Intermenstrual bleeding is bleeding at times other than menstrual flow. In a normal [ovulatory cycle](https://nabtahealth.com/news/cycle-monitoring-with-ovusense/), one [ovum](https://nabtahealth.com/glossary/ovum/) is released from the [ovaries](https://nabtahealth.com/glossary/ovaries/); if fertilization does not occur, the [ovum](https://nabtahealth.com/glossary/ovum/) and a part of thickened endometrial tissue (endometrium is the inner layer of the [uterus](https://nabtahealth.com/glossary/uterus/)) are sloughed off with the beginning of menstruation. [Menstrual cycles](https://nabtahealth.com/article/what-is-abnormal-uterine-bleeding/) usually range between 21 and 35 days in length, although most women begin their periods around 10-14 days following [ovulation](https://nabtahealth.com/glossary/ovulation/). If the person is not using hormonal contraception, menstruation a regular intervals indicates that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred, and the person is not pregnant. Usually, the amount of blood discharged is less than 80 ml. What is Abnormal Uterine Bleeding? ---------------------------------- Bleeding outside the normal menstrual cycle in a woman female who is not on hormones, for instance, bleeding before day 20 of the cycle is [abnormal uterine bleeding](https://nabtahealth.com/article/what-is-abnormal-uterine-bleeding/). Bleeding between periods has explicitly been variously described as intermenstrual bleeding. It is estimated that 14-17% of women bleed between periods. If anyone gets vaginal bleeding after stopping hormones or after [menopause](https://nabtahealth.com/glossary/menopause/) are also considered as abnormal uterine bleeding. Causes of Intermenstrual Bleeding --------------------------------- **Age and Developmental Stage**: On the occasions of younger girls who have just started going through menstruation, it is very typical for them to possess irregular cycles. This may take as much as six years to get the cycle right. Similarly, during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)\-a transition stage before [menopause](https://nabtahealth.com/glossary/menopause/)\-the irregularity of the cycle occurs because of changes in levels of hormones. **Spotting vs. Heavy Bleeding**: First and foremost, distinguish between spotting and heavy bleeding. Light bleeding, or spotting, may occur in early pregnancy or as a side effect of hormonal birth control and is generally not a concern. Heavy bleeding can be indicative of structural problems, such as [polyps](https://nabtahealth.com/glossary/polyps/), uterine a or [fibroids](https://nabtahealth.com/glossary/fibroids/), or hormonal imbalances contributing to ovulatory dysfunction. **Structural Abnormalities**: Heavy bleeding during periods may be caused by living conditions such as [polyps](https://nabtahealth.com/glossary/polyps/) and [fibroids](https://nabtahealth.com/glossary/fibroids/). Monitoring hormone levels, specifically estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels, is recommended in heavy bleeding as it may point to endocrine disorders. **Infection**: Infection along the reproductive tract may cause bleeding from the [vagina](https://nabtahealth.com/glossary/vagina/). In most instances, the body clears the infection itself; however, medical consultation may be helpful to avoid future complications, such as scarring of the affected area, which can reduce fertility. **Cancer**: This is rarely the cause, but intermenstrual bleeding can be a sign of cancer, such as that of the [cervix](https://nabtahealth.com/glossary/cervix/), endometrium, or [vagina](https://nabtahealth.com/glossary/vagina/). Medical advice must be sought to rule out these severe conditions. What causes intermenstrual bleeding? ------------------------------------ Anemia: Heavy bleeding between periods carries some primary risks, one of which is anemia, an outcome of blood loss that results in a deficiency of hemoglobin in the blood. Anemia-related symptoms include fatigue, dizziness, headaches, and irregular heartbeat. It can be treated with [iron](https://nabtahealth.com/glossary/iron/) supplements. If the anemia is severe, someone might need a [blood transfusion](https://nabtahealth.com/glossary/blood-transfusion/). **Impact on Fertility**: Whether intermenstrual bleeding results in [infertility](https://nabtahealth.com/glossary/infertility/) depends upon the cause. Hormonal imbalances may affect [ovulation](https://nabtahealth.com/glossary/ovulation/) and, hence, make conception tough. Structural causes make fertilization difficult. Single episodes of intermenstrual bleeding may not result in any difference in fertility, but frequent episodes diminish this opportunity. Persistent bleeding between periods does not necessarily need to be ignored. Although related to common issues such as hormonal fluctuations or structural problems, the problem can denote other severe conditions in certain instances. It requires timely diagnosis, and only a proper investigation by a healthcare provider will determine the cause and recommended treatment. The first thing to consider is whether **age** may be contributing. ------------------------------------------------------------------- [Irregular periods](https://nabtahealth.com/articles/why-are-my-periods-irregular/) are very common in girls who have only just started their periods. In fact, it can take up to six years for the menstrual cycle to become regular. Thus, whilst it is worth monitoring dates and timings, irregularities in menstruation in females of this age are rarely anything to be concerned about. Abnormal cycles are also frequently seen in women who are approaching the [menopause](https://nabtahealth.com/glossary/menopause/). The years that precede the [menopause](https://nabtahealth.com/glossary/menopause/) are known as the [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[perimenopause](https://nabtahealth.com/glossary/perimenopause/). It is during these years that [ovulation](https://nabtahealth.com/glossary/ovulation/) starts to slow down and menstruation becomes irregular, then sporadic, before ceasing altogether. It is also important to establish the **type of bleeding**; whether it is heavy and period-like, or spotting. Spotting is light, there will not be enough to fill a tampon or pad, and the blood will usually be dark red or brown. It can happen during pregnancy (particularly in the early stages when the fertilised egg first implants) and as a side effect to [hormonal birth control](https://nabtahealth.com/articles/what-types-of-hormonal-birth-control-are-there/). Spotting is not usually anything to worry about and can simply be an indication that not all of the endometrial tissue was removed during menstruation. Monitor any spotting and if it is consistent and becoming heavier see your doctor. Heavy bleeding between periods can be caused by structural abnormalities, such as [](https://nabtahealth.com/what-are-uterine-polyps/)[polyps](https://nabtahealth.com/glossary/polyps/) and [](https://nabtahealth.com/a-simple-guide-to-fibroids/)[fibroids](https://nabtahealth.com/glossary/fibroids/); or hormonal imbalances causing ovulatory dysfunction. If you are experiencing heavy intermenstrual bleeding your doctor may want to check your [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [](https://nabtahealth.com/what-happens-if-my-progesterone-levels-are-too-low/)[progesterone](https://nabtahealth.com/glossary/progesterone/) levels across your cycle to identify whether you have an endocrine disorder. Another cause of intermenstrual bleeding is **infection**. [Vaginal bleeding](https://nabtahealth.com/articles/i-keep-bleeding-between-periods-is-this-normal/) can be a symptom of an [infection of the reproductive tract](https://nabtahealth.com/causes-of-female-infertility-infection). Often the body is able to clear infections without the need for medical intervention; but you should still consult a doctor for confirmation and to ensure that there will be no lasting negative effects. In severe cases, infection-induced scarring of the reproductive organs can result in difficulties in conceiving. In rare cases, intermenstrual bleeding can be a sign of **cancer**. _Abnormal bleeding_ between periods can be a symptom of [cervical](https://nabtahealth.com/cervical-cancer-symptoms/), [endometrial](https://nabtahealth.com/a-guide-to-endometrial-cancer/) or vaginal cancer. You should consult a doctor, who will be able to perform the necessary tests to rule this out as a possibility. The health risks of intermenstrual bleeding ------------------------------------------- One of the main health risks of [heavy bleeding](https://nabtahealth.com/articles/what-can-i-do-to-regulate-my-periods/) between periods is [anaemia](https://nabtahealth.com/glossary/anaemia/). The symptoms of [anaemia](https://nabtahealth.com/glossary/anaemia/) are fatigue, headaches, dizziness and an irregular heartbeat. It can be treated with [iron](https://nabtahealth.com/glossary/iron/) supplements. You may also wonder whether frequent episodes of intermenstrual bleeding will have an effect on fertility. This will largely depend on the reason for the bleeding. If fluctuating hormone levels are responsible, you may experience difficulty conceiving because your hormones need to be present at exactly the right levels for [](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate)[ovulation](https://nabtahealth.com/glossary/ovulation/) to occur. Likewise, [structural barriers](https://nabtahealth.com/causes-of-female-infertility-structural-issues-with-the-reproductive-tract) can impede fertilisation. If the bleeding occurs as a single episode, you are unlikely to [fall pregnant](https://nabtahealth.com/articles/calculate-if-im-pregnant/) that cycle, but may find that your fertility is actually enhanced during the cycle that follows. Subsequent cycles should not be affected. Repetitive episodes of intermenstrual bleeding probably will lower your overall chances of conceiving. No woman should have to put up with _persistent bleeding_. It can be draining from a financial, physical and emotional perspective. Diagnosis may have to be made via a process of elimination, but it is essential that doctors consider all eventualities and perform the necessary tests, so that the right treatment can be instigated. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#3b425a57575a7b555a594f5a535e5a574f5315585456) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Abnormal Uterine Bleeding (Booklet).” ReproductiveFacts.org, The American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/). Revised 2012. * Crawford, Natalie M., et al. “Prospective Evaluation of the Impact of Intermenstrual Bleeding on Natural Fertility.” Fertility and Sterility, vol. 105, no. 5, May 2016, pp. 1294–1300., doi:10.1016/j.fertnstert.2016.01.015. * Shapley, M, et al. “An Epidemiological Survey of Symptoms of Menstrual Loss in the Community.” The British Journal of General Practice, vol. 54, no. 502, May 2004, pp. 359–363. * “Vaginitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Nov. 2019, [www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707](http://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707). * Whitaker, L, and H O D Critchley. “Abnormal Uterine Bleeding.” Best Practice & Research. Clinical Obstetrics and Gynaecology, vol. 34, July 2016, pp. 54–65., doi:10.1016/j.bpobgyn.2015.11.012.
