Hot flushes can be at the very least uncomfortable and embarrassing, night heat and sweat lead on to sleeplessness whilst brain fog and concentration issues can have a disastrous knock on effect on family life and the working day.

Headaches and the recurrence of previous migraines are frequent. Many women who have menopause associated headaches will also have had headaches during their periods when they were younger. Estrogen receptors are present in the brain, so we should not be surprised that bran fog/ concentration problems happen. It's a total mystery to me why these “higher function” problems are more common in some women. The financial cost of brain fog/ concentration problems is high, and I will often hear how HRT is a necessity for a women to continue working. Without hormonal support, many women feel unable to work to the same level as they did before their symptoms started.

Skin and hair are not improved by the menopause and joint aches and pains are frequently voiced concerns. Joint discomfort can occur quite early in the menopause and thankfully is not necessarily an indication of bone weakening.

The vulva, vaginal walls, bladder and urethra (pipe that takes urine from the bladder) are known as ‘the lower genital tract’. These structures together with their supporting tissues are very sensitive to estrogen and so it is not surprising that problems begin with the fall in hormones that accompany the Menopause.

Bladder issues and vaginal dryness are very frequent and not really that widely discussed. Vaginal dryness leads to discomfort during sex, which can then cause relationship issues which are often already a little strained during the Menopause. Vaginal dryness can be treated with vaginal creams or pessaries to good effect. Bladder problems can be trickier to treat but can definitely be improved by a combination of lifestyle change, pelvic floor exercise and sometimes medication.

Loss of libido often comes hand in hand with the Menopause. There are many reasons for this including a fall in hormone levels, changes in relationships and families. Although medication can help (Testosterone), we believe that psychological support is just as vital in addressing problems with intimacy and sex.

One symptom that is very common is changes in weight (and body shape) during he menopause. Additionally, many women are worried about weight gain if they start HRT. It seems to be a no-win situation, in that women are aware of increasing weight during the menopause and HRT causing further weight issues seems to add insult to injury! Nobody (including myself!) really likes to take on a couple of home-truths about weight change/ body shape, but we have to accept them. If we eat more energy than we burn (through daily activities and exercise) then the body will store the energy as fat. Also as we get older our bodies change shape. It's not nice to hear, but it’s true. Do falls in  hormones levels affect weight ?….well yes but they are only part of the picture. So its not really fair on your hormones to put all the blame in their camp. It's important to look at your life as a whole.