Could it be menopause? With so many symptoms it’s easy to see why it’s often misdiagnosed.

If you have a quick look at menopause sites on social media it wont take long to find a plethora of women who say their GP has told them they’re too young to be menopausal, put them on anti-depressants or sent them off on a merry-go-round of investigative procedures to try and find the cause of their malaise.

The experience leaves many asking how hard can it be to diagnose menopause?

Well, there is a long list of symptoms – many of which may appear completely unrelated.

For example, while we all associate hot flushes, mood swings and night sweats with menopause, things like a burning tongue, heart palpitations, migraines or repeated UTI’s can easily be put down to other things.

Let’s face it, if you turn up at the GPs saying you feel low, anxious, tired and have lost your mojo, it’s not surprising that the first thing they may reach for is the prescription pad to write a script for antidepressants.

But ‘Menopause Doctor’, Louise Newson, is urging both doctors and women to have a different conversation. She says she sees patient after patient who has been misdiagnosed and given medications they may not need because GPs have not joined the dots and realised that these things may in fact be the symptoms of menopause.

The result, she says, is that these women continue to endure these symptoms – sometimes for years – without getting the help they need. And, she says it can take a huge toll on their mental and physical health on both the short and the long term. It can also affect their relationships. While ruling out other underlying conditions is important, she says often the simplest answer – in this case – ‘perimenopause’ could be the right one.

Perimenopause is the period that precedes menopause. Menopause is diagnosed one year after your last period, but the symptoms can start up to a decade earlier. and, given that 51 is an average,  it’s not uncommon for women in their late 30’s to start experiencing some of the symptoms – and they there is a very broad range of them.

What are the symptoms of menopause?

There are more than 40 symptoms of menopause. While many people may have the obvious ones like the hot flushes and night sweats, others may have entirely different ones. And some lucky women may ‘sail though’, as they say, hardly noticing any of them.

The symptoms are generally divided into vasomotor, mood, genitourinary and ‘others’ and include:

– Vasomotor

• night sweats
• hot flushes (or flashes depending on where you live)
• chills

Mind

• mood swings and increased irritability
• anxiety
• low mood/depression
• panic attacks
• low libido
• memory loss
• difficulty concentrating
• brain fog
• migraines

Genitourinary Syndrome of Menopause or (GSM)

• vaginal dryness
• an itching and burning sensation around the external genitalia
• pain during sex
• stress urinary incontinence (peeing when you sneeze, laugh or exercise)
• frequent UTIs or thrush like symptoms
• changes to periods – irregular/infrequent or lighter or heavier periods

Other:

• dry skin
• dry eyes
• bleeding gums
• thinning hair/hair loss
• digestive issues such as heart burn and/or bloating
• a dry mouth or sensation of a burning tongue or mouth
• increase in facial hair
• joint pain and muscle aches
• fatigue
• weight gain
• dizziness
• brittle nails
• itchy skin  (some women find the calves and scalp are especially prone to this)
• tingling in the extremities
• insomnia
• palpitations (irregular heart beats)
• breast pain and loss of breast volume
• electric shock sensation (a feeling like a rubber band is being flicked on your skin or like ants crawling on you)
• excessive sweating
• changes in body odour
• tinnitus (ringing in the ears)
• new allergies or worsening allergies
• rashes
• osteoporosis (bone thinning).

And as if the list itself weren’t long enough, different symptoms may appear at different times, and just to be really irritating, they may come and go. Some can even last for years.

Some women say they experience hot flushes and insomnia from the outset and it may go on for decades, but things like vaginal dryness and pain during sex may only start a few years after the menopause, and if help isn’t sought in the form of localised oestrogen creams or pessaries or treatments like PRP or Femilift, it will not get better.

So knowing the symptoms and your own body is important.

While it may be confronting for a woman in their late 30’s or early 40’s to think they could be ‘perimenopausal’ Dr Newson says if you have any of these symptoms it’s a good idea to discuss them with your doctor so you can get the right advice early on.

This is especially important for things like long term bone, heart and brain health, but they’re also important for quality of life as the Genitourinary Syndrome of Menopause or GSM, can see many women unable to have sex or having to plan their trips out of the house around public toilet access as the stress incontinence can be so bad.

Do I need a blood test?

Your doctor may ask for a blood test, especially if you are very young to rule out any underlying conditions. But NICE no longer recommends a blood test unless you are under 45. Instead it says a GP should be able to diagnose perimenopause  and menopause based on symptoms alone.  If you are taking the contraceptive pill containing oestrogen and progestergen the results will be compromised so the test should not be offered.

Treatment should be aimed at relieving the symptoms and HRT should be offered as the first line treatment, NICE recommends.

It is important to have a discussion about risks and benefits of the treatments on offer and if your GP is not able or is unwilling to provide this you are within your rights to ask to be referred to a NHS menopause clinic or a specialist.

Liz Earle, MBE and Dr Louise Newson, GP

Dr Newson and Liz Earle MBE, who has been campaigning on menopause issues have done an excellent podcast that discusses all of this in detail. You can listen to it here: https://www.newsonhealth.co.uk/resources/podcasts/s1e13-hrt-and-breast-cancer-dr-louise-newson-and-liz-earle-mbe