The menopause symptoms no one tells you about

It’s the one experience other than birth and death that every woman in her life will go through.

But for the vast majority of women, menopause is very much still shrouded in mystery.

The average age for a woman to go through ‘the change’ is 51 – but symptoms can start many years before.

Indeed, the phrase ‘menopause’ actually means ‘last period’ – and a woman is only considered post-menopausal when she has not had a period for 12 months.

In the lead up to this – a stage of life known as the perimenopause – the physical symptoms of menopause, from hot flushes to aching joints and sleepness nights, can be crippling.

But for many women, the low mood and anxiety that develops at this time of life is just as debilitating.

A third of women in a new survey said they were embarrassed by the symptoms that they had not expected to face, and half said the whole ordeal affected their confidence levels

In fact, 61 percent of women are suffering with anxiety due to the symptoms of the perimenopause, the survey by the online vitamin company Healthspan found.

A quarter of women reported suffering from extreme fatigue, while nearly a third said their mood was affected, triggering tears and sudden emotional outbursts.

Meanwhile 49 percent of women who were experiencing symptoms leading up to menopause didn’t realize this was due to the perimenopause.

Overall, a third of women in the survey said symptoms of menopause left them embarrassed – and half said the whole ordeal affected their confidence levels.

‘Yet many women are suffering in silence,’ says Dr Dawn Harper, a family doctor in Gloucestershire, England, with a special interest in women’s health.

‘In the 1990s, I couldn’t do a surgery without a woman coming in to ask me about menopause or HRT (hormone replacement therapy).

‘Then there was the big health scare over HRT and these ladies stopped coming in literally overnight as they were worried about taking HRT.

‘It’s really sad, as we now know HRT is not the devil incarnate – and it really can help women.

‘Also, it’s not HRT or nothing – there are now many other options that can help women.

‘That’s why I would urge all women to see their doctor if they are suffering any of the debilitating side effects.

‘Many women are also too embarrassed to mention some of their symptoms, meaning they never get help for them.’

Here, Dr Harper reveals the issues many women shy away from discussing – and what to do about them…


‘It’s rare that a patient will admit to suffering from vaginal dryness – it’s usually something I have to bring up,’ says Dr Harper.

‘I might ask them is sex is painful – which often provokes the response “sex, what’s that?” Or they say their husband is long-suffering but usually understanding.

‘That is a real shame as there is something that can be done.

‘My first choice of treatment is something called Vagifem. This is a pessary containing a naturally-occurring form of the female sex hormone estrogen. To start with, you use it every night for a fortnight, then twice a week.

‘It helps to improve lubrication of the vagina by hydrating and ‘plumping’ up the tissues there that have become thin, dry and/or sore and itchy.

‘It can also help women who suffer from cystitis which is more likely when the tissue in the vagina is thinner.

‘Often these women also wrongly think they have thrush but it might be a lack of estrogen causing dryness, stinging and burning.’

A vaginal moisturizer can help, alongside a water-based lubricant to be used when having sex, adds Miss Tania Adib, a consultant gynecologist at The Kensington Medical Chambers.

Increasingly, doctors are getting exciting by another new treatment called The MonaLisa Touch could be the right choice. 

‘The laser works on the tissue of the vaginal mucosa, boosting collagen and restoring function,’ she explains. ‘This simple procedure is performed in clinic, and three treatments are often required with a top-up treatment once a year. Success rates are about 85 percent.’


Black cohosh is believed to reduce menopausal symptoms through a direct action on the brain. It has been shown to lower levels of LH (luteinising hormone) which helps to normalize estrogen-progesterone balance. 

It also has an effect on dilation of blood vessels, and can help to relieve hot flushes, night sweats, low libido, anxiety and mood swings. 

Black cohosh is often used together with soy isoflavones. It can also improve sleep quality by reducing waking during the night. 

Sage leaf is not just useful for flavoring stuffing in the kitchen (though by all means add extra fresh leaves to bought mixes). 

Researchers have found that sage leaf extracts can relieve menopausal hot flushes and night sweats. 

A study involving 69 women who’d experienced menopausal symptoms for at least a year, and who had at least five flushes a day, showed that sage leaf extracts reduced the frequency of mild hot flushes by 46 percent, moderate flushes by 62 percent, severe flushes by 79 percent and stopped very severe flushes altogether. 

