Menopause Mastery: Part 1
In recognition and celebration of International Women’s Day 2023 (8th March), we interviewed Lexie Minter, who heads up the menopause treatment clinic at the Lloyd’s Wellbeing Centre.
In a previous life, Lexie Minter was an A&E nurse and a midwife. Now a highly experienced menopause practitioner and Nurse Prescriber, she strives to educate women about the perimenopause and the menopause, explaining how hormone replacement therapy (HRT) can improve long-term health and wellbeing, easing the transition into the post-menopausal period.
In the first part of Lexie’s interview, she shares her knowledge about the perimenopause and the menopause, including explanations and common signs and symptoms. She also highlights the importance of oestrogen in women’s bodies.
Lexie Minter runs the Lloyds Wellbeing Centre’s menopause treatment clinic, and is a highly experienced menopause practitioner and Nurse Prescriber with a special interest in hormone health.
“I’m an independent Nurse Prescriber with a special interest in menopause and hormone health. I’ve been a registered nurse for over 20 years and have worked in a variety of disciplines, including Accident & Emergency, Occupational Health, Midwifery, Primary Care, Corporate Health and Wellbeing.”
“I spent 20 years working as an A&E nurse and a midwife, and nobody ever mentioned the menopause or the perimenopause. This needs to change.”
Lexie Minter – Lloyd’s Wellbeing Centre menopause practitioner (BSc Nursing, BSc Midwifery, Independent Nurse Prescriber)
What is the menopause?
When your body enters the menopause, you completely stop ovulating. You no longer have any follicles (tiny fluid-filled sacs where eggs are produced), and your body stops producing oestrogen. After one year and one day without a period, you’re no longer menopausal but are instead post-menopausal. It’s a rather eventful 24 hours…
In the UK, the average age of menopause for women is around 51 or 52. However, women can become menopausal much earlier, and in extreme cases this could happen at any time from the age of 12 to 40. Those who enter the menopause under 40 will be described as having premature ovarian insufficiency. An early menopause is defined as being experienced by those aged 40-45.
However, the menopause can also be induced by various medical interventions or treatments, autoimmune diseases, and a whole host of genetic and lifestyle factors, including smoking and drinking excessive amounts of alcohol. So, if you have a really wild twenties, unfortunately, you’re more likely to become menopausal prematurely.
The menopause can be surgically induced. For example, singer Michelle Heaton entered the menopause as a result of chemotherapy treatment. Furthermore, Angelina Jolie also became menopausal as a consequence of undergoing a bilateral oophorectomy and hysterectomy (meaning both her ovaries and uterus were removed), a route she decided to go down after BRCA gene testing confirmed her risk of developing cancer was high.
Overall, you’ve got to remember that there’s no such thing as being too old or too young to go through the menopause – everyone is different.
What is the perimenopause? Are there any signs or common symptoms you should look out for?
I often use an analogy to explain this to my patients: it’s like you’re getting dressed up for an evening out. When your oestrogen’s working, you feel put together - your hair’s done, your outfit’s ready, and your makeup’s perfect. But the next month, when you enter the perimenopause, your hormones are not coming out to play – you’re in a dressing gown, your hair won’t go right, and you feel a bit all over the place. It can be a really difficult time.
In terms of symptoms, so many people think that the menopause or the perimenopause are just about hot flushes, but there are so many more symptoms than just extreme temperature changes. In fact, not everyone gets hot flushes, and they’re often one of the last symptoms to arrive. Indeed, they can last for 20 years after the menopause (and can still be treated for 20 years after, might I add!).
Symptoms we associate with the perimenopause are sometimes bizarre – they often don’t make any sense to us at all, they’re just so variable and vague. For most women, the earliest symptoms can include increased anxiety, trouble sleeping, joint pain, and plantar fasciitis (pain on the soles of your feet).
