Menopause means ‘the final menstrual period’ or monthly bleed. A woman has reached menopause when she has not had a period naturally (without ‘the pill’ or other medication) for 12 months in a row. Menopause is the end of a woman’s reproductive life; she can no longer have children naturally.
Most women reach menopause between the ages of 45 and 55 years, but the average age is 51 years.
Perimenopause is the time leading up to menopause when the ovaries begin to run out of eggs and the menstrual cycle (period) often becomes irregular. During this time, women can have premenstrual and menopausal-like symptoms (see below). The time between having regular periods and the final period or menopause is usually between four to six years, but may be shorter or longer.
Women are born with about a million eggs in each ovary and by the time they reach menopause there are no eggs left. From the time a woman starts her period until she reaches menopause, a total of about 400-500 eggs are released through ovulation. When a woman reaches 35 - 40 years, the remaining eggs in her ovaries quickly reduce in number and she will ovulate less frequently until the periods finally stop. The rest of the eggs disappear, break down or deteriorate by the time she reaches menopause.
The hormone (one of the body’s chemical messengers) oestrogen is produced from the cells around the eggs. The body produces less oestrogen when the number of eggs left in the ovaries is small. In the few years before menopause, hormone levels can go up and down a lot.
With less oestrogen produced by the ovaries, women might notice that their menstrual cycle changes, with:
Eventually hormone levels get so low that menstruation stops altogether, this is menopause.
When women get closer to menopause and their hormone levels begin to change and go up and down they might experience some of physical and emotional symptoms such as:
Not all women will experience menopause symptoms:
Women may experience menopause symptoms from the time of perimenopause and for many years following the final period. Every woman is different and the length of time she will have symptoms can’t be predicted. On average though, women will experience menopausal symptoms for about 8 years. Only 10% (1 in every 10 women) will have symptoms that last longer than 10 years.
It is possible to improve some menopause symptoms with some of the following changes.
Some of these suggestions might help with some menopause symptoms such as hot flushes and mood. Others will be good for health generally.
Physical activity may help general health, control weight gain and help keep bones healthy.
Sometimes women notice mood changes such as mild depression, mood swings and irritability. These might be because of hot flushes, night sweats and interrupted sleep.
Managing the physical symptoms of menopause with treatment and might help improve emotional and mental health as well as general wellbeing.
It is important to see a doctor if women are experiencing mental and emotional health problems. Referral to a psychologist or counsellor may also be helpful.
Low dose oral contraceptive pill or hormonal IUD (Mirena) can help with symptoms of irregular and /or heavy blood loss, some symptoms and provide contraception.
Hormone replacement therapy (HRT) can help improve the symptoms of menopause (hot flushes, night sweats, poor sleep) but like any medication it can have side effects.
HRT will be a suitable treatment for some women depending on age, medical history and the symptoms she is experiencing. HRT may not be suitable for women who have cardiovascular disease.
There is a small risk of breast cancer and blood clots for women using HRT so it is important that this treatment is discussed with a doctor. A doctor will talk to a woman about any other risks she might have for these health conditions and make sure any screening is done e.g. lipids, mammogram.
Whether or not HRT is suitable for a woman will depend on whether the benefits of the treatment outweigh the risks.
All women who are using HRT need to be reviewed once a year by their doctor.
Some women cannot have HRT because of their medical history, for example it may not be suitable for women who go through menopause after treatment or surgery for breast cancer. There are a range of non-hormonal medications for menopausal symptoms such as the antidepressants called SSRIs. These may relieve mood changes, anxiety and also improve hot flushes and night sweats.
Some women prefer to use natural or complementary therapies to manage menopause symptoms. The treatments that can be used with/instead of HRT include phytoestrogens (plant estrogen) in the diet, herbal remedies, naturopathic approaches, meditation and massage. Evidence from good research trials that these treatments are effective (for menopause symptoms including hot flushes and night sweats) is very limited. It is important to remember that ‘natural’ herb and plant medications should be treated as medicines as they can have side effects. If a woman is using natural therapies it’s important that she tells the doctor, as some natural therapies have interactions with other medications.
