbs and sweats a lot, despite what you might see in the media. It’s a time in a woman’s life that lasts for many years, and can have huge effects on physical health, emotional wellbeing, ability to do your job, the quality of relationships and of course, your sex life.

So, I’m going to break it down for you: explain what hormones do for you, why they change, how you might feel as a result, and let you know what you can do about it.

The Big 3

Let’s start with the biggie, estrogen ­­– the mothership – this hormone plays a huge role all over your body and helps your heart, bones, brain, skin, hair, vagina, everywhere basically. When your ovaries slow down production of eggs and your periods eventually stop, your levels of estrogen drop dramatically. This change can result in some pretty unpleasant symptoms, which we’ll get to in a moment.

The other hormones that fall when you go through the menopause are progesterone; this one normally keeps your womb lining healthy and gets it ready for a pregnancy or triggers a period. And the third one of the Big 3 is testosterone. Wait…really? Yes, really! Women produce lots of testosterone as well as estrogen (4x as much actually) and it helps with our energy and stamina, brainpower, and libido.

Stages And Symptoms Of The Menopause

You might be thinking this is way off for me and I’ll worry about that when I’m grey and retired. Did you know that it’s common for women to start noticing periods changing and hormone-related symptoms begin in their early 40s or even mid to late 30s? Changes can happen 5-10 years before your periods stop altogether. This transition time is known as perimenopause, then once you’ve not had a period for over 12 months – congratulations – you have now officially become postmenopausal. This doesn’t mean your symptoms will then vanish, unfortunately they can stick around for another 5-10 years or more (if no treatment is taken).

You might only get a few symptoms; every woman is completely unique and your experience will be yours and yours alone. Here’s a rundown of some of the most common symptoms that might happen in the perimenopause and beyond:

Heart Palpitations
Difficulty in sleeping
Feeling tired or lacking in energy
Feeling dizzy or faint
Muscle and joint pains
Breathing difficulties
Needing a wee more often, leaks of urine
Vaginal dryness, soreness
More thrush, cystitis episodes
Dry or itchy skin
Thinning hair
Feeling tense or nervous
Memory problems
Attacks of anxiety or panic
Difficulty concentrating
Loss of interest in most things
Feeling unhappy or depressed
Crying spells
Mood swings
Loss of confidence
Loss of interest in sex and/or level of arousal  
(it’s a heat regulation thing)

Hot flushes
Sweating at night  

Doesn’t sound great does it! So let’s take a more positive outlook and consider what to do about all of this.

Living Your Best Menopause-Smashing Life

Living a healthy lifestyle becomes even more important when you’re going through this phase of life. Your body needs all the help it can get, so you can do yourself a favour by focussing on these 5 things:

1.      Eat a healthy diet with plenty of fruit and veg, wholegrains, that’s low in salt and sugar and rich in calcium, pre- and probiotics, vitamin D and Omega 3 oils. All good stuff for your gut, bones, heart and brain.

2.      Enjoy regular exercise – however you like to get the heart beating a little faster and joints moving around, try and do it every day for at least 20 minutes.

3.      Get enough sleep – the best way to keep a good routine is to stick to the same going to bed times and getting up times, every single night. Sleep is vital for feeling well.

4.      Stay on top of stress and anxiety – easier said than done I know, but there are lots of simple ways to relax and calm your mind, such as using apps, daily breathing exercises or meditation.

5.      Limit alcohol and smoking – both of these can make menopausal symptoms worse, interfere with sleep, worsen your mood, not to mention the risks they pose for developing diseases in the future, such as cancer.

Reclaim Those Lost Hormones

You can be doing all the right things for a healthy life and take every herbal supplement on the market, but it doesn’t guarantee you a symptom-free menopause, unfortunately. The most effective treatment for your symptoms is to give your body back the hormones its missing. Because, after all, that’s what the root of the problem is.

Hormone Replacement Therapy or HRT – the clue is in the name! This is the term for the range of hormonal treatments you can take to help menopausal symptoms. The types of HRT I usually prescribe are estrogen through the skin via a patch, gel or spray, and oral micronised progesterone, which is branded in the UK as Utrogestan.

Less widely available – but often very useful – is testosterone replacement, as this can really help with a lack of energy, concentration and sex drive. (Testosterone is not often available on the NHS and you might need to see a menopause specialist for this one.)

Most women after a few months on the right type and dose of HRT notice a big improvement in their symptoms and feel so much better and more like their usual selves. If you decide to see your doctor for some HRT, a good way to show healthcare professionals that you have changing and falling hormone levels is to log and track your symptoms and periods. The free ‘balance’ menopause support app is a great way to do this, and it also has a health report you can print off and show to your doctor.

HRT has an unfair reputation as a controversial or ‘risky’ drug. There is a lot of misinformation circulating about HRT that is inaccurate and based on a flawed study from nearly 20 years ago. For the vast majority of women, the benefits from taking HRT outweigh any risks. In fact, it’s even better than that, women who’ve taken HRT for more than 18 years have been shown to have a lower risk of all diseases, including heart disease, type 2 diabetes, dementia and cancer – and they’ve even been found to have a lower risk of death compared to women not taking HRT. This is because hormones help our bodies fight off infection and disease and slow down biological ageing processes.

Many women worry about the risk of breast cancer with HRT, but most types of HRT do not actually increase the risk of breast cancer. Some studies have shown that there may be a very small risk of breast cancer when taking estrogen and a progestogen (a chemically created progesterone) but this isn’t the case if you take the micronised progesterone we mentioned earlier. If you’ve had a hysterectomy in the past and are only taking estrogen you actually have a lower risk of breast cancer than women who don’t take HRT.

Rebranding The Menopause

I’m working hard to rebrand the menopause as more than just some hot flushes that can cause a giggle, it is a hormone deficiency that begins much earlier than people realise, can last a lot longer and have a significant and negative impact on women’s lives. Just like a woman with diabetes takes  insulin, women should be offered replacement hormones if they want them, when they need them, for as long as they want to take them.

It’s time to talk about HRT and how safe it is these days, how it can protect your future health from disease and vastly improve a woman’s quality of life. Only 10% of the women in the UK take it, due to a combination of lack of awareness about the menopause, misguided fear of HRT, and healthcare professionals who are unaware of the safety and benefits of it.

I want to empower women to know their perimenopause and menopause and own it. Take control and get the help you need; make choices based on accurate, evidence-based information, and not inaccuracies and misguided fear.