[Menopause](https://nabtahealth.com/glossary/menopause/) is a natural and [inevitable stage in a woman’s life](https://nabtahealth.com/articles/nabta-health-celebrates-women-during-their-age-of-hope/) that marks the end of reproductive years. While it is a significant milestone, it can also bring about various physical and emotional changes. [Menopause](https://nabtahealth.com/glossary/menopause/) often presents a unique set of challenges, but with proper knowledge and strategies, it is possible to navigate this transition with grace and improved well-being. In this article, we will explore effective strategies for managing [menopause](https://nabtahealth.com/glossary/menopause/) and empowering women to embrace this new chapter in their lives. #### Understanding [Menopause](https://nabtahealth.com/glossary/menopause/) [Menopause](https://nabtahealth.com/glossary/menopause/) typically occurs between the ages of 45 and 55, with the average age being 51. It is defined as the permanent cessation of menstruation, which happens when a woman’s [ovaries](https://nabtahealth.com/glossary/ovaries/) stop producing eggs and her hormone levels, particularly estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/), decline. The transition to [menopause](https://nabtahealth.com/glossary/menopause/), known as [perimenopause](https://nabtahealth.com/glossary/perimenopause/), can last several years and is often accompanied by various symptoms that can range from mild to severe. #### **Managing Symptoms** **Hot Flashes and Night Sweats:** Hot flashes are one of the most common symptoms of [menopause](https://nabtahealth.com/glossary/menopause/). To manage them, try wearing light and breathable clothing, avoiding triggers like spicy foods and caffeine, and keeping your living and sleeping spaces cool. Deep breathing [exercises and meditation](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/) techniques can also help reduce the intensity and frequency of hot flashes. **Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)):** For women experiencing severe menopausal symptoms, hormone replacement therapy may be an option. [HRT](https://nabtahealth.com/glossary/hrt/) involves taking estrogen and, in some cases, [progesterone](https://nabtahealth.com/glossary/progesterone/) to alleviate symptoms. However, [HRT](https://nabtahealth.com/glossary/hrt/) should be approached with caution and under the guidance of a healthcare professional, as it carries potential risks and side effects. **Sleep Disturbances:** [Menopause](https://nabtahealth.com/glossary/menopause/) can disrupt sleep patterns, leading to [insomnia](https://nabtahealth.com/glossary/insomnia/) and daytime fatigue. Establishing a consistent sleep routine, creating a comfortable sleeping environment, and practicing relaxation techniques before bed can improve sleep quality. Avoiding caffeine and electronic devices close to bedtime is also recommended. **Mood Swings and Emotional Well-being:** [Menopause](https://nabtahealth.com/glossary/menopause/) can bring about mood swings, irritability, and feelings of sadness or anxiety. Engaging in regular exercise, such as yoga or brisk walking, can help stabilize mood and reduce stress. Prioritizing self-care, maintaining a support network, and seeking professional help, if needed, are essential for [maintaining emotional well-being](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/) during this phase. **Bone Health:** Estrogen plays a crucial role in maintaining bone density. As estrogen levels decline during [menopause](https://nabtahealth.com/glossary/menopause/), women become more susceptible to [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). To promote bone health, ensure an adequate intake of calcium and [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) through a balanced diet or supplements. Engaging in weight-bearing exercises, such as strength training or dancing, can also help maintain bone density. **Vaginal Dryness and Sexual Health:** Reduced estrogen levels can [lead](https://nabtahealth.com/glossary/lead/) to vaginal dryness, discomfort during intercourse, and a decreased libido. Using water-based lubricants or vaginal moisturizers can alleviate dryness. Open communication with your partner and seeking guidance from a healthcare professional can help address concerns related to sexual health. #### **Lifestyle Adjustments** In addition to symptom management, adopting a healthy lifestyle can contribute to overall well-being during [menopause](https://nabtahealth.com/glossary/menopause/): **Balanced Diet:** A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports hormonal balance and provides [essential nutrients](https://awake-wellness.com/about-us). Limiting processed foods, sugar, and caffeine can help manage symptoms. **Regular Exercise:** Engaging in regular physical activity has numerous benefits during [menopause](https://nabtahealth.com/glossary/menopause/), including reducing hot flashes, improving mood, and maintaining bone health. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, along with strength training exercises. **Stress Management:** [Menopause](https://nabtahealth.com/glossary/menopause/), coupled with other life stressors, can contribute to increased stress levels. Adopt stress management techniques like deep breathing, meditation, yoga, or engaging in hobbies to reduce stress and promote relaxation. **Smoking and Alcohol:** Smoking and excessive alcohol consumption can worsen menopausal symptoms and increase the risk of health problems such as [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) and cardiovascular disease. Quitting smoking and moderating alcohol intake are vital for overall health during [menopause](https://nabtahealth.com/glossary/menopause/). #### **Conclusion** While [menopause](https://nabtahealth.com/glossary/menopause/) brings about significant changes in a woman’s life, it doesn’t have to be a time of suffering. By understanding the physical and emotional aspects of [menopause](https://nabtahealth.com/glossary/menopause/) and implementing management strategies, women can successfully navigate this transformative phase. Remember, each woman’s experience is unique, so it’s essential to work closely with healthcare professionals to develop a personalized approach to managing [menopause](https://nabtahealth.com/glossary/menopause/) effectively.
You may have heard [menopause](https://nabtahealth.com/glossary/menopause/) is [different for every woman](https://nabtahealth.com/articles/nabta-health-celebrates-women-during-their-age-of-hope/). When [perimenopause](https://nabtahealth.com/glossary/perimenopause/) starts (typically sometime between 45 and 55 years), how long each stage of [menopause](https://nabtahealth.com/glossary/menopause/) lasts (there are three stages – [perimenopause](https://nabtahealth.com/glossary/perimenopause/), [menopause](https://nabtahealth.com/glossary/menopause/), and [postmenopause](https://nabtahealth.com/glossary/postmenopause/)), the effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body … And the effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the mind. To confuse matters further, many early signs of [menopause](https://nabtahealth.com/glossary/menopause/) can be mistaken for other health conditions. And how [perimenopause](https://nabtahealth.com/glossary/perimenopause/) is diagnosed isn’t always consistent. Some [doctors will recommend](https://nabtahealth.com/product/menopause-wellbeing-consultation/) a series of blood tests to monitor hormone levels over time, while others will diagnose [perimenopause](https://nabtahealth.com/glossary/perimenopause/) based on physical symptoms. But there are some changes that happen to a menopausal woman’s body over time that can impact long-term health. It’s worth talking about these so that women can prepare for the symptoms and effects and [protect their health long-term](https://nabtahealth.com/articles/about-the-three-stages-of-menopause/). #### _‘Short-term’ effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body_ First, let’s talk about the ‘short-term’ effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body. When a woman is perimenopausal her hormones start to fluctuate due to the decline in reproductive hormones (estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/)) produced by her [ovaries](https://nabtahealth.com/glossary/ovaries/). These hormonal deficiencies [lead](https://nabtahealth.com/glossary/lead/) to many physical changes taking place in a woman’s body long before her ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). The physical changes and symptoms women experience due to the reduction in hormones can be unpleasant and debilitating. Common ‘short-term’ symptoms of [menopause](https://nabtahealth.com/glossary/menopause/) include: – Hot flashes / flushes – Night sweats – Irregular periods – Disturbed sleep – Urinary incontinence – Mood swings and anxiety – Low libido ‘Short-term’ is misleading here because for some women [these symptoms](https://nabtahealth.com/articles/about-the-three-stages-of-menopause/) can continue for several years. However, it’s important to differentiate between these common signs of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and early [postmenopause](https://nabtahealth.com/glossary/postmenopause/), and the long-term negative effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body. #### _What are the long-term effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body?_ Periods eventually stop completely (a woman is officially considered in [menopause](https://nabtahealth.com/glossary/menopause/) after 12 consecutive months of no periods) and for some women this finality can be emotionally tricky. The decline in estrogen has a profound impact throughout a woman’s body and can have serious implications for her health, the most significant of which are heart health and bone strength and density. [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is linked with estrogen deficiency, making postmenopausal women particularly prone to loss of bone mass and fragile bones that fracture easily. Studies show that [half of all women over 60](https://www.menopause.org.au/hp/information-sheets/osteoporosis) will suffer at least one fracture due to [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). Estrogen also protects cardiovascular health by shielding against cardiovascular disease, high blood pressure, and controlling [LDL](https://nabtahealth.com/glossary/ldl/) (bad) [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and [inflammation](https://nabtahealth.com/glossary/inflammation/). Ongoing low levels of estrogen mean menopausal and postmenopausal women are at higher risk of developing coronary heart disease or a stroke. Long-term hormone deficiency also increases a woman’s risk of chronic health conditions including type 2 diabetes, dementia, and bowel cancer. Other [long-term side effects](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) of [menopause](https://nabtahealth.com/glossary/menopause/) include hair loss, loss of skin elasticity and wrinkles, dark spots and dry skin, [insomnia](https://nabtahealth.com/glossary/insomnia/), decreased muscle mass, vaginal dryness, weight gain, depression, brain fog, and joint and muscle pain. #### _[HRT](https://nabtahealth.com/glossary/hrt/) to treat effects of [menopause](https://nabtahealth.com/glossary/menopause/) on the body_ [HRT](https://nabtahealth.com/glossary/hrt/) replaces the hormones the body is no longer producing. The hormone treatment includes estrogen, and sometimes [progesterone](https://nabtahealth.com/glossary/progesterone/), and is given as a skin patch, gel, spray, or pill. Research has shown that for most women who take [HRT](https://nabtahealth.com/glossary/hrt/) the benefits outweigh the risks with their [perimenopause](https://nabtahealth.com/glossary/perimenopause/) [symptoms improving within 3-6 months](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) of starting [HRT](https://nabtahealth.com/glossary/hrt/). And taking [HRT](https://nabtahealth.com/glossary/hrt/) reduces the risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease, type 2 diabetes, bowel cancer, osteoarthritis, and other health conditions due to hormone deficiency.
