A doctor answered the 7 menopause questions women aren't asking out loud.

Thanks to our brand partner, InstantScripts

When it comes to menopause, there's a lot of misinformation, not to mention a whole lot of unnecessary mystery. But it doesn't need to be that way. Experts in the field of women's health have made huge strides when it comes to understanding just what menopause is, and how to manage it — which is why we went to Dr Sarah Cavanagh, GP and the Chief Medical Officer at InstantScripts, to get all our burning questions answered. 

Dr Cavanagh said her interest in menopause began when she was working in the fertility space. "I'd see women in their late thirties and forties coming in for fertility concerns, and often they'd mention other symptoms in passing — things like irregular periods, brain fog, sleep disturbances. And it became clear that many of them didn't realise these were connected, or that perimenopause could start much earlier than they expected. There was this knowledge gap that I kept seeing," she told Mamamia.

Where should women go to find advice or treatment?

One of the major issues that Dr Cavanagh has observed with menopause in Australia is that women often don't know where to turn for expert advice.

"When I moved into digital health at InstantScripts, I saw an opportunity to create an evidence-based service where women could access experienced female GPs who understand menopause, without the usual barriers of cost, wait times, or awkward conversations in busy waiting rooms," she said.

InstantScripts is Australia's largest online platform helping Australians to access quality, affordable healthcare whenever and wherever they need it. For time-poor women, it's an opportunity to access comprehensive telehealth consultations via video with Australian-registered female GPs, trained and experienced in managing perimenopause and menopause.

"These are longer format consultations, so women don't feel rushed," Dr Cavanagh noted. "You actually have the time and space to talk through your symptoms, discuss your concerns, and work with your doctor to develop a management approach that's right for you. The consultations are driven by the latest Australian evidence-based guidelines, so you know the care you're receiving is backed by science. And importantly, you can see the same doctor again for continuity of care."

When, exactly, does menopause start and finish?

"So menopause is technically just one day," Dr Cavanagh explained. "It's the point when you've gone 12 consecutive months without a period. The average age is around 51 in Australia, but it can happen anywhere from your mid-forties to mid-fifties, and sometimes earlier."

What many women perceive as "menopause", which is the end of this journey, doctors refer to as "perimenopause" — that's the lead-up, or the transition phase before menopause, which can last anywhere from a few years to over a decade. Perimenopause is when your hormones start fluctuating. "You might notice changes in your cycle, your mood, your sleep, your body temperature regulation and more," she said. 

Then, just to complicate things further, there's a period called "postmenopause", which is everything after the point of menopause.

"So when we talk about 'going through menopause' in everyday conversation," Dr Cavanagh explained, "we're usually actually talking about perimenopause and the early postmenopausal years combined. It's a whole transition, not a single event."

How early can perimenopause begin?

"Many women don't realise how early perimenopause can start," Dr Cavanagh said. "They think menopause is something that happens in your 50s, so when they're 42 and experiencing symptoms, it doesn't occur to them that this might be hormonal." It's common, she said, to mistake the symptoms for stress symptoms. 

How broad are the symptoms, really?

"Women often don't know the full range of symptoms. Everyone's heard of hot flushes, but fewer people connect things like joint pain, anxiety, or changes in memory to the menopause transition. So they're dealing with multiple symptoms and not connecting the dots."

Dr Cavanagh said it's tricky to put together a definitive list of symptoms, because menopause affects every woman differently. With that said, "there are definitely patterns".

"The most common symptoms are probably vasomotor symptoms — that's hot flushes and night sweats. Then there's sleep disturbance, which often goes hand-in-hand with the night sweats but can also happen independently. Mood changes are common — anxiety, irritability, low mood. Some women describe feeling like they're not themselves anymore. Brain fog and memory issues come up a lot too — women will say they walk into a room and forget why, or they can't find words as easily as they used to."

And that's in addition to physical symptoms like joint aches, changes in weight distribution, vaginal dryness, skin changes, changes in libido, and period changes. Periods might get heavier, lighter, closer together, or further apart before they stop altogether.

What are the most surprising menopause symptoms?

"Rage or sudden irritability is a big one. Women will say they snapped at their kids or partner over something minor and thought, 'Who am I?'. That loss of emotional regulation can be really unsettling."

"Changes in body odour definitely surprise people. They've used the same deodorant for 20 years and suddenly it's not working anymore. And the genitourinary symptoms — things like recurrent UTIs, urgency, or pain with intercourse — women often suffer with these silently because they're embarrassed to bring them up."

"I think what surprises women most is the sheer breadth of it. They expect hot flushes, maybe some mood swings. They don't expect menopause to touch virtually every system in their body. And because we haven't talked about it enough as a society, they don't know that what they're experiencing is actually very common and, importantly, that there are ways to manage it," Dr Cavanagh said.

How many of those symptoms will women experience?

"You might experience three of these symptoms or thirteen," Dr Cavanagh advised.

"They might be mild or they might significantly impact your quality of life. There's no one-size-fits-all experience, which is partly why it can be so confusing for women to navigate."

What do you wish women knew about menopause?

"You're not imagining it, and you don't have to just put up with it," Dr Cavanagh said. "If your symptoms are affecting your quality of life — your work, your relationships, your sleep, your sense of self —that's reason enough to seek help. You don't need to be suffering in silence or waiting until things are unbearable."

Check out InstantScripts to request scripts or speak to a doctor 24/7.

Dr Sarah Cavanagh is employed by InstantScripts, with comments supplied on behalf of InstantScripts.

This information is general in nature and does not replace the personalised advice of a healthcare professional. As with any health treatment, always seek health and medical advice from your healthcare professional.

Feature image: Supplied.

InstantScripts is Australia's leading online clinic with doctors availale 24/7. Whether you need medical advice or a script for your medication, InstantScripts is a simple and convenient way to ensure you get the care you need, when you need it. That's why over 2 million people have turned to InstantScripts for their healthcare.