Menopause and bladder leakage: by Dr Shahzadi Harper.

Women in their 30s tend to know very little about the menopause or bladder leakage, but knowledge is power and by learning about signs and symptoms you can actually prepare yourself for it. We all know that looking after our health is important, but so is thinking about our future health.

With this in mind, here are some facts, for any women who hasn’t gone through the menopause yet, to help you prepare for your future and make it all a lot less daunting when it does happen.

1. The menopause might happen sooner than you think

Five percent of women go through the menopause (their periods will stop completely) before the age of 45. One percent will go through it before the age of 40, which is called premature ovarian insufficiency. Other reasons for an early menopause include surgery to remove the ovaries or medication taken specifically to bring it about, often as part of a treatment for cancer. And smokers reach menopause just over two years earlier than those who don’t.

Even if you don’t have an early menopause, symptoms can start earlier than you might have thought, as they begin in perimenopause, the four to ten years leading up to the menopause. So if your menopause comes at the average age, 51, your symptoms could start when you are 41.

During perimenopause, women often assume any changes are due to other reasons – being busy with children or looking after parents, their partner or their career, for example. And hormones don’t decline in a straight line, they tend to fluctuate, so the change can feel very gradual.

Many think that the main symptom of perimenopause is hot flushes but often, the very first symptoms are feeling tired and/or joint pains. You may notice your cycle perhaps getting a bit shorter and/or your periods doing the same. Then, in your early 40s, the main symptoms women tell me they notice are fatigue and changes in their skin and hair, perhaps feeling anxious when they never used to, or starting to put on weight around the middle.

2. Think about your weight

There are a lot of factors that lead to mid-life weight gain. Not all of them are down to the menopause, but some are. So it’s good to be aware you may not be able to eat as you did in your 20s.

From our 40s onwards, women tend to put on half to 1k of weight per year. It tends be around the middle, which is related to the decline of oestrogen. Declining testosterone can lead to a drop in metabolism and muscle mass, as well as energy and libido too. But weight gain can also be related to the hormone insulin not working as well. Or there may be a drop in thyroid function, which also affects metabolism.

3. Be aware of breast cancer

Although we hear a lot about younger women who have breast cancer, when women reach the menopause the risk rises significantly. Eight out of ten cases of breast cancer are in women over the age of 50.

So it’s good to be aware of the other breast cancer risk factors so you can reduce them while you’re younger. If you haven’t already, stop smoking. Drinking any amount of alcohol increases your risk; the more you drink, the greater the risk. Weight is also important as breast cancer is linked to being overweight or obese. And inactivity is a risk factor too; aim for at least 150 minutes of moderate activity a week, according to Cancer Research UK.

Breast cancer isn’t the only reason to stay a healthy weight, to exercise, to drink sensibly; these will have an impact on your later life health in other ways, for example on your cardiovascular system.

4. Look after your pelvic floor

After the menopause, because of the change in oestrogen levels, women are much more likely to suffer from bladder leakage, as well as vaginal dryness and atrophy at this time. So it’s worth getting your pelvic floor in shape as early as possible. This is especially relevant for anyone who’s been pregnant, as you may know. I suggest doing pelvic floor exercises pre- and post-pregnancy. For those that struggle with the exercises (50% of women do them incorrectly), you could consider Pelviva, a disposable pelvic floor muscle trainer, that does all of the hard work for you!

5. Be prepared, but don’t be scared

Ideally, I’d like everyone to be aware of the menopause as a natural process, just like pregnancy. I’d like it to be taught in school so boys know about it. I’d like for everyone to know there are treatments available as well as support, so it feels much less scary and more manageable. I’d like it to be talked about in the workplace too, and see the development of menopause policies that make life a little easier for women at this time.

The earlier in your life you tackle the lifestyle factors above – smoking, drinking, exercise, eating well – the better prepared you’ll be when the menopause does happen. If you are in good shape and get good advice, the menopause needn’t be terrible. That’s why it’s worth focusing time and energy on your health, right now!

PEL_00083_UK Oct 2019