#### Nabta Health celebrates women during their ‘Age of Hope’ You may notice a shift in the language we use for [](https://nabtahealth.com/health-goals/i-think-im-going-through-perimenopause/)[perimenopause](https://nabtahealth.com/glossary/perimenopause/), [menopause](https://nabtahealth.com/glossary/menopause/), and post-[menopause](https://nabtahealth.com/glossary/menopause/) at Nabta Health; \[Age of Despair\] is now \[Age of Hope\]. You will see this evolution reflected on our Aya app, throughout our information hub and across all our communications. And it is our hope that with this shift, [menopause](https://nabtahealth.com/glossary/menopause/), a natural biological [process in every woman’s life](https://nabtahealth.com/articles/getting-started-with-nabta-health-your-101-guide-to-perimenopause-and-menopause/), will start to be celebrated as a time of renewal, transformation, and even improved social status. #### _Age of Hope. What’s in a word?_ Nabta supports women throughout their healthcare journey. We help women overcome physical and mental barriers and enable them to [lead](https://nabtahealth.com/glossary/lead/) a healthy and confident life. And we celebrate every stage of a woman’s life, from periods and [puberty](https://nabtahealth.com/glossary/puberty/), to pregnancy, postpartum, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and beyond. Doing this effectively sometimes means challenging taboos, negative or damaging beliefs, and overcoming stigmas. And in certain cases, it means championing more positive ways to communicate universal experiences. We recognise the part language plays in shaping and defining how whole societies think about a subject. #### _Nabta Health champions a positive women’s health experience_ 51% of the world’s population will [go through](https://nabtahealth.com/articles/getting-started-with-nabta-health-your-101-guide-to-perimenopause-and-menopause/) [menopause](https://nabtahealth.com/glossary/menopause/) and each woman’s experience of how [menopause](https://nabtahealth.com/glossary/menopause/) affects her own mind and body is deeply personal and unique to her. This is mirrored in cultural attitudes to [menopause](https://nabtahealth.com/glossary/menopause/), which differ across the globe, and in some cases across communities. [Studies](https://www.pghr.org/post/menopause-understanding-the-implications-of-society-and-culture) show that our culture and its influence on the way we approach [menopause](https://nabtahealth.com/glossary/menopause/) has a powerful effect on how women experience emotional and physical perimenopausal symptoms. And whether [menopause](https://nabtahealth.com/glossary/menopause/) is seen as a positive or negative event. In those societies with a more positive cultural attitude towards [menopause](https://nabtahealth.com/glossary/menopause/), and where aging is viewed positively, women report fewer symptoms of [menopause](https://nabtahealth.com/glossary/menopause/). In these societies the post-reproductive years are widely viewed as a positive transition into a stage of life crucial to society: older, experienced, and wise women with [energy to spare](https://nabtahealth.com/articles/perimenopause-weight-gain/). #### _Move over ‘age of despair’_ For many years the word for ‘[menopause](https://nabtahealth.com/glossary/menopause/)’ in Arabic has literally translated to ‘age of despair’. This expression is thought to be linked with the end of childbearing years, as if a woman’s value is defined by her youth and fertility. Her usefulness and attractiveness linked with her ability to produce children. The message of misery and hopelessness was hard to ignore. #### _Finding optimism in [menopause](https://nabtahealth.com/glossary/menopause/)_ Nabta hopes that in challenging this limiting terminology, and all its negative connotations, we can begin to celebrate this new stage in a woman’s life as one of hope, regeneration, and renewal. Nabta’s initiative is reflected by a recent campaign in Saudi Arabia. A sanitary products brand aimed to change the perceptions of [menopause](https://nabtahealth.com/glossary/menopause/) in the Middle East because 81% of Saudi women surveyed believed the word for [menopause](https://nabtahealth.com/glossary/menopause/) should be changed to something more positive such as, [“renewal, reflection, wisdom or creativity”.](https://www.campaignlive.co.uk/article/tena-bids-rebrand-menopause-women-middle-east/1709590) Nabta is reimagining women’s health. From periods and [puberty](https://nabtahealth.com/glossary/puberty/), to pregnancy, postpartum, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and beyond, Nabta Health offers a new, holistic model of healthcare that is built around you and your health goals.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
**[Menopause](https://nabtahealth.com/glossary/menopause/) is a natural process, which normally takes a number of years. We take a look at the three stages of [menopause](https://nabtahealth.com/glossary/menopause/) – [perimenopause](https://nabtahealth.com/glossary/perimenopause/), [menopause](https://nabtahealth.com/glossary/menopause/) and [postmenopause](https://nabtahealth.com/glossary/postmenopause/) – and how they can affect you, together with some tips for coping.** [Menopause](https://nabtahealth.com/glossary/menopause/) is the point at which a woman’s [ovaries](https://nabtahealth.com/glossary/ovaries/) stop producing eggs, and her periods come to an end. [Menopause](https://nabtahealth.com/glossary/menopause/) normally happens between the ages of 44 and 55, with the average age being 51. However, the transition to [menopause](https://nabtahealth.com/glossary/menopause/) is a gradual process, and some significant changes begin to happen in the months and years leading up to [menopause](https://nabtahealth.com/glossary/menopause/), as hormone levels start to decline. Women can experience a range of different symptoms at each stage. ##### [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) refers to the period of time before [menopause](https://nabtahealth.com/glossary/menopause/), when a woman’s hormone levels start to change as her [ovaries](https://nabtahealth.com/glossary/ovaries/) gradually begin to produce less [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). During [perimenopause](https://nabtahealth.com/glossary/perimenopause/), you may begin to experience a range of menopausal symptoms, which commonly include: **Irregular periods** This is often one of the first signs that you are in the [perimenopause](https://nabtahealth.com/glossary/perimenopause/) stage. The menstrual cycle starts to become erratic, and bleeding can be heavier and last longer. Missed periods, shorter periods and spotting between periods are also common. Some women also experience an increase in [Premenstrual Syndrome](https://nabtahealth.com/glossary/premenstrual-syndrome/) symptoms, such as cramping and breast tenderness. **[Hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and night sweats** These affect up to 75% of perimenopausal women, and often continue through to the [postmenopause](https://nabtahealth.com/glossary/postmenopause/) stage. Also known as hot flashes, they are a sudden rush of heat, often followed by excessive sweating, palpitations, chills and reddening of the skin. **Vaginal dryness and low sex drive (libido)** Changing hormones can cause a drop in sexual desire as well as changes to the vaginal area. The [vagina](https://nabtahealth.com/glossary/vagina/) can become drier and less lubricated, which can cause itching and irritation, and may make [sex uncomfortable or painful](https://menopause.livebetterwith.com/blogs/stories-info/how-to-cope-with-painful-sex-during-menopause). **Sleep disturbances** You may have problems with getting to sleep, waking frequently during the night, or waking in the early hours. **Mood swings** It’s common to experience sudden [changes in mood](https://menopause.livebetterwith.com/blogs/stories-info/the-truth-about-menopause-and-mood-swings), irritability, depression or anxiety. Other common menopausal symptoms can include: headaches, fatigue, feeling the need to urinate more often, joint and muscle pain, brain fog and difficulty concentrating. ##### [Menopause](https://nabtahealth.com/glossary/menopause/) [Menopause](https://nabtahealth.com/glossary/menopause/) is the point at which the [ovaries](https://nabtahealth.com/glossary/ovaries/) finally stop releasing eggs, and menstruation stops. A woman has officially reached [menopause](https://nabtahealth.com/glossary/menopause/) when she hasn’t had a period for 12 months in a row. By this point [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels have dropped substantially, and many of the symptoms you experienced during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) are likely to subside, although others may continue, including: * [Hot flushes](https://nabtahealth.com/glossary/hot-flushes/) * Vaginal dryness * [Insomnia](https://nabtahealth.com/glossary/insomnia/) * Urinary urgency * Brain fog and difficulty concentrating ##### [Postmenopause](https://nabtahealth.com/glossary/postmenopause/) [Postmenopause](https://nabtahealth.com/glossary/postmenopause/) describes the period in a woman’s life after [menopause](https://nabtahealth.com/glossary/menopause/) has been reached. Many women will now see a general reduction in their [menopause](https://nabtahealth.com/glossary/menopause/) symptoms overall, although you may continue to experience some symptoms following [menopause](https://nabtahealth.com/glossary/menopause/), including: * [Hot flushes](https://nabtahealth.com/glossary/hot-flushes/) – these normally subside after 1-2 years * Vaginal dryness and thinning of the vaginal tissues (atrophy) * Loss of bladder control * Mood changes or depression * Brain fog and forgetfulness After [menopause](https://nabtahealth.com/glossary/menopause/), women are also more at risk of problems such as [](https://nabtahealth.com/osteoporosis-and-menopause/)[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) (a thinning of the bones) and heart disease, so it’s important to make healthy lifestyle choices. Eating a [balanced diet](https://nabtahealth.com/gut-health-and-menopause/), which includes plenty of [iron](https://nabtahealth.com/glossary/iron/), calcium and [vitamin D](https://nabtahealth.com/glossary/vitamin-d/), doing regular exercise, avoiding smoking, and limiting your caffeine and alcohol intake can all help to reduce the risks. ##### Coping with the three stages of [menopause](https://nabtahealth.com/glossary/menopause/) [Menopause](https://nabtahealth.com/glossary/menopause/) is a natural phase of life, and each stage can have its challenges. The good news is, the majority of symptoms begin to ease off as you progress through the [menopause](https://nabtahealth.com/glossary/menopause/) – and there are lots of things you can do in the meantime to help feel more comfortable. Here are some top tips for dealing with some of the most common symptoms that occur at the different stages of [menopause](https://nabtahealth.com/glossary/menopause/): * [Hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and night sweats – you can help to turn down the heat by dressing in layers and wearing loose, light clothing made from natural materials such as [bamboo](https://menopause.livebetterwith.com/pages/search-results?q=bamboo+clothing), which is naturally moisture-wicking. Avoid hot, spicy foods, alcohol and caffeine and drink plenty of cool fluids. * Vaginal dryness and low libido – using topical creams, moisturisers and lubricants can help to relieve vaginal soreness and restore suppleness. Meanwhile, a stimulating gel can help to improve sensation. Remaining sexually active can also help to retain vaginal elasticity. You can view a range of intimate aids [here](https://menopause.livebetterwith.com/collections/intimate-aids). * Urinary issues – doing [Kegel exercises](https://menopause.livebetterwith.com/pages/search-results?q=kegel) can help to strengthen the muscles in the pelvis (the pelvic floor). * [Insomnia](https://nabtahealth.com/glossary/insomnia/) – make sure your bedroom is comfortable and well ventilated by opening the windows or using a fan. Many women find that wearing a [sleep mask](https://menopause.livebetterwith.com/products/jasmine-silk-sleep-mask) and using a relaxing sleep balm can also help them get a better night’s sleep. * Mood swings and anxiety – practising relaxation techniques, such as deep breathing, yoga and mindfulness can help with [mental wellbeing](https://menopause.livebetterwith.com/collections/stressed-sad-or-snappy). Doing some regular exercise can also help to balance your hormones, reduce [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and boost your mood, as well as helping you to maintain a healthy weight. It would be best to consider [Post](https://nabtahealth.com/product/postmenopause-test/) and [](https://nabtahealth.com/product/perimenopause-test/)[Perimenopause](https://nabtahealth.com/glossary/perimenopause/) Tests. ##### About Live Better With This article was originally written and published by our partner [Live Better With](https://livebetterwith.com/). Live Better With’s mission is to make everyday living a bit better for the millions of people living with long term health conditions, all over the world. We do this through thousands of curated products, informative content, useful services and a thriving online community. Visit Live Better With [here](https://livebetterwith.com/).
