3 key reasons why every menopause is unique

By Dr. Nicole Avard

There’s a lot of information about natural menopause out there, telling you it usually hits around 51/52, that hot flushes are the main symptom, or even that symptoms ease off after your periods stop. But I’m guessing your experience doesn’t tick all the ‘usual’ boxes. The need for individual menopause care is exactly why we founded Metluma – because every woman’s experience is unique.

So you’re not weird or difficult if your menopause follows its own rules – that’s what’s ‘normal’!  Stay confident that tracking your personal symptoms and asking for care that helps deal with your unique needs is exactly what you should be doing. Because menopause is about more than hot flushes (though we know just how challenging they can be, too). And here are 3 good reasons why.

1. The 3 stages of menopause can mean your symptoms shift and change over time.  
   
   • In perimenopause – when you still have periods and levels of oestrogen and progesterone fluctuate  –  key symptoms more likely in this stage are periods changing in frequency and/or heaviness and a low mood or hormonally-driven depression. Other early symptoms women often notice are hot flushes/night sweats, sleep issues, and uncomfortable sex.
     
   • At menopause – which is actually the one day when you’ve been without a period for 12 months – your periods stop completely.
     
   • Post menopause – some women find that hot flushes become less intense and frequent (though for some women, they can carry on for years). But genito-urinary symptoms like needing to pee more, leaking pee, dry vagina, or more UTIs can get worse if you don’t treat them, and can even start years after your last period.
     
2. The 40 symptoms of menopause. At Metluma, we recognise 40 medical symptoms that affect physical, cognitive, and emotional well-being. There are a variety of numbers you might see, with some suggesting over 100 symptoms; however, we focus on the evidence-based medical symptoms that can be treated. Every one of us gets our own combination, and this can change over the years. You may never get the ‘classic’ ones people talk about most readily, such as hot flushes or mood swings, or you might get them but alongside other things that you or your doctor may not have realised were down to hormonal changes. 
   
   It can be so easy to put many of these down to stressful, busy lives or even the effects of ageist attitudes, but believe me, low confidence and self-esteem, flashes of rage, heart palpitations, thinning hair, and forgetfulness can all be down to your changing hormones, too.
   
   That’s why Metluma has created the UMA40 list of symptoms – based on the latest evidence plus women’s own voices – to make sure all of the variety of experiences can be captured and talked about with doctors and each other. Discover the full list of 40 symptoms, from migraines to dry eyes, joint pain and more – and which might be affecting you.

Physical	Hot flushes	Hot, sudden feelings of warmth, often with sweating.
	Night sweats	Excessive sweating during sleep, often disrupting rest.
	Sleep issues or insomnia	Difficulty falling asleep or staying asleep at night.
	Headaches or migraines	Dull ache, sharp pain, or pressure-like sensation in the head.
	Breast tenderness	Pain, sensitivity, or swelling in the breasts.
	Muscle aches and pains	Soreness, stiffness or pain in muscles.
	Joint pain	Aching, stiffness, or swelling in joints.
	Fatigue or low energy	Constant tiredness and lack of energy despite rest.
	Weight gain	Unexplained increase in body weight over time.
	Thinning hair	Noticeable hair loss, reduced volume, or thinning strands.
	Acne	Breakouts, pimples, or skin blemishes.
	Crawling on the skin	Sensation of itching or crawling under the skin.
	Dry skin	Skin that feels rough, flaky, or tight due to lack of moisture.
	Dry eyes and/or mouth	Eyes or mouth feel dry, irritated, or uncomfortable.
	Palpitations	Racing, pounding, or irregular heartbeat.
	Bloating	Feeling of fullness or puffiness in the abdomen.
	Dizziness or lightheaded	Feeling faint, unsteady, or like you might fall.
Psychological and emotional wellbeing	Feeling of anxiousness	Persistent feelings of worry, nervousness, or unease.
	Low mood or feeling down or blue	Feeling sad, hopeless, or disconnected from things that usually bring you joy.
	Difficulty concentrating (brain fog)	Trouble focusing, feeling mentally unclear or distracted.
	Forgetfulness	Psychological and emotional well-being
	Lack of motivation	Feeling uninterested or unable to start or complete tasks, regardless of your mood.
	Frequent short-term memory lapses, for example, forgetting tasks or names.	Feeling insecure, doubting your abilities, or being overly self-critical.
	More easily overwhelmed	Emotions, tasks, or situations feel too much to handle
	Irritability or rage	Becoming easily angered or feeling intense frustration.
	Feelings of isolation	Feeling disconnected, lonely, or withdrawn from others.
	Panic and Paranoia	Experiencing intense fear, irrational worries, or suspicion.
	Low libido	Lack of sexual desire or drive
Genitourinary	Vaginal dryness	Lack of moisture, irritation, or discomfort in the vaginal area.
	Urinary incontinence	Unintentional leakage of urine, often during movement or activity.
	Frequent urination	Needing to urinate more often than usual.
	Frequent urinary infections	Low confidence or self-esteem
	Vaginal discomfort or pain	Irritation, pain or discomfort in the vaginal area, often during sex.
	Painful intercourse	Discomfort or pain during sexual activity.
Menstrual	Recurrent infections cause burning, pain, or urgency to urinate.	Irregular or skipped periods, variations in cycle length or heavier than usual periods.
	Irregular vaginal bleeding	Bleeding between menstrual cycles.

3. Ethnicity can affect when, how and what symptoms come up. This is a complex issue as cultural context and traditions, attitudes, and access to HRT also feed in. And we definitely need more research (sound familiar?). But emerging evidence around the world has shown some interesting insights that need to be considered:

• Age of menopause and intensity of symptoms.
  
  • In one study in far North Queensland, the average age of onset for menopause ranged from 45.9 years (rural areas) and 46.9 years (urban areas) for Indigenous women, compared to 48.3 years in urban Caucasian women. For Indigenous women, the incidence of hot flushes ranged from 36% of those living in rural areas to 71.9% of those living in urban areas.
    
  • Women of Afro-Caribbean descent in the US may experience menopause up to 8.5 months earlier and are much more likely to have hot flushes for longer and more severely.
    
• Cycle length. In the US, Chinese and Japanese women experience longer menstrual cycles than Caucasian women during perimenopause
  
• Type of symptoms. Women from China, Japan and other southeast Asian countries may experience more forgetfulness, joint pain, muscle pain, low libido and sexual pain.  Indian women may complain more of vulval and urogynaecological symptoms. 

References

Racial and Ethnic Differences in the Menopause Experience

Menopause and the influence of culture: another gap for Indigenous Australian women?

Disparities in Reproductive Aging and Midlife Health between Black and White Women: The Study of Women’s Health Across the Nation (SWAN)

Menopause in ethnic minority women

Impact of stress on objectively recorded menopausal hot flushes and on flush report bias