Earlier in your life, your body might also show specific signs that you’re going to struggle when you hit the perimenopause. Experiencing post-natal depression, gestational diabetes, or blood pressure issues whilst pregnant are common warning signs of what’s to come. For example, if you suffer from PMS (Pre-Menstrual Syndrome – otherwise known as PMT, Pre-Menstrual Tension) in your twenties and thirties, you’re bound to find the perimenopause emotionally challenging.
I spent 20 years working as an A&E nurse and a midwife, and nobody ever mentioned the menopause or the perimenopause. I saw so many women present with palpitations and an impending sense of doom, thinking they were having a heart attack. Yes, some of them may have been experiencing cardiac issues, but so many of these symptoms are classic indicators of the perimenopause, and I wish I could go back and tell these women that.
Why is opening up conversations surrounding the menopause relevant to everyone?
If you’re thinking, “I still have a period”, or “well, I’ve been through the menopause – I’m out the other side by 5/10/15 years”, this conversation still involves you. Despite common misconceptions, HRT can be given to women who are still menstruating, even 10 years before they enter the menopause. Indeed, it can also be given to older, post-menopausal women who are still experiencing stubborn, uncomfortable symptoms. Both these situations are absolutely OK.
What role does oestrogen play in the body, and what issues can a lack of oestrogen (brought on by the menopause) have for the body?
Firstly, oestrogen regenerates our bones, meaning that post-menopause, 1 in 2 women may develop fragile, thin, osteoporotic bones due to this lack of oestrogen. This can lead to women repeatedly breaking bones or having undiagnosed spinal fractures, all of which can cause frailty, death, long-term disability, or significant care needs. Such high levels of osteoporosis are reversible and treatable, and these situations shouldn’t be happening in today’s modern world.
Oestrogen keeps the blood vessels elastic, meaning that when we lack this hormone, we are more likely to develop a cardiovascular disease, and are more prone to Alzheimer’s and dementia than men.
Not only this, but without this oestrogen, we also experience an increase in fat levels in the blood, as well as increased levels of insulin resistance. This means that we’re left with higher body mass indexes and fat distribution levels – it’s really annoying! The body is frantically trying to store the wrong type of oestrogen, resulting in a ‘middle-aged spread’ that just won’t shift.
Oestrogen is also highly immune-protective, and interestingly, research shows that women on HRT actually suffer less when exposed to COVID-19. Furthermore, emerging evidence indicates that HRT might offer some protection against certain cancers (e.g., bowel cancer), whilst reducing the risk of developing depression and type 2 diabetes.
Losing this oestrogen can cause significant internal and external skin and tissue changes too. Oestrogen produces collagen which keeps skin firm and smooth, so when we lose this oestrogen, the skin quickly ages. When you’re younger, the vagina is plump and lubricated. It also has a great microbiome, making it well-prepared to fight off any infections. However, as we lose oestrogen, the vagina gets thinner, more delicate, and more friable. Its pH levels also change, making infections much more likely. In elderly ladies, a nasty, recurrent urine infection could result in a cracking head injury or a broken hip from a fall, when the root cause is not the infection, but the lack of oestrogen that caused the infection. By replacing women’s oestrogen, we can restore the microbiome and get those pH levels back to normal, drastically reducing the risk of recurrent infections.
Is it normal to suffer from urinary incontinence after your periods stop?
Women joke about crossing their legs or not going on trampolines, but I think anything that’s life-limiting is wholly unacceptable. Because there’s so much going on in our lives – elderly parents, teenagers who need our support, and work pressures – we tend to put our own health on the back burner. We put up with so much more than we should.
Incontinence can become an issue because the bladder trigone (the mechanism that controls the passing of urine) contains oestrogen. When we lose our oestrogen, our bladders are impacted. This can also lead to recurrent UTIs or vaginal infections, particularly in the post-menopausal period. Women are bounced back and forth to their GPs for treatments when the real problem is a lack of oestrogen.
You can read part 2 of our Q&A with Lexie (publishing 9th March 2023) to find out more about HRT, the myths that surround it, and whether you could benefit from it.