The [menopause](https://nabtahealth.com/glossary/menopause/) is a time of change. Typically occurring between the ages of 45 and 55, it is the time at which a female stops having her monthly periods. Whilst some women relish their postmenopausal years, freed from the constraints of monthly menstruation and constant fertility awareness; for others, it can be a difficult stage to navigate, dealing with a plethora of associated symptoms and, perhaps, facing up to their own mortality for the first time. The symptoms that are associated with the [menopause](https://nabtahealth.com/glossary/menopause/) usually start during the [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[perimenopause](https://nabtahealth.com/glossary/perimenopause/). This is the time before [menopause](https://nabtahealth.com/glossary/menopause/), when a female’s periods become increasingly irregular. There are symptoms that are widely accepted as being synonymous with the [menopause](https://nabtahealth.com/glossary/menopause/), for example [hot flushes](https://nabtahealth.com/glossary/hot-flushes/), difficulty sleeping, reduced libido and [vaginal dryness](https://nabtahealth.com/5-reasons-why-you-may-be-experiencing-vaginal-dryness/). These symptoms are common and, whilst it probably comes as little comfort to those in the midst of it, usually subside in the years following the [menopause](https://nabtahealth.com/glossary/menopause/). There are other symptoms too though; symptoms that are either not as well understood, or not quite as strongly associated as some of the aforementioned. In fact, there are thought to be more than 30 menopausal symptoms. Three out of four women report experiencing symptoms of the [menopause](https://nabtahealth.com/glossary/menopause/), but as not all of the associated symptoms are well known, it is likely that the true number of women affected by the [menopause](https://nabtahealth.com/glossary/menopause/) is actually even higher. We wanted to take the time to highlight some of the lesser known symptoms, particularly as they bring with them physical and emotional changes that can have a large impact on quality of life during the menopausal years. #### **Brain fog** Brain fog refers to the decline in cognitive function that many women experience during their [menopause](https://nabtahealth.com/glossary/menopause/). Usually manifesting as memory problems and an inability to concentrate; some women struggle to remember the right words at the right time, or find themselves attempting to use their car key zapper to enter their house. It can be quite a frightening experience, especially when paired with the worry that it might be an early sign of dementia. The reason for menopausal brain fog is not well understood. Suggestions that it is associated with declining [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels and/or impaired sleep patterns, sounded good in theory ([oestrogen](https://nabtahealth.com/glossary/oestrogen/) directly affects the parts of the brain involved in brain function and verbal memory); however, experimental studies have not supported these hypotheses. One study that found more pronounced cognitive impairment in the early stages of the [menopause](https://nabtahealth.com/glossary/menopause/), suggested that it was fluctuating [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels, rather than an absolute decline, that was causing the issues. #### **Fatigue** Fatigue, or a lack of energy and feeling of overwhelming tiredness, is another symptom of the [menopause](https://nabtahealth.com/glossary/menopause/). 44-65% of menopausal women report feeling fatigued. Perhaps this is of little surprise, given the high proportion of women suffering from night sweats and disrupted sleep. Unfortunately, fatigue is strongly associated with emotional negativity, meaning that those who are experiencing fatigue are more likely to experience feelings of depression and anxiety. Fatigue has also been shown to be associated with brain fog. #### **Mood swings and anxiety** Mood changes are a frequently observed consequence of the [menopause](https://nabtahealth.com/glossary/menopause/), but are often given very little consideration. All too often mood swings are thought to be the plight of the young; a defining feature of that other time of huge hormonal upset, [](https://nabtahealth.com/what-is-puberty/)[puberty](https://nabtahealth.com/glossary/puberty/). However, mood swings regularly reappear during the menopausal years, and whilst women at this stage may be older and wiser in many ways, they are just as susceptible to the emotional effects of fluctuating hormones as their younger selves. Furthermore, aside from their hormones, women at this stage of life often have many things to consider; their children ‘flying the nest’, elderly parents, increasing work commitments and responsibilities. Pair this with some of the physical symptoms of the [menopause](https://nabtahealth.com/glossary/menopause/), such as [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and night sweats, and it is easy to see why the rates of anxiety-based disorders amongst women in their 40s and 50s are increased compared to the rates in younger women. Anxiety and panic attacks are two of the major mental health issues that can affect menopausal women. #### **Hair loss and weight gain** Not all women mourn the passing of their fertile years; as mentioned previously, for some it almost certainly comes as a relief. However, for others it is difficult to come to terms with the knowledge that those years are behind them. As women, having periods is what defines us, it is one of the main things that separates us from men. In an article written by women, for women, let’s be honest, it is what makes us special. It is something that we have lived with and managed for the preceding 25 years or so. Change and the loss of a physiological norm should always be considered a potential source of emotional challenge. Now consider that on top of this emotional upheaval, many women at this stage also have to deal with unwanted physical changes. Up to two thirds of menopausal women experience hair thinning or bald spots. Many women see their stores of adipose tissue rise and as a result gain unwanted body fat. These are changes that would be unwelcome at the best of times, but when they affect those who are already feeling emotionally vulnerable, they can be particularly hard to manage. #### **Immune dysfunction** Aging brings with it ‘immune senescence’, in other words a reduced ability to manage infections. This happens to males and females, but seems to be exacerbated in menopausal women, who become particularly susceptible to an impaired immune response in their reproductive tract, increasing the risk of urinary tract infections (UTI). 10-15% of those aged 60 and over experience recurrent UTIs, most likely due to an altered vaginal [microbiome](https://nabtahealth.com/glossary/microbiome/) (the growth of different bacterial species in the lining of the [vagina](https://nabtahealth.com/glossary/vagina/)) in postmenopausal women. #### **Managing the [menopause](https://nabtahealth.com/glossary/menopause/)** The [menopause](https://nabtahealth.com/glossary/menopause/) cannot be ‘cured’, it is an inevitable stage of life. However, there are steps that can be taken to provide relief from some of the unwanted symptoms. The most widely known is almost certainly Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and this is probably the singularly most effective way of minimising [hot flushes](https://nabtahealth.com/glossary/hot-flushes/); but [HRT](https://nabtahealth.com/glossary/hrt/) has side effects and its long-term use is not recommended due to an association with blood clots and [breast cancer](https://nabtahealth.com/is-the-first-sign-of-breast-cancer-always-a-lump/). Instead, you may wish to consider certain lifestyle adjustments and home remedies that seem to improve some of the symptoms of the [menopause](https://nabtahealth.com/glossary/menopause/): * **Identify triggers** and avoid them. You might find alcohol, or caffeine, or stress are making your [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and mood swings worse and, by reducing your exposure to these, you lessen the severity of your menopausal symptoms. If you are unclear what your triggers are, try keeping a diary to identify common factors. * Consume a **balanced diet**. Eat more fruit, vegetables and whole grains and try to limit saturated fats and sugars. Eating well will improve your mood, as you will avoid the irritability that comes with fluctuating blood sugar levels; and will also help you to manage your weight more effectively. * **Exercise** more. There is no evidence that regular exercise reduces the frequency of [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) or night sweats, but it does improve energy and reduce stress. This makes it an effective tool in the management of fatigue and low mood. As with eating the right sorts of food, undertaking regular physical activity, can also help to minimise unwanted weight gain. * **Relaxation practices** such as [yoga](https://nabtahealth.com/hatha-vinyasa-ashtanga-what-is-the-best-type-of-yoga-for-me/), massage and paced breathing can all help to reduce the symptoms of anxiety. * **Supplements**. Whilst more women are relying on the use of supplements for management of their menopausal symptoms, the evidence supporting their use is limited and further studies are required. It is generally accepted that [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) and calcium are essential for good bone health and if your endogenous levels are low, boosting with supplements is a good idea. However, there are other supplements that are widely used, without the scientific support to validate their supposed beneficial effects. Examples of these include, plant-based oestrogens (phytoestrogens), black cohosh and red clover. Further work is required to establish both the safety profile and actual therapeutic effectiveness of these alternative therapies. #### **Summary** Women are amazing! This article attempts to cover just some of the associated symptoms many of us will have to deal with as we approach our menopausal years. It is far from an exhaustive list, but gives some indication of the changes our bodies need to go through; changes that impact our emotional, physical and sexual health. In fact, in English the [menopause](https://nabtahealth.com/glossary/menopause/) is colloquially referred to as ‘the change’, and it is easy to see where this moniker comes from. Many of the associated symptoms of the [menopause](https://nabtahealth.com/glossary/menopause/) are interlinked, meaning that for a significant number of women the negative emotions they feel at this time may be exacerbated by physical dissatisfaction. Of course not all women struggle. There is no right or wrong way to deal with the [menopause](https://nabtahealth.com/glossary/menopause/). We have also tried to provide some options for the management of these lesser known symptoms of the [menopause](https://nabtahealth.com/glossary/menopause/), without relying solely on hormone therapy. One of the most important things, however, is to share any concerns, worries or fears with friends and loved ones, and seek help from a medical professional if any of your symptoms are starting to overwhelm you. Try Nabta’s [](https://nabtahealth.com/product/perimenopause-luxury-selfcare-pack/)[Perimenopause](https://nabtahealth.com/glossary/perimenopause/) pack and consider the [](https://nabtahealth.com/product/postmenopause-test/)[perimenopause](https://nabtahealth.com/glossary/perimenopause/) Test. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0d746c61616c4d636c6f796c65686c617965236e6260) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Ali, Amira Mohammed, et al. “Psychological Climacteric Symptoms and Attitudes toward [Menopause](https://nabtahealth.com/glossary/menopause/) among Emirati Women.” _International Journal of Environmental Research and Public Health_, vol. 17, no. 14, 13 July 2020, p. 5028., doi:10.3390/ijerph17145028. * Ghosh, Mimi, et al. “The Immune System in [Menopause](https://nabtahealth.com/glossary/menopause/): Pros and Cons of Hormone Therapy.” _The Journal of Steroid Biochemistry and Molecular Biology_, vol. 142, July 2014, pp. 171–175., doi:10.1016/j.jsbmb.2013.09.003. * Glazier, M. Gina, and Marjorie A. Bowman. “A Review of the Evidence for the Use of Phytoestrogens as a Replacement for Traditional Estrogen Replacement Therapy.” _Archives of Internal Medicine_, vol. 161, no. 9, 14 May 2001, pp. 1161–1172., doi:10.1001/archinte.161.9.1161. * Heinemann, Christine, and Gregor Reid. “Vaginal Microbial Diversity among Postmenopausal Women with and without Hormone Replacement Therapy.” _Canadian Journal of Microbiology_, vol. 51, no. 9, 1 Sept. 2005, pp. 777–781., doi:10.1139/w05-070. * Maki, Pauline M., and Victor W. Henderson. “Cognition and the [Menopause](https://nabtahealth.com/glossary/menopause/) Transition.” _[Menopause](https://nabtahealth.com/glossary/menopause/)_, vol. 23, no. 7, July 2016, pp. 803–805., doi:10.1097/gme.0000000000000681. * Mansikkamäki, Kirsi, et al. “Physical Activity and [Menopause](https://nabtahealth.com/glossary/menopause/)\-Related Quality of Life – A Population-Based Cross-Sectional Study.” _Maturitas_, vol. 80, no. 1, 30 Sept. 2014, pp. 69–74., doi:10.1016/j.maturitas.2014.09.009. * “[Menopause](https://nabtahealth.com/glossary/menopause/).” