A more open public conversation around menopause – and the often strange, hard time leading up to it, perimenopause – has been ignited in recent years. Celebrities from Davina McCall to Gwyneth Paltrow have discussed the realities of hormone replacement therapy, irregular cycles and trippy mood swings; a nascent industry selling supplements, creams and hot flush-proof pyjamas has risen.

Women may not know that there are newer, better forms of HRT available nowadays, which are body identical and transdermal - meaning they can go through the skin ," she explains. The dates when my peri ­, or, indeed, menopause, started are still very unclear in my head because I believe there was a denial that something was wrong, which stemmed from my belief that I would no longer be able to work – I feared dependence on someone else, being ill and vulnerable.

The now 61-year-old says that she entered “surgical menopause” in her 40s after having a hysterectomy due to fibroids in 2011. Her symptoms were initially put down to a mental breakdown and dementia. Dr Shahzadi Harper is a specialist in menopause, and the author of The Perimenopause Solution. She warns that misconceptions and misunderstanding around menopause particularly affect women's attitudes to HRT. Another common concern is irritability and intense emotions. A 2016 study found that people who experienced depression after childbirth or mood changes during menstruation were more likely to experience these symptoms during menopause. But more research is needed to know that for sure.

These can includeirregular bleeding,vaginal dryness and painful sexor problems controlling your bladder, for example. The menopause marks the end of a woman’s periods meaning she can no longer become pregnant naturally, usually occurring between the ages of 45 and 55 years old. You may need treatment for a few years, until most of your menopause and perimenopause symptoms have passed. Green R, Polotsky AJ, Wildman RP, et al. Menopausal Symptoms Within a Hispanic Cohort: SWAN, the Study of Women’s Health Across the Nation. Women’s Health . February 2012. Before menopause, estrogen binds to and inhibits activity in the kisspeptin, neurokinin B, and dynorphin (KNDy) neurons. With menopausal loss of estrogen, KNDy neurons can stimulate the hypothalamic thermoregulatory center inappropriately, causing vasomotor symptoms. A novel class of non-hormonal neuromodulators includes the recently approved fezolinetant, and several under investigation, such as elinzanetant and Q-122.

nutrient-dense vegetables like Brussels sprouts, kale, broccoli, spinach, collard greens, and asparagus

Bisphosphonates or denosumab are first line for most women. For those at very high risk, anabolic therapy should be used first for rapid reduction of fracture risk and BMD improvement, followed by potent antiresorptive agents. 144 145 146 147 148 149 Adverse events of bisphosphonates and denosumab include osteonecrosis of the jaw and atypical femur fracture, both of which are rare. 150 151 Discontinuation of denosumab increases risk of vertebral fracture. 149 Women should discuss the menopause transition and menopause with healthcare providers, relatives, and friendsI wanted to detach from the truth of what I thought was happening to me based on my limited knowledge, but curiously I also wanted to know what lay ahead. El Khoudary SR, et al. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A Scientific Statement From the American Heart Association. Cortés YI, Marginean V. Key factors in menopause health disparities and inequities: Beyond race and ethnicity. Current Opinion in Endocrine and Metabolic Research. 2022;26:100389. doi:10.1016/j.coemr.2022.100389 I asked people who told me you shouldn’t talk about menopause, it’s private and personal. The book is to be used as a conversation starter for people who are still ashamed to talk about menopause so people do not feel they are alone and isolated,” she says.