Most people think of hot flushes (also called hot flashes) when they hear the word menopause.

Around 80% of women experience them.  Which means 20% of them don’t. They often start as a feeling of heat on the chest or neck and spread upwards towards the face and head, but they can affect anywhere on the body. Sometimes there is sweating and redness, but not always. They often come on suddenly and can last anywhere from seconds to hours. Some women can have upwards of 20 of them per day.

There can be an adrenaline rush before the flush – many women have feelings of palpitations, anxiety or light-headedness.

When they happen at night they are called Night Sweats and some women wake up several times, so drenched in sweat they have to change their bedding and often can no longer sleep with their partners.

For most women, hot flushes eventually stop. They last an average of around two years. But for some unfortunate women, they continue having them for decades.

Alcohol, hot drinks (especially caffeine), spicy foods, stress, tight fitting clothing and hot environments can all make hot flushes worse.

Noone is really sure what causes them, but it is thought to be due to the effects of estrogen on our internal thermostat (a place in our brain called the hypothalamus) which is where we regulate our body temperature. The lack of estrogen means we mis-interpret ourselves as being hot even if we are not.  

In the perimenopause, the fluctuating hormone levels can often lead to changes in the timing, length and flow of your periods. This varies between women and can be a change that makes them lighter, heavier, more spaced out, closer together, longer or shorter in duration. Other women notice no change in their periods at all. For women who get heavier periods, this can sometimes be so severe that they become anaemic.

In menopause, your periods stop altogether. Once you have not had a period for one whole year, then we can call this menopause.

It’s very common to have disturbances in your sleep. This can be trouble falling asleep, waking up throughout the night or waking very early in the morning and not being able to return to sleep.

Sometimes women wake up because they are having night sweats or because they need to pass urine or because their mind is racing with anxious thoughts – other times there seems to be no reason at all.

This is probably one of the most common symptoms I see as a GP. Women are often exhausted – and there are lots of reasons for this. They may not be sleeping properly because of night sweats or bladder symptoms. They may be spending most of their days overwhelmed with anxiety and feelings of panic which drive up our cortisol and rip away our energy levels. Many women just feel like their ‘oomph’ has gone. They are running on empty and struggling to keep up with their busy lives.

This is when women notice changes in their memory, mental focus and concentration. They often worry they are having an early dementia.

The hormonal changes of menopause can rob us of our multi-tasking superpower – we are no longer able to juggle all of life’s demands. We are left feeling overwhelmed and inadequate. Many women going through the menopause find they can no longer perform in their jobs and need to take increasing time off, reduce their hours or even resign.

This is a hugely significant symptom for many women. Our hormones play a key role in regulating our mood and mindset. Fluctuating estrogen, progesterone and testosterone can lead to feelings of depression, anxiety, irritability and even anger. These mood changes can be sudden – so you can go from feeling fine one minute, to feeling hopeless, panicky or enraged the next. It can affect women who already have a past history of mental health problems, but also women who have never experienced depression or anxiety before.

The mood changes also may not respond to classical treatments for depression and anxiety. This is why some women who are already on anti-depressants or having therapy, often report that their usual treatments seem to ‘stop working’ in their midlife years.

Estrogen helps keep our vaginas and our bladders happy. It acts as a natural lubricant, so when levels fall, the tissues around our vagina become thin, dry and inflamed.  These changes can make things feel very uncomfortable down below. It can be the main reason why some women stop having sex with their partners. Our bladder and urethra (the tube that carries urine from your bladder to the outside) also depend on estrogen to function effectively. As levels fall, we therefore start to experience bladder problems such as pain when passing urine, passing urine more frequently/urgently or getting recurrent urine infections.

As a GP, I feel so sad when I ask a patient if they have any such symptoms and they finally reveal that they have been silently suffering with painful ‘bits’, often for many years. Women can be too embarrassed to tell anyone. Or they think there is nothing that can be done because it’s a normal part of ageing.

The truth is that something can be done. And it is simple, effective and safe. Estrogen cream is available on prescription in NZ, fully funded in a product called Ovestin. Women can apply it twice a week to their vagina for the rest of their lives to put back the estrogen that is missing. It is not linked to breast cancer or clots. In the UK, they have recognised how safe and helpful vaginal estrogen can be for women and have made it available to purchase directly from a pharmacy - no doctor's prescription required.