The Maya Centre sits down with GP and BMS Menopause Specialist Dr Claire Phipps to understand how to best navigate the menopause.

Hannah Uguru

The menopause can often be a confusing and daunting process for women due to the unpredictable hormonal changes our bodies go through during this period. These nuances are regularly overlooked by healthcare providers due to a general lack of research and awareness on women’s health. With this in mind, The Maya Centre has partnered with GP and British Menopause Society (BMS) Menopause Specialist Dr Claire Phipps to deliver a series of four standalone group workshops on navigating the menopause. With the final session planned for 12:30pm – 2:00pm, 14 June, ‘A Second Spring: Journey of the Menopause‘ gives a guide on how to spot symptoms, speaking with your GP, the impact and variety of physical and emotional symptoms, the risks and effectiveness of different holistic and medical approaches and how to embrace menopausal changes.

Dr Phipps joins us today to take us on a deep dive into what we currently do know about the menopause and what further research needs to be done to get as comprehensive an understanding as possible about this pivotal change in many women’s lives. 

The perimenopause, menopause and postmenopause — understanding the difference

Menopause marks the end of a woman’s menstrual cycles, defined as not having had a period for 12 months. This change is caused by declining levels of reproductive hormones like estrogen and progesterone produced by the ovaries. 

Often, when we talk about menopause symptoms — such as hot flushes, night sweats, vaginal dryness. sleeping problems and mood swings — we’re actually thinking of the perimenopause, the period before the menopause. “The perimenopause is that time when we might still be having periods and they might be irregular, but we’re still having them. And that’s the run-up to the menopause, which is actually just one day in time, where we can look back and say we’ve not had a period for 12 months. After that time, we’re postmenopausal,” Dr Phipps explains. 

Lasting an average of four to eight years, the perimenopause is the process of a woman’s body preparing itself for menopause and the end of its reproductive years. The menopause is, therefore, a singular event rather than the transition itself, as often framed. After this, we enter postmenopause, in which a woman can no longer ovulate, release fertile eggs or get pregnant naturally. Most women will continue to experience menopause symptoms for around two to seven years after their final period, though they can continue for longer for some.

Women who report infertility before menopause due to ovarian insufficiency or other causes generally still experience this shift. However, surgical removal of the ovaries at a younger age (causing surgical menopause) and rare cases of premature ovarian failure before 40 are the only scenarios in which (natural) menopause does not occur. 

What we don’t know about the menopause (yet)

The average age that women reach menopause is from around 51 to 53, but women can experience this as early as their 20s and 30s, and Dr Phipps has seen women in their 60s with perimenopausal symptoms. “We generally start having symptoms of the perimenopause in our mid-40s. When we’re thinking about earlier menopause, those symptoms are happening below the age of 40,” she explains. 

“As to why, we just don’t know for the vast majority of cases. We don’t have a clear idea. There are lots of tests that we do to try and clarify that, and sometimes we do, such as genetic causes or conditions such as auto-immune conditions, which can also cause us to have an earlier menopause. But most of the time, we don’t actually find a cause.”

This ambiguity behind early and late menopause can take a real toll on women’s mental health, given the rapid fluctuations in hormone levels at the time and uncertainty of the cause, leading to significant anxiety, stress and a sense of losing control. At The Maya Centre, we’ve emotionally supported women navigating:

• Fears about their health and what’s causing premature or late menopause
• Grief over sudden infertility and loss of ability to have (more) children naturally
• Struggles with self-image and sense of identity tied to reproductive life stages
• Mood swings, irritability, brain fog exacerbated by hormonal chaos
• Relationship tensions due to sexual problems and emotional volatility

Whether menopause arrives early or later than expected, deviations from the typical timeline can have profound effects beyond the physical symptoms. An increased understanding and prioritisation of women’s health can help clear some of this confusion, but unfortunately, mainstream medicine continues to overlook it. “I always think there can be more money and more research into women’s health. That’s an absolute given,” adds Dr Phipps. 

Indeed, recent data from McKinsey shows that just 5% of global healthcare research and development is dedicated to women’s health, with only 1% focusing on female-specific conditions outside of cancer. In the UK, less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite one in three British women having suffered from severe reproductive health issues in the past 12 months. In contrast, men not only receive more total investment research for diseases, but male-dominant health conditions also garner more public funding.

“Women have more complex hormonal profiles than men. Instead of using this fact as a point of medical intrigue, female inclusion is deemed ‘too complicated’ to factor into research. The need to address this imbalance is part of why I chose to specialise in menopausal health,” Dr Phipps adds. 

What we currently do know

While we don’t know the exact causes of irregular menopause, we can predict the likelihood. Research from the Journal of Human Molecular Genetics tells us that genetics plays a role in both the timing of menopause onset and the severity of its subsequent symptoms. The heritability of menopausal age has been estimated to be between 30 and 85%, for example, so if your mother experienced premature menopause, chances are you’ll follow a similar timeline.

More broadly, race and ethnicity have been shown to affect the timings and symptoms of menopausal transition as well. According to the British Menopause Society, women of colour are more likely to experience a longer menopausal transition with more severe symptoms. For Black women, this can be more prominent weight issues and sleeping problems; for East Asian women, this will look like a higher prevalence of forgetfulness and joint and muscle pains; South Asian women are more likely to face a higher incidence of cardiovascular disease (CVD) risk factors like hypertension, insulin resistance and diabetes. Though each ethnicity bears distinct genetic profiles that impact a woman’s menopause, social, economic and cultural factors that may also uniquely affect certain ethnicities more than others are also at play. For instance, women of colour, particularly Black and South Asian, tend to be under greater socioeconomic stress, increasing the likelihood of early menopausal onset and difficulties. 

Dr Phipps speaks on the importance of managing stress hormones during the menopause, saying, “Self-care is key to bringing down stress hormones and making us feel more calm and relaxed during this pivotal time. Stress and anxiety can trigger low self-esteem and make us feel less confident in our appearance or our abilities. Activities as simple as going for a walk, taking personal time and focusing on sleep hygiene can hugely reduce our stress levels and anxiety. “

“I’m a really big advocate for talking therapy during the menopause, because I think it can be a really useful tool that we can each learn and we can each bring out when we need it. Cognitive behavioural therapy is also a useful skill to learn to help bring us back from that edge of anxiety,” she concludes.

At The Maya Centre, we not only offer cognitive behavioural therapy but also psychoeducation workshops, wellbeing activities and mind-body therapies, such as reiki, which can have brilliant effects on women’s stress levels and overall mood during their menopause journey. “All of these therapies don’t stand alone in isolation. They are all tools that can work together to help women flourish in their ‘second spring’,” according to Dr Phipps.

‘A Second Spring: Journey of the Menopause’ offers women the opportunity to gain specialist insight into the menopause, perfect for those currently on their journey or wishing to support someone who is. Held at The Maya Centre, Elthorne Rd, N19 4AJ and planned for 12:30pm – 2:00pm, 14 June, next month will be your last chance to take part in this workshop. To register, email edna@mayacentre.org.uk or text/call 07724027538.