The intensity of flushes overall was halved within four weeks, and reduced by 64 percent within eight weeks. 

St John’s Wort is a popular traditional herbal remedy for lifting a low mood due to its natural antidepressant effect. 

What’s less well known is that it also improves low sex drive that can accompany menopause.

After three months of taking it, 60 percent of women with a low sex drive became interested in sex again, and enjoyed or even initiated sex with their partner, according to a German study published in the journal Advances in Therapy. 

Eighty-two percent also suffered less irritability, anxiety, low mood, hot flushes, sweating and disturbed sleep. 

Before the trial, 60 percent said they were too exhausted for sex. 

At the end of the trial, none of them felt that way. They also reported increased self-esteem, as well as a marked increase in self-confidence and self-respect. 

Dr Sarah Brewer a GP and Medical Nutritionist who has written numerous books on menopause also recommends sea buckthorn oil. 

She says: ‘Sea buckthorn oil is set to become the most popular menopausal supplement, as it is unusually rich in omega-7 – an important building block for healthy skin and mucous membranes. 

‘It has been used for centuries to relieve conditions associated with dryness, especially dry eyes, dry hair and female intimate dryness – all of which can occur during and after menopause.’ 

A study involving postmenopausal women with troublesome gynecological dryness, itching or burning, found that taking sea buckthorn oil daily for three months significantly improved vaginal dryness, as assessed by gynecologists.

Those taking sea buckthorn oil every day had a three-fold greater rate of improvement in the integrity of the vaginal walls than those taking placebo.

Other benefits include the ability of essential fats in sea buckthorn oil to improve the flexibility of arterial walls, the effects of its plant sterols on cholesterol balance, and its antioxidant ability to protect against unwanted blood clots.


Urinary incontinence – leaking urine, especially during exercise or when you laugh, cough or sneeze – is very common in women going through or after menopause, especially if they’ve had big babies or a forceps delivery,’ says Dr Harper.

‘Often, women are fine until they hit menopause – because estrogen helps to maintain collagen and elastin in the skin. But once the level of the hormone falls, everything can ‘sag’ – including our skin.’

The best solution is pelvic floor exercises, she says.

‘I cannot overestimate the benefits of pelvic floor exercises. Every woman should do them every day regardless of her age – don’t leave it until you hit menopause.’

Indeed, around three-quarters of women with continence issues can get some benefit from these exercises, if done properly, long-term.

‘As a rough guide, you want to create the sensation that you need to stop mid pee,’ says Dr Harper. (But don’t do these exercises while peeing). ‘Try and do 10 ‘stop, let go’ movements, then hold ‘stop’ for 10 seconds. Do these once a day – ideally more.’

If you are not sure what to do, speak with your doctor, a physio or continence nurse specialist.


‘Anxiety is such an underestimated symptom of menopause, yet women often don’t realise it is a sign,’ says Dr Harper.

‘They blame their low mood on their children flying the nest or hitting an age milestone that reminds them about their mortality.

‘I see so many sassy, savvy, high-flying women who suddenly feel so anxious and lacking in confidence once menopause hits. It can really throw them.

‘They come and see me saying ‘you have to help me – I’m being absolutely horrific to my husband but I just can’t stop myself – I’m not being me’.

‘Or, they’ve gone from being high flyers in the boardroom to not even being able to decide which pair of knickers to put on in the morning. They say ‘I used to be so on it, but I’ve completely fallen apart’.

‘If you are feeling emotional but don’t want to take HRT or antidepressants (another option), then St John’s Wort is another option. It’s been shown in decent trials to be as effective as Prozac for mild to moderate depression.’

CBT can also be of huge benefit in learning to deal with anxiety, ads Dr Harper. 


Caffeinated shampoos relax scalp blood vessels to improve the flow of oxygen and nutrients to hair follicles, says Dr Sarah Brewer, a GP and medical nutritionist. 

Caffeine applied topically also inhibits an enzyme, 5-α-reductase, which is associated with both male and female pattern hair loss. 

When applied as a shampoo, just two minutes contact with the scalp allows the caffeine to penetrate deeply, where it remains for up to 48 hours, even after hair washing. 

Unfortunately, drinking caffeine in coffee or tea does not have the same effect – the caffeine must penetrate directly into hair follicles to stimulate hair growth.