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 7 Aug. 2017, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401)[menopause](https://nabtahealth.com/glossary/menopause/)/diagnosis-treatment/drc-20353401. * “[Menopause](https://nabtahealth.com/glossary/menopause/): Symptoms .” _NHS Choices_, NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/menopause/symptoms/)[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms/. * Roberts, Helen. “Managing the [Menopause](https://nabtahealth.com/glossary/menopause/).” _Bmj_, vol. 334, no. 7596, 5 Apr. 2007, pp. 736–741., doi:10.1136/bmj.39153.522535.be. * “Treating Female Pattern Hair Loss.” _Harvard Medical School_, Harvard Health Publishing, 14 Nov. 2018, [www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss](http://www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss). * Weber, Miriam T., et al. “Cognition in [Perimenopause](https://nabtahealth.com/glossary/perimenopause/).” _[Menopause](https://nabtahealth.com/glossary/menopause/): The Journal of The North American [Menopause](https://nabtahealth.com/glossary/menopause/) Society_, vol. 20, no. 5, May 2013, pp. 511–517., doi:10.1097/gme.0b013e31827655e5. * “What Is [Menopause](https://nabtahealth.com/glossary/menopause/)?” _National Institute on Aging_, U.S. Department of Health and Human Services, [www.nia.nih.gov/health/what-](http://www.nia.nih.gov/health/what-menopause)[menopause](https://nabtahealth.com/glossary/menopause/). * Zhu, Xiaoshu, et al. “Chinese Herbal Medicine for Menopausal Symptoms.” _Cochrane Database of Systematic Reviews_, 15 Mar. 2016, doi:10.1002/14651858.cd009023.pub2.
[Cultural attitudes to](https://journals.sagepub.com/doi/10.1177/0898010107299432) [menopause](https://nabtahealth.com/glossary/menopause/) differ across the globe and in some cases across continents. Stigma. Taboo. Misconceptions. Embarrassment. Barriers to care. A biological stage that will be experienced by half the world’s population is still largely hidden in secrecy and euphemism, ‘the change’. 51% of the world’s population will go through [menopause](https://nabtahealth.com/glossary/menopause/) and each woman’s experience of how [menopause](https://nabtahealth.com/glossary/menopause/) affects the body is deeply personal and unique to her. There is also a clear difference in how women in diverse cultures experience this natural stage in a woman’s life. #### _Culture influences the way women experience [menopause](https://nabtahealth.com/glossary/menopause/)_ [Studies](https://www.pghr.org/post/menopause-understanding-the-implications-of-society-and-culture) show that our culture and its influence on the way we approach [menopaus](https://nabtahealth.com/product/menopause-wellbeing-consultation/)e has a powerful effect on how women experience [perimenopausal symptoms](https://nabtahealth.com/product/perimenopause-test/). And whether [](https://nabtahealth.com/product/menopause-wellbeing-consultation/)[menopause](https://nabtahealth.com/glossary/menopause/) is seen as a positive or negative event. Research by [Yale School of Medicine](https://medicine.yale.edu/) reported in [Reuters Health](https://www.reuters.com/news/archive/healthNews) found that [“In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome,”](https://www.reuters.com/article/us-health-menopause-perceptions-idUSKBN0OL1XH20150605)according to [lead](https://nabtahealth.com/glossary/lead/) study author [Dr Mary Jane Minkin](https://medicine.yale.edu/profile/maryjane_minkin/), a professor in obstetrics, gynaecology and reproductive health. And [menopause](https://nabtahealth.com/glossary/menopause/) specialist Dr Sandra Thompson explained [to Reuters Health](https://www.reuters.com/article/us-health-menopause-perceptions/culture-may-influence-how-women-experience-menopause-idUSKBN0OL1XH20150605), [“If](https://www.reuters.com/article/us-health-menopause-perceptions-idUSKBN0OL1XH20150605) [menopause](https://nabtahealth.com/glossary/menopause/) symptoms were due solely to hormonal changes then the menopausal experience would be more homogenous.” In the West, the arrival of [menopause](https://nabtahealth.com/glossary/menopause/) is viewed with something akin to dread. Like death and taxes, it is treated with a bleak inevitability, something women cannot avoid and must bear in embarrassed silence. While in some cultures in the Middle East, Asia and for certain First Nations people the ‘transition’ is a time of renewal, transformation and improved social status. And in [shamanic cultures](https://www.womenshealthnetwork.com/menopause-and-perimenopause/menopause-in-different-cultures/#:~:text=A%20common%20belief%20among%20traditional,their%20shamanic%20and%20healing%20powers) [menopause](https://nabtahealth.com/glossary/menopause/) is a spiritual wakening. Women must go through [menopause](https://nabtahealth.com/glossary/menopause/) to access their wiser selves. In societies where aging is viewed positively, women report fewer symptoms of [menopause](https://nabtahealth.com/glossary/menopause/). Dr Mary Jane Minkin told Reuters Health, [“Where older is not better, many women equate](https://www.reuters.com/article/us-health-menopause-perceptions-idUSKBN0OL1XH20150605) [menopause](https://nabtahealth.com/glossary/menopause/) with old age, and symptoms can be much more devastating.” #### _What’s in a name? [Menopause](https://nabtahealth.com/glossary/menopause/) in Western society_ The word [menopause](https://nabtahealth.com/glossary/menopause/) literally means ‘monthly stop’, making a direct reference to the end of menstruation. It comes from the ancient Greek ‘men’ (month) and ‘pausis’ (cease). In Western women the focus is on the collection of emotional and physical symptoms resulting from the decline in reproductive hormones and their link with aging. The top 10 signs of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) are hot flashes, irregular periods, loss of libido, hair loss, vaginal dryness, brain fog, mood swings, [insomnia](https://nabtahealth.com/glossary/insomnia/), night sweats and weight gain. [Menopause](https://nabtahealth.com/glossary/menopause/) awareness is evolving in the West with vocal celebrity Gen X campaigners forcing a much-needed public debate, but there is still a way to go. For too long now the view of [menopause](https://nabtahealth.com/glossary/menopause/) in popular Western culture has been miserable. Menopausal women are presented as having passed their sell by date. As if a woman’s value is defined by her youth and fertility. Her usefulness and attractiveness linked with her ability to produce children. This is even reflected in the way the healthcare profession has traditionally treated ‘women’s problems’, shrugging off a natural part of aging that affects over 50% of the population with limited investment in medical research and training. And this has played out in workplaces. Little understanding of the physical and emotional impacts of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) on the female workforce means there is inadequate support in the workplace. This means that women going through ‘the change’ are leaving the workforce early. They are overwhelmed by the burden of symptoms. Fears of hot flashes in meetings, flooding, impact of brain fog and sleeplessness, and hair loss force an early retirement. And yet until recently [perimenopause](https://nabtahealth.com/glossary/perimenopause/) hasn’t been a subject working women think they can broach. But even across Western society there are differences in how women report their experience of [menopause](https://nabtahealth.com/glossary/menopause/). For example, in Scandinavian countries Denmark, Norway and Sweden women surveyed didn’t find it as bad as expected. While in the United Kingdom and North America women report finding the experience much more difficult than predicted. #### _[Menopause](https://nabtahealth.com/glossary/menopause/) in Middle East_ Knowledge and experience of [menopause](https://nabtahealth.com/glossary/menopause/) differs by ethnic and [socioeconomic](https://nabtahealth.com/glossary/socioeconomic/) group across the Middle East. The word ‘[menopause](https://nabtahealth.com/glossary/menopause/)’ in Arabic translates to ‘age of despair’. The expression is thought to be linked with the end of childbearing years, rather than feelings of hopelessness around aging and the experience of [menopause](https://nabtahealth.com/glossary/menopause/). A 2021 advertising campaign in Saudi Arabia by a sanitary products brand aimed to change the perceptions of [menopause](https://nabtahealth.com/glossary/menopause/) in the Middle East because 81% of Saudi women surveyed believed the word for [menopause](https://nabtahealth.com/glossary/menopause/) should be changed to something more positive such as, [“renewal, reflection, wisdom or creativity”.](https://www.campaignlive.co.uk/article/tena-bids-rebrand-menopause-women-middle-east/1709590) #### _[Menopause](https://nabtahealth.com/glossary/menopause/) in Eastern culture_ In general women in [Asian cultures report fewer hot flashes](https://pubmed.ncbi.nlm.nih.gov/23562010/) or night sweats, but more mood changes, [insomnia](https://nabtahealth.com/glossary/insomnia/), and muscle and joint pains. The post-reproductive years are widely viewed as a positive transition into a stage of life crucial to society: older, experienced, and wise women with energy to spare. #### _[Menopause](https://nabtahealth.com/glossary/menopause/) in Japan_ In Japan ‘konenki’ means renewal of life and regeneration. Women in Japan generally report fewer perimenopausal and menopausal symptoms. While there may be diet and lifestyle considerations – the Japanese diet is high in soy, which contains [phytoestrogens isoflavones](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390141/) – there’s no doubt the more positive cultural attitude to [menopause](https://nabtahealth.com/glossary/menopause/) in Japanese society also plays a role. #### _[Menopause](https://nabtahealth.com/glossary/menopause/) in India_ Some communities in India embrace [menopause](https://nabtahealth.com/glossary/menopause/) as a [time of liberation](https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1990.tb30321.x). The women of Rajasthan report experiencing typical perimenopausal symptoms, but view [menopause](https://nabtahealth.com/glossary/menopause/) as a natural stage of life that comes with benefits and frees them from societal constraints. #### _[Menopause](https://nabtahealth.com/glossary/menopause/) and First Nations women_ The limited research on attitudes to [menopause](https://nabtahealth.com/glossary/menopause/) among [Mayan](https://www.sciencedirect.com/science/article/abs/pii/S0378512203000367) and Aboriginal women reports that the communities [embrace the freedom and gain in status](https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-47) brought by the menopausal transition. More detailed research is needed on reporting of symptoms, although exploratory interviews with Mayan women reported typical perimenopausal symptoms were accepted with [“equanimity; and rejoicing at the cessation of their periods”.](https://www.sciencedirect.com/science/article/abs/pii/S0378512203000367) [Menopause](https://nabtahealth.com/glossary/menopause/) is a [neutral or positive experience](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554544/) for Native American Indians, who are celebrated as ‘women of wisdom’ in their communities. #### _Positive [menopause](https://nabtahealth.com/glossary/menopause/) support with Nabta Health_ If you are going through [menopause](https://nabtahealth.com/glossary/menopause/) or if you think you might be experiencing signs of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) symptoms speak with your healthcare team about options for managing your symptoms. Nabta Health offers a wealth of resources, access to clinical advice, at-home testing, and wellness kits to support you during your [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) journey.
