Menopause Guide

Female osteopath Natalie Adam speaking at Menopause and Me menopause awareness event

Menopause Guide

Last month I hosted a menopause awareness event with my friend and Wellness Coach Mariella Murray. The event aimed to provide answers to some of the common questions we are all asking about the menopause – Are the symptoms I’m experiencing due to the menopause? Is Hormone Replacement Therapy (HRT – the gold standard medication given to women to treat the menopause) safe? Where do I go for menopause help or advice? What can I do to help myself?

There is a lot of information out there about the menopause – much of which is contradictory and confusing – research is limited and people have variable experiences based on differences in factors such as genetics, lifestyles and how they respond to symptoms. To help answer questions, and because menopause affects so many different parts of the body, we brought together a wonderful panel of different experts; a Consultant Physician (Dr Monica Lascar) who specialises in sexual health and prescribes HRT, a Mental Health Nurse and Cognitive Behavioural Psychotherapist (Claire Crispin), a Registered Nutritional Therapist (Samantha Smith), a Menopause Fitness Coach and Personal Trainer (Louisa Smith), and a Women’s Health Physiotherapist (Bally Lidder).

Although there is a lot of variation between individuals when it comes to negotiating your way through the menopause, all the experts were sending the same message – HRT can be beneficial, with minimal risks, for a huge number of people and that whether you take HRT or not, the best thing any woman can do as she approaches her late 30s is to focus on living a healthy lifestyle. And when it comes to menopause, reducing stress, adapting diet to the changing body and including strength training to any exercise routine are the areas to focus on.

Below is a summary of my guide to the menopause. This is based on extra training for health care professionals and a lot of research to help answer these questions that I am commonly asked by the people I see in my clinic.

Female osteopath Natalie Adam talking about menopause and brain health at Menopause and Me event

What is the menopause

Menopause is defined as a consecutive 12 months without having a period. But symptoms associated with the menopause can last for many years in the run up to menopause (perimenopause) and for some years after (post menopause). For some people, the symptoms can continue for the rest of their lives. This is because your periods stop due to levels of certain sex hormones declining over time. The decline is not a slow, progressive decline. It’s an irregular fluctuation of hormone levels as the levels drop then increase again as the body tries to compensate, only to drop again, and so on. In most cases these fluctuations in levels become less pronounced as you reach the menopause and will eventually level out at a level much lower than they started off.

What age does the menopause start

The average age of menopause is 51 years old, so most people will go through the menopause between the ages of 45-55 years old. Some people can have a natural menopause between 40-45 years old, which is called early menopause, and can mean perimenopause symptoms can start in the late 30s. Below the age of 40, menopause can occur if the body is not working correctly. This is called premature ovarian insufficiency, or POI. There are a number of different causes of POI, including surgery to remove your womb (hysterectomy) or ovaries (oophorectomy), or certain cancer treatments, but the cause is often unknown. POI can occur in your teens, 20s or 30s and affects 0.01% of the population, which is around 20,000 people in the UK!

Menopause symptoms word cloud image

Symptoms of the menopause and getting help

Most lists of menopause symptoms are somewhere between 30-35 items long. The best thing to do, if you are approaching the menopause is to download one of these checklists of symptoms (see download button below) and know what the symptoms are. Note down what symptoms you are experiencing, when you are experiencing them, how severe they are and how they are affecting your daily life. This information can be taken to your GP as over the age of 45 years guidance for doctors says that menopause should be diagnosed by symptoms alone. Below the age of 45 years old you may be sent to have a blood test for diagnosis, and commonly you should have more than one test spread out over a period of time to see if the levels of hormones they are testing for remain the same.

Hormone Replacement Therapy prescribing and safety

HRT is the gold standard medication for treating symptoms of the menopause in the UK. It can involve topping up levels of the sex hormones oestrogen, progesterone or testosterone. Oestrogen is most commonly given, and is likely to be given alongside progesterone for women who have a uterus as progesterone can protect against risks of endometrial cancer (cancer of the womb lining). Testosterone can be given for certain symptoms of the menopause but is not currently licenced in the UK for treating women, so it can only be prescribed off -licence, based on guidance from the British Menopause Society. This is likely to be via a menopause specialist or someone confident in the knowledge of when to prescribe testosterone, so may not be readily prescribed by GPs. The British Menopause Society lists menopause specialists by postcode, as well as online services.

In 2002 a large US study called the Women’s Health Initiative published their results saying that the risks of taking HRT far outweighed the benefits, in particular in relation to risks of breast cancer and cardiovascular events (heart disease, blood clots and stroke). Many studies have been carried out since and a new generation of HRT drugs called body identicals, with many different ways of administering the drugs (tablets, gels, patches, pessaries, creams) have been developed. Body identical drugs, especially when taken via the skin over tablet form, are associated with fewer risks than the old drugs used in 2002. So for many women taking these new HRT drugs nowadays the benefits can far outweigh the risks, although many health care professionals may not be as up to date with the newer research and may still be sceptical of the risks. When taking any medication – especially for a long period of time – the risks and benefits to you personally, based on your own genetics, medical history, age, lifestyle and symptoms, need to be weighed up alongside advice from someone that specialises in prescribing and the menopause.

Female osteopath Natalie Adam hosting question and answer with experts session at Menopause and Me menopause awareness event

How osteopathy can help menopause symptoms

Going through a natural menopause increases the risk of osteoporosis – along with increased risk of Alzheimer’s Disease, diabetes and certain cancers. Osteoporosis is when the bones weaken and are more likely to fracture. The World Health Organisation states that 30% of women over the age of 50 have osteoporosis. This compares to 8% of men of the same age. The difference is due to menopause. I treat people with pain, muscle strains and tension caused by underlying osteoporosis. But muscle tensions as well as muscle and joint pains that I treat can also be directly caused by menopause itself. This is due to the affects of lowering sex hormones (in particular oestrogen) on collagen – the building block of our tissues. Collagen is the most abundant protein in our body and gives strength to muscles, tendons and ligaments. Collagen weakens when we go through menopause making these tissues less resilient and more vulnerable to injury, such as tears and strains. Weakening ligaments, that hold bones together at joints, can result in less stable joints, causing muscles and tendons to work harder to support the joints. This can result in aching, overused muscles and tensions. Pins and needles can also be a symptoms of brain changes during the menopause, but there are many other causes of continuous pins and needles. I can carry out an assessment to see if pins and needles symptoms need further investigation.

For more information on specific menopause symptoms or treatments you can contact the expert speakers from my Menopause and Me event via their websites:

Further information / References

Too many references were used in researching for this event and for this blog to list here, but can be dug out if needed. Please ask. But a PDF of the event handout listing useful resources for finding out further information can be downloaded below, as can a PDF checklist of menopause symptoms (adapted from

A number of people have asked if we will do another similar event giving more details on all the information above and another chance for people to ask experts questions about the menopause. No future events are currently planned but please email me at if you would like me to add your email to our mailing list to be informed of future events.