If a woman does not want to become pregnant, she should continue using contraception until:
It is important that a woman who has reached menopause and then has any bleeding, should see her doctor to find out what is causing it.
Women who have reached menopause should continue to have a Pap test every two years until the age of 70 years. Women should visit their local health centre for information.
Women should get to know the normal look and feel of their breasts, this will help them notice if any changes happen. Women should check their breasts while showering, dressing or looking in the mirror. They should look for changes in the breast or nipple, a lump, changes to the skin, discharge or pain. If a woman finds any of these changes she should visit her doctor or women’s health nurse.
Women who are 50 years over and have no breast changes, should have a breast screen every two years. A breast screen or mammogram is a special X-ray of the breast and is the best way to find breast cancer early. Women should visit their local health centre for information.
Libido or sexual desire can be affected by many things including hormone levels and some women find that when they reach menopause that they no longer feel like having sex any more. This can cause problems in the relationship with their partner.
The symptoms that many women experience at menopause such as hot flushes, mood swings, poor sleep and vaginal dryness may not help their libido. It is important that they get help for these symptoms if they are having an effect on their life and relationships. Some health conditions and medications can affect a person’s level of desire so it is important to discuss the issue with a doctor or health professional. Everybody’s libido is different and it is not helpful for a woman to compare her sex life with others.
A common symptom of menopause is vaginal dryness, caused by the lower levels of sex hormones the body is producing. Vaginal dryness can make sex painful and may prevent a woman feeling like sex. This condition can be treated with hormone creams and/or lubricants when having sex and it is important to discuss the problem with a doctor or health professional.
Before menopause, women have a lower risk of heart disease than men but as women age and their oestrogen levels go down after menopause, their risk of heart disease increases.
Menopause can result in increased blood pressure, increased LDL or ‘bad cholesterol’, decreased HDL or ‘good cholesterol’. Other blood fats like triglycerides may also increase.
It is very important to try and reduce the risk of heart disease especially at this time with a healthy lifestyle including:
Lifestyle changes may not be enough for some women with a higher risk of heart disease, and medication for high blood pressure and or cholesterol may be required.
It is more common for women to develop osteoporosis after menopause; this is because of the low levels of oestrogen in a woman’s body which affects her bone health. Most bone loss occurs in the first three years after menopause, and then the rate of bone loss slows. Osteoporosis is a condition in which a loss of bone mass and strength makes bones more fragile which can lead to breaks in the bones.
Smoking, lack of exercise, alcohol and high caffeine intake (5-6 cups per day) can increase the risk of osteoporosis.
Healthy eating with adequate calcium intake is important for bone health. The diet should include foods containing calcium such as dairy, canned fish with bones (e.g. sardines), almonds, tofu, leafy green vegetables, and legumes, such as chick peas or kidney beans.
It is important for women to have bone health checks as part of their health screening. This may include medical history, an examination checking risk factors for osteoporosis and may include bone density testing.
Many women experience changes to their weight around the time of menopause. The factors that are the main cause of weight gain at this time are likely to be:
Menopause doesn’t cause women to gain weight but it can cause body fat to shift from the hips to the abdomen due to the decrease in levels of oestrogen.
Weight gain around the stomach is not healthy and can increase blood pressure, increase blood fat and increase the risk of high blood pressure, diabetes, cardiovascular disease, dementia and some cancers. Maintaining a healthy weight at this time of life is very important to help reduce the risk of chronic disease.
The effects of a woman’s symptoms of menopause on their partners will often create challenges for relationships; these may include low mood, emotional changes, irritability, effects on libido and desire to have sex.
It is important that partners have information about the effects of menopause so they can understand any changes. They may need to be more understanding and encourage their partner to see a doctor if the symptoms are affecting her quality of life.
Partners should know:
Jean Hailes for Women’s Health (2013) Managing menopause. Retrieved 9 October 2013 from http://www.managingmenopause.org.au