 **[Perimenopause](https://nabtahealth.com/glossary/perimenopause/)** is a natural process in a woman’s life caused by a normal biological decline in reproductive hormones. [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) onset varies from woman to woman and can take place at any stage from a woman’s mid-30s (premature [menopause](https://nabtahealth.com/glossary/menopause/)) into her late 50s. Also known as the ‘[menopause](https://nabtahealth.com/glossary/menopause/) transition’, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) lasts between three and 10 years. The average length of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) is 4-5 years, and the average age of [menopause](https://nabtahealth.com/glossary/menopause/) is 51 years. **[Menopause](https://nabtahealth.com/glossary/menopause/)** marks the end of [perimenopause](https://nabtahealth.com/glossary/perimenopause/), when a woman has gone a full 12 months without menstruating. After a year of no menstrual periods a woman is considered to have gone through [menopause](https://nabtahealth.com/glossary/menopause/) to her post-menopausal phase. **Induced [menopause](https://nabtahealth.com/glossary/menopause/)** is when a woman’s menstrual periods stop due to medical treatments or intervention. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) or radiation damage to the [ovaries](https://nabtahealth.com/glossary/ovaries/), and surgical removal of the [ovaries](https://nabtahealth.com/glossary/ovaries/) result in medically induced [menopause](https://nabtahealth.com/glossary/menopause/). **[Postmenopause](https://nabtahealth.com/glossary/postmenopause/)** is the ongoing phase of a woman’s life after [menopause](https://nabtahealth.com/glossary/menopause/). It’s important to note that many women continue to experience the classic [menopause](https://nabtahealth.com/glossary/menopause/) symptoms for years after their ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What happens to a woman’s body when she is perimenopausal? The hormones that flooded a woman’s body during [puberty](https://nabtahealth.com/glossary/puberty/) and her fertile years start to fluctuate due to the decline in the female reproductive hormones (estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/)) produced by her [ovaries](https://nabtahealth.com/glossary/ovaries/). These hormonal deficiencies [lead](https://nabtahealth.com/glossary/lead/) to many physical changes taking place in a woman’s body long before her ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What are the symptoms of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/)? * Hot flashes / flushes * Night sweats * Vaginal dryness * Irregular periods * Hair loss * Weight gain and slowed [metabolism](https://nabtahealth.com/glossary/metabolism/) * Itchy or dry skin * Disturbed sleep * Urinary incontinence * Mood swings and anxiety * Brain fog or memory loss * Low libido The physical changes and symptoms women experience due to the reduction in hormones can be debilitating. #### What are the long-term health risks of [menopause](https://nabtahealth.com/glossary/menopause/)? Long-term hormone deficiency increases women’s risk of chronic health conditions including cardiovascular disease, [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), type 2 diabetes, dementia, and bowel cancer. #### How is [perimenopause](https://nabtahealth.com/glossary/perimenopause/) diagnosed? A doctor will assess symptoms and may recommend a blood test to check follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) and estrogen levels. As hormones fluctuate during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) the test may be repeated after a few months if the results are inconclusive. Women who want to confirm their symptoms can also take a [perimenopause](https://nabtahealth.com/glossary/perimenopause/) test measuring the levels of three hormones [from the comfort of their home](https://nabtahealth.com/product/perimenopause-test/). However, a hormone test isn’t always necessary, and some doctors will diagnose [perimenopause](https://nabtahealth.com/glossary/perimenopause/) based on physical symptoms. #### Can [perimenopause](https://nabtahealth.com/glossary/perimenopause/) be treated? [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) are natural biological processes in a woman’s body and cannot be delayed or halted with treatment. That said, a healthcare professional may discuss Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and lifestyle adjustments to help manage the physical impacts of hormone deficiency. #### What is [HRT](https://nabtahealth.com/glossary/hrt/)? [HRT](https://nabtahealth.com/glossary/hrt/) replaces the hormones the body is no longer producing. The hormone treatment includes estrogen, and sometimes [progesterone](https://nabtahealth.com/glossary/progesterone/) and [testosterone](https://nabtahealth.com/glossary/testosterone/) if needed, and is given as a skin patch, gel, spray, or pill. Most women report their [perimenopause](https://nabtahealth.com/glossary/perimenopause/) symptoms improving within 3-6 months of starting [HRT](https://nabtahealth.com/glossary/hrt/). Taking [HRT](https://nabtahealth.com/glossary/hrt/) reduces the risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease, type 2 diabetes, bowel cancer, osteoarthritis, and other health conditions due to hormone deficiency. There are risks associated with [HRT](https://nabtahealth.com/glossary/hrt/), including a small increased risk of breast cancer and blood clots in women with a family history. However, research has shown that for most women who take [HRT](https://nabtahealth.com/glossary/hrt/) the benefits outweigh the risks. A woman should always have a conversation with her healthcare team to decide the best approach for her individual circumstances. #### Are there natural ways to reduce the symptoms of [menopause](https://nabtahealth.com/glossary/menopause/)? Lifestyle adjustments can also be beneficial in managing perimenopausal symptoms. Women should try to eat a balanced diet with plenty of fresh fruit and vegetables, protein, whole foods, and foods rich in omega-3 fatty acids and calcium. Phytoestrogens can mimic the effects of estrogen in the body and occur naturally in foods including flaxseeds, sesame seeds, beans, soy, garlic, and cruciferous vegetables. Stop smoking and cut back on foods that might disturb sleep or trigger hot flashes, such as caffeine and alcohol. And exercise is essential. The decline in hormones affects bone and joint health, so it is more important than ever to maintain strength and flexibility with regular cardio and weight bearing exercise. As a woman’s [metabolism](https://nabtahealth.com/glossary/metabolism/) naturally changes with age, exercise will also help with weight control. #### Can I still become pregnant during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)? While you are still having your period you can become pregnant. If you don’t want to be pregnant you should continue to use contraceptives until you are postmenopausal. #### Understanding [menopause](https://nabtahealth.com/glossary/menopause/) Health organisations and governments are increasingly recognising the gaps in knowledge and understanding of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) and its enormous impact on women’s health and wellbeing. Efforts are now being made to address gender inequalities in broader healthcare provision and rebalance the lack of [menopause](https://nabtahealth.com/glossary/menopause/) research. The last few years have seen investment in improving education around [perimenopause](https://nabtahealth.com/glossary/perimenopause/) with the goal of empowering the more than 50% of the world’s population who will go through [menopause](https://nabtahealth.com/glossary/menopause/) with evidence-based therapeutic support. Sources: Internal > [What is](https://nabtahealth.com/articles/what-you-need-to-know-about-perimenopause/) [Perimenopause](https://nabtahealth.com/glossary/perimenopause/)? External: > [](https://www.balance-menopause.com/menopause-library/)[Menopause](https://nabtahealth.com/glossary/menopause/) Library https://www.mayoclinic.org/diseases-conditions/[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms-causes/syc-20353397 https://flo.health/menstrual-cycle/[menopause](https://nabtahealth.com/glossary/menopause/)/changes/[menopause](https://nabtahealth.com/glossary/menopause/)\-symptoms-and-stages
_Can you overcome [perimenopause](https://nabtahealth.com/glossary/perimenopause/) weight gain? We look at how diet and exercise play essential roles in maintaining weight and health during and after [menopause](https://nabtahealth.com/glossary/menopause/)._ * As you transition through [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/), it is normal to gain weight, particularly abdominal weight or belly fat. * This is caused by a change in hormone levels. * Excess weight around a woman’s middle is linked with an increased risk of cardiovascular disease. * You can reduce risks by making healthy lifestyle choices. Menopausal transition or [perimenopause](https://nabtahealth.com/glossary/perimenopause/) (means ‘around [menopause](https://nabtahealth.com/glossary/menopause/)’) lasts 2 to 8 years, the average being 4 years. As a woman nears [menopause](https://nabtahealth.com/glossary/menopause/) her [ovaries](https://nabtahealth.com/glossary/ovaries/) gradually stop making the hormones estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/), and [testosterone](https://nabtahealth.com/glossary/testosterone/) levels drop. With estrogen fluctuating menstrual cycles change in length, can become irregular, or might skip a cycle. Some more common symptoms of [menopause](https://nabtahealth.com/glossary/menopause/) are [hot flushes](https://nabtahealth.com/glossary/hot-flushes/), vaginal dryness, hair loss (and gain), mood swings, night sweats, sleep problems, and weight gain. #### Why do women gain stomach fat during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)? While each woman’s experience with [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) is different, the change in hormone levels, mainly estrogen, often influences body fat distribution. Many women find they gain fat mass, particularly around the abdomen, during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and the early post-[menopause](https://nabtahealth.com/glossary/menopause/) years. Excess weight around a woman’s middle is linked with an increased risk of cardiovascular disease. An Australian government health website cites animal studies showing that [a lack of estrogen leads to unwanted abdominal fat, saying the exact mechanisms are not yet understood](https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause-and-weight-gain). Estrogen maintains a woman’s [cholesterol](https://nabtahealth.com/glossary/cholesterol/) levels in the blood, so a drop in estrogen levels can mean an increase in [LDL](https://nabtahealth.com/glossary/ldl/) (bad) [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and a decrease in [HDL](https://nabtahealth.com/glossary/hdl/) (good) [cholesterol](https://nabtahealth.com/glossary/cholesterol/). This spike in bad [cholesterol](https://nabtahealth.com/glossary/cholesterol/) increases the risk of heart disease, stroke, and type 2 diabetes. And during this period a drop in [testosterone](https://nabtahealth.com/glossary/testosterone/) levels is linked with slowing normal metabolic functions and a [decrease in muscle and bone strength](https://patient.info/news-and-features/what-you-need-to-know-about-testosterone-and-menopause), also contributing to weight gain. #### Targeting that unwanted belly fat. What’s the advice for perimenopausal women experiencing weight gain? Move more, eat less. As you age you need fewer calories. Women require 200 fewer calories per day in their 50s than in their 20s. Up to the age of 50 moderately active women generally need around 2,000 calories a day, after 50 years daily calorie intake should decrease to around 1,800. Weight gain and increased stomach fat happen as a result of aging, regardless of hormones. Lifestyle factors (diet and exercise) and genetics can play a role. And overweight women, or women with obesity, are more likely to experience higher weight gain due to changes in hormones. Eat a healthy, balanced diet. Avoid restrictive or rapid weight-loss diets and try to eat fewer processed foods and refined sugars. Exercise regularly, daily if possible. [The Mayo Clinic](https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916) recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity every week. Doing strength training and weight-bearing exercise at least twice a week will help build and maintain muscle mass to prevent [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). Accept that age and hormone-related changes in your body are totally natural and try to reduce risks by making healthy lifestyle choices. Unwanted physical and mental changes during [menopause](https://nabtahealth.com/glossary/menopause/) can cause confusion and distress so don’t be afraid to seek medical advice. Your doctor can advise on appropriate treatment including hormone replacement therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and alternative therapies. [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) is the first stage at the end of a woman’s reproductive years. [Menopause](https://nabtahealth.com/glossary/menopause/) is when you have gone for 12 months or more without having your period. During post-[menopause](https://nabtahealth.com/glossary/menopause/) many of your menopausal symptoms will ease, but the risks for heart disease and [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) will increase. It’s important to talk to your doctor or an experienced medical practitioner who can offer support and advice during each stage. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). You can track your symptoms and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#6c150d00000d2c020d0e180d04090d001804420f0301) if you have any questions about this article or any aspect of women’s health. We’re here for you. #### Sources The Mayo Clinic, Healthy Lifestyle [https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916](https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916) Better Health Channel, [Menopause](https://nabtahealth.com/glossary/menopause/) and weight gain, [http://Better Health Channel,](http://Better%20Health%20Channel,%20Menopause%20and%20weight%20gain,%20https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause-and-weight-gain) [Menopause](https://nabtahealth.com/glossary/menopause/) and weight gain, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/[menopause](https://nabtahealth.com/glossary/menopause/)\-and-weight-gain
[Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is a condition that is characterised by brittle bones. The bones become [porous](https://nabtahealth.com/glossary/porous/) and weak, which means that people with the condition are at increased risk of experiencing fractures. [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is very common; in fact, it is thought that as many as 50% of women over the age of 50 will suffer an osteoporotic fracture, whilst 24% of men will. So what causes it? Bone is a dynamic tissue, which means it is constantly being broken down and replaced. [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) occurs when **the creation of new bone does not keep up with the loss of old bone**. The skeleton becomes less dense as a result and in extreme cases bones can fracture in response to something as innocuous as bending over, or coughing. The most common sites of fracture are the wrist, the hip and the spine. #### **What are the warning signs for [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)?** [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is a challenging condition to prevent because it tends to develop slowly and without warning. Many people only become aware that they have the condition when they experience a fracture, by which time it is too late for preventative measures. Some people do discover they have [osteopenia](https://nabtahealth.com/glossary/osteopenia/) earlier in life, which is often thought of as a precursor to [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) and happens when bone density is lower than the average for that age. Taking steps to improve your overall bone health following a diagnosis of [osteopenia](https://nabtahealth.com/glossary/osteopenia/) might reduce your risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) later in life. #### **What causes [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)?** Losing bone mass is a normal part of aging. Typically we reach our peak bone mass in our mid 30s and from this point on we continuously lose mass as we age. This loss is accelerated in the first few years after [menopause](https://nabtahealth.com/glossary/menopause/), which is why women of this age are at particularly high risk of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). The enhanced loss is thought to be due to declining [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels. There are, however, other risk factors, which include: * Family history. * Eating disorders and/or a [](https://nabtahealth.com/what-is-body-mass-index-bmi/)[BMI](https://nabtahealth.com/glossary/bmi/) < 19 * Heavy drinking or smoking * Certain medical conditions, which include: * Autoimmune ([Lupus](https://nabtahealth.com/glossary/lupus/), arthritis) * Digestive ([celiac disease](https://nabtahealth.com/glossary/celiac-disease/), inflammatory bowel disease) * Cancer ([breast](https://nabtahealth.com/is-the-first-sign-of-breast-cancer-always-a-lump/), prostate) * Haematologic/blood disorders (multiple myeloma) * Neurological (multiple sclerosis, stroke) * Endocrine/hormonal conditions ([Cushing’s syndrome](https://nabtahealth.com/what-is-cushings-syndrome/), premature [menopause](https://nabtahealth.com/glossary/menopause/), thyroid disorders) * Medication use. Most notably high dose steroids, used long-term to treat arthritis and asthma. There are also known associations between [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) and some anti-cancer medications (particularly those that are anti-oestrogenic), anti-seizure medications and transplant rejection medicines. [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is less common in men than women, but it does happen. It is not well understood why some men are more susceptible, but there is a link between [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) and reduced [testosterone](https://nabtahealth.com/glossary/testosterone/) levels. #### **How is [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) diagnosed?** [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is diagnosed using a special low-level X-ray scan, called a dual energy X-ray absorptiometry ([DEXA](https://nabtahealth.com/glossary/dexa/)) scan. During this procedure, the density of the bones is measured and compared to the expected bone density of a healthy young adult. Results are expressed as the standard deviation (SD) of the T score: * T score above -1 SD: Normal * T score -1 to -2.5 SD: [Osteopenia](https://nabtahealth.com/glossary/osteopenia/) * T score below -2.5: [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) #### **How is [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) managed and treated?** Following a diagnosis of [osteopenia](https://nabtahealth.com/glossary/osteopenia/) or [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) there are lifestyle adjustments you can make to improve your overall health. These include eating healthily and undertaking regular exercise. ##### **_Exercise_** It is recommended that adults between the ages of 19 and 64 do at least two and a half hours of moderate intensity exercise each week. For optimal bone strength, this should be a combination of weight bearing exercises and resistance training. Weight bearing exercises include walking, aerobic classes and tennis; anything where the legs and feet support the weight of the body. They strengthen the muscles, ligaments and joints. Resistance exercises improve bone strength by encouraging the tendons to pull on the bones. Examples include press-ups and weight lifting. Further medical advice includes reducing the likelihood of falls, so exercises such as Tai-chi that improves balance are worth incorporating into your regular routine. ##### **_Diet and supplements_** Calcium and [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) are very important for good bone health. Calcium is the main mineral found in bone. Most people can get sufficient calcium from their diet, by including foods such as leafy green vegetables, tofu, yoghurt and other dairy products. Women over 50 and men over 70 are recommended to ensure that their daily intake of calcium is between 1000 and 1200 mg. If they struggle to do this through diet alone, calcium supplements should be added to the diet. [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) helps the body to absorb calcium. The main source of [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) is the sun, which means that depending on where you live and what time of year it is, you may get sufficient quantities of the vitamin from just spending time outside. In parts of Europe that have limited daylight hours during the winter it can be very difficult to absorb sufficient [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) from the sun alone. Likewise, in the Middle East, when temperatures rarely drop below 40°C in the summer months, many inhabitants of the region find that they are deficient in the vitamin. Oily fish, red meat, liver and egg yolks can all help to boost your intake; however, many find that they also require supplements to reach the recommended 10 micrograms a day. ##### **_Medications_** Whilst medication is not a route that everyone wants to take, the consequences of unmanaged [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) can be severe. As many as 20% of senior citizens who break their hip will die within 12 months, either due to complications or during surgery to repair it. Broken bones in the spine can cause long-term, debilitating pain and a stooped posture; and limited mobility can result in loneliness and depression. There are several drug treatments available for the treatment of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/): * Bisphosphonates, such as alendronic acid, ibandronic acid, risedronic acid and zoledronic acid. These can be given intravenously or orally and work by slowing the rate at which old bone is broken down. Side effects include nausea, stomach pains and difficulty swallowing and they can take between 6 to 12 months to exert a positive effect. * Selective [oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptor modulators (SERMS). The only SERM licensed for the treatment of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is raloxifene. SERMs exert a similar effect to the hormone [oestrogen](https://nabtahealth.com/glossary/oestrogen/), without the associated health risks of [HRT](https://nabtahealth.com/glossary/hrt/) (see below). They work by maintaining bone density and reducing the risk of fracture. Side effects include [hot flushes](https://nabtahealth.com/glossary/hot-flushes/), blood clots and leg cramps. * Parathyroid hormone-like drugs, for example teriparatide. Endogenous parathyroid hormone regulates the amount of calcium in bone. Medications such as teriparatide are given as injections and work to stimulate the production of new bone and therefore, increase bone density. They are usually given in more severe cases of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), or when other treatments have failed to work. After two years of treatment, most patients are switched off these drugs and onto medication that will maintain their new bone growth. Nausea and vomiting are common side effects. * Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)). [HRT](https://nabtahealth.com/glossary/hrt/) is given to many women to relieve the [plethora of symptoms](https://nabtahealth.com/menopause-the-symptoms-nobody-talks-about/) they may encounter during their menopausal years. Whilst some women with [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) do take [HRT](https://nabtahealth.com/glossary/hrt/), it is not specifically recommended for treating this condition due to an increased risk of breast cancer, [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/), [ovarian cancer](https://nabtahealth.com/the-diversity-of-ovarian-cancer/), stroke and venous thromboembolism. If you are considering [HRT](https://nabtahealth.com/glossary/hrt/), it is important to discuss these risks with your doctor prior to commencing treatment. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#aad3cbc6c6cbeac4cbc8decbc2cfcbc6dec284c9c5c7) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Learn What [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Is and What It’s Caused By.” _National [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Foundation_, 25 Sept. 2020, [www.nof.org/patients/what-is-](http://www.nof.org/patients/what-is-osteoporosis/)[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)/. * “[Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/).” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 19 June 2019, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968)[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)/symptoms-causes/syc-20351968. * “[Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/).” _NHS Choices_, NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/osteoporosis/)[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)/. * “Overview: Raloxifene and Teriparatide for the Secondary Prevention of Osteoporotic Fragility Fractures in Postmenopausal Women: Guidance.” _NICE_, [www.nice.org.uk/guidance/ta161](http://www.nice.org.uk/guidance/ta161).
