• Hormonal fluctuations can cause cyclical breast tenderness and causes irregular menstrual cycles.
  • Hormones affect the ocular tissues and the composition of tears which the eyes produce, resulting in excessively dry eyes and changes in vision.
  • Epinephrine and Norepinephrine, the neurotransmitters that regulate heart rate and blood pressure, tend to fluctuate in menopausal women causing flutters and palpitations.
  • Lower oestrogen levels cause the lining of the urethra to thin and this can contribute to leaking of urine.
  • Less oestrogen causes acne and dry and thinning skin for many women.
  • A drop in oestrogen levels tricks the hypothalamus gland into thinking that the woman is overheated, signaling your body to sweat more and causing body odour.
  • Migraines may start for the first time or worsen as the women starts going through the menopause because of new hormonal fluctuations.
  • Lower oestrogen levels cause thinner, drier and less-elastic vaginal tissue and decrease blood flow to the area. This can result in vaginal dryness, itching and painful sex.
  • A woman’s weight gain and altered distribution throughout her menopausal journey is impacted by five factors: hormones, diet, exercise, stress, and genetics.
  • Irregular periods also increase the risk of pregnancy. “The second highest unintended pregnancy age for women is during their 40s”.
  • The less oestrogen the ovaries produce, the more the acceleration of loss of bone mass there will be.

Take a past surgical history, check BMI and obstetric history.

Mood changes could also be due to;

  • anxiety and depression

Take an assessment for these e.g HAD scale.

  • Forgetfulness/difficulty concentrating.

Studies suggest that these symptoms are unlikely to be related to the menopause (NICE 2017).

  • Loss of Libido – also check for;
    • androgen deficiency
    • insomnia
    • inadequate sexual stimulation
    • life stresses
    • depression

Take a sleeping history.

Ask about sexual relationship if appropriate.

HAD scale.

Muscle and Joint pains could be due to;

  • osteo arthritis
  • rheumatoid arthritis
  • fibromyalgia

Ask about pain history.

Any morning stiffness of joints.

Family history of above conditions.

Carry out a muscular skeletal exam.

Skin Changes;

  • ageing
  • smoking
  • sun exposure
  • ask if they smoke, vape or ex smoker
  • ask about sun exposure

Weight Gain.

Weight gain increases with age.

Women gain on average 2.25 – 4.19kg as they get older.

There is also fat redistribution with age which can be mistakenly thought the menopause is causing.