* [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) has a direct link with [menopause](https://nabtahealth.com/glossary/menopause/) as women lose as much as 20% of their bone density after [menopause](https://nabtahealth.com/glossary/menopause/). * [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is a disease that makes bone tissue less strong. * Lifestyle changes can reduce some risk factors associated with [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). * There are genetic factors that also impact the risk of getting [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) after [menopause](https://nabtahealth.com/glossary/menopause/). **What’s the connection between [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) and [menopause](https://nabtahealth.com/glossary/menopause/), and how can you protect your bones in midlife? Here’s our guide…** What do you think of when you hear the word ‘[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)’? You might have an image of a frail elderly person with weakened bones that break easily. While many older people do suffer from [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), changes in our bone strength start far earlier in life that most of us realise – in our late thirties. Furthermore, for women, that strength diminishes even more rapidly once we are the other side of [menopause](https://nabtahealth.com/glossary/menopause/); according to the [NHS](https://www.nhs.uk/live-well/healthy-body/menopause-and-your-bone-health/), women lose 20% of their bone density in the five to seven years after [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[menopause](https://nabtahealth.com/glossary/menopause/). We wanted to know why this happens and what we can do to protect our bones as we move into and beyond [menopause](https://nabtahealth.com/glossary/menopause/). #### What causes [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)? [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) is now a global disease that affects an estimated 200 million people worldwide. It is all down to bone density (the amount of bone tissue that your body makes and repairs) and how strong that bone tissue is. While there are some things (known as risk factors) that you can control or change to support your bone health, there are other factors that you cannot change. As the [Royal](https://theros.org.uk/information-and-support/understanding-osteoporosis/causes-of-osteoporosis-and-broken-bones/) [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Society explains, the risk factors that you can do something about are: * **Low body weight** – less bone tissue and, when you’re older, less body padding to cushion falls. * **Smoking**. * Excessive **alcohol** consumption. * **Frequent falls** caused by poor coordination and balance – check for any underlying health issues. The things that you can’t change are: * **Genes** – if you have a family history of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/). * **Age** – bone strength decreases as we get older and we are more likely to have falls. * **Being female** – [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels, which support bone strength, drop during and after [menopause](https://nabtahealth.com/glossary/menopause/). * **Asian or Caucasian heritage** – you are less at risk of broken bones if you are of Afro-Caribbean heritage. * **Broken bones or fractures in the past** – just one break increases your risk of having more in the future. Medication, such as aromatase inhibitors used to treat some types of breast cancer, can affect bone strength too. You can find a full list [here](https://theros.org.uk/information-and-support/understanding-osteoporosis/causes-of-osteoporosis-and-broken-bones/) on the Royal [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Society website. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) may have a similar effect and if your breast cancer is hormone related, you will probably have regular [DEXA](https://nabtahealth.com/glossary/dexa/) (Dual-energy X-ray absorptiometry) scans (see below) to monitor any changes in your bone density. #### How is [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) diagnosed? If your doctor thinks that you are at risk of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), they will arrange for you to have a special type of x-ray, known as a [DEXA](https://nabtahealth.com/glossary/dexa/) scan, to measure your bone density. If you are given a diagnosis of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), it means that your bones could break easily; if you are diagnosed with [osteopenia](https://nabtahealth.com/glossary/osteopenia/), your bones are weaker than normal but not yet at such high risk of breaking. #### What happens if I have [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) or [osteopenia](https://nabtahealth.com/glossary/osteopenia/)? If you are diagnosed with either condition, your GP will recommend medication, such as bisphosphonate tablets, to strengthen your bones. You can read more about different types of treatment, including benefits and risks, [here](https://www.nhs.uk/conditions/osteoporosis/treatment/). #### What can I do to support my bone health during [perimenopause](https://nabtahealth.com/glossary/perimenopause/), [menopause](https://nabtahealth.com/glossary/menopause/) and beyond? It’s a good idea to put a bone health and strength protection plan in place as you move towards and into [menopause](https://nabtahealth.com/glossary/menopause/). Even if you have already been diagnosed with [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) or [osteopenia](https://nabtahealth.com/glossary/osteopenia/), there are things to avoid and things you can do that can make a difference. **Stop smoking** Ask your doctor for help with this if you are finding it difficult to stop. **Watch your alcohol intake** Avoid binge drinking and don’t exceed current guidelines of 14 units a week. If you are in the habit of drinking daily, try to have one or two alcohol-free days each week. Better still, think of alcohol like cake – something best kept for special occasions! **Partake in regular exercise** Include weight-bearing and resistance exercises and don’t forget that brisk walking is excellent exercise too. [Yoga](https://nabtahealth.com/hatha-vinyasa-ashtanga-what-is-the-best-type-of-yoga-for-me/) and Pilates can help with coordination, balance and flexibility, and Pilates develops core strength, which supports your entire body. **Eat a healthy, balanced diet and aim for a healthy (but not too low) [BMI](https://nabtahealth.com/glossary/bmi/)** Make sure you eat plenty of calcium-rich foods including dried fruit, green vegetables, tofu and yogurt. For help with healthy eating during [menopause](https://nabtahealth.com/glossary/menopause/), we recommend [The Midlife Kitchen: Health-boosting Recipes for Midlife & Beyond](https://menopause.livebetterwith.com/products/midlife-kitchen-cookbook) by Mimi Spencer and Sam Rice. #### What’s the connection between [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) and [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)? Despite the name, [](https://nabtahealth.com/vitamin-d-the-sunshine-vitamin/)[Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) is actually a hormone and is vital for bone strength and health. A daily dose of sunshine is great, but in countries with exceptionally hot daytime temperatures and in cooler countries with fewer sunny days, it is very difficult to get enough [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/), especially in its crucial form of cholecalciferol (Vitamin D3), from sunshine alone. Try to include these [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/)\-rich foods in your diet: egg yolks, fortified breakfast cereals (but avoid any with high sugar levels), fortified plant milks such as almond, liver, mushrooms, red meat (two portions a week but avoid smoked meats), oily fish such as sardines and tofu. Think about a [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) supplement – even if you are able to get out into the sunshine regularly and you are eating well, your [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) levels still might not be at the optimum level. A daily dose of [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) supplement of at least 10 micrograms (that’s 400 IU – International Units) can sufficiently boost levels. Some experts recommend combining [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) supplements with Vitamin K2 supplements, but you should always check with a healthcare professional before starting any supplements. You can test your [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) levels affordably and discreetly at home by booking a [blood test with Nabta Health.](https://nabtahealth.com/product/vitamin-d-test/) ##### Where can I find out more about [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/)? The [Royal](https://theros.org.uk/) [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Society (formerly the National [Osteoporosis](https://nabtahealth.com/glossary/osteoporosis/) Society) is an excellent resource. The society offers information, advice and support on all aspects of [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), including treatment and prevention, focusing on exercise and diet. This article was originally written and published by our partner [Live Better With](https://livebetterwith.com/). Live Better With’s mission is to make everyday living a bit better for the millions of people living with long term health conditions, all over the world. We do this through thousands of curated products, informative content, useful services and a thriving online community. Visit Live Better With [here](https://livebetterwith.com/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0b726a67676a4b656a697f6a636e6a677f6325686466) if you have any questions about this article or any aspect of women’s health. We’re here for you.
