What is menopause?
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, once she has reached menopause she can no longer have children naturally.
When does menopause occur?
Most women reach menopause between the ages of 45-55 years, but the average age is 51 years.
What is perimenopause?
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). This time between having regular periods and the final period or menopause is usually between four to six years, but may be shorter or longer.
What happens to the body at menopause?
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. The rest of the eggs disappear, break down or deteriorate and by the time she reaches menopause.
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 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:
- longer, shorter or irregular periods
- lighter bleeding
- unpredictable and heavy bleeding
Eventually hormone levels get so low that menstruation stops altogether, this is menopause.
What are the signs & symptoms of 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:
- hot flushes and night sweats
- aches and pains
- a feeling of crawling under the skin or itching
- a dry vagina (can make sex uncomfortable)
- reduced libido (sexual interest and desire)
- needing to urinate more often
- trouble sleeping
- not feeling good about themselves
Not all women will experience menopause symptoms
- 20% (1 in every 5 women) experience no menopause symptoms
- 60% (6 in every 10 women) experience mild symptoms
- 20% (1 in every 5 women) suffer severe symptoms
How long do the symptoms of menopause last?
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 for can’t be predicted. On average though, women will experience menopausal symptoms for about eight years. Only 10% (1 in every 10 women) will have symptoms that last longer than 10 years.
How is menopause managed?
It is possible to improve some menopause symptoms with some of the following changes.
Some of these might help with some menopause symptoms such as hot flushes and mood. Others will be good for health generally.
- Maintain a healthy weight – women who are overweight can have more hot flushes than those with a healthy weight
- Eat plenty of fresh vegetables, fruits, cereals and wholegrains to manage weight and reduce the risk of heart disease
- Drink 6-8 glasses of water daily
- Reduce caffeine in the diet (including coffee, tea, cola, chocolate) – it can cause hot flushes
- Limit alcohol to 1-2 standard glasses, or less, per day – it can cause hot flushes
- Eat high-calcium, low-fat dairy foods to reduce risk of osteoporosis
- Eat lean meats and fish to manage weight and reduce risk of heart disease
- Phytoestrogens (plant oestrogens found in soy and linseed bread, soy beans, tofu, wholegrains and legumes) may reduce the risk of high cholesterol and blood pressure
Regular physical activity
Physical activity may help general health, control weight gain and help keep bones healthy.
- Aim for 30 minutes of moderate intensity physical activity on all or most days of the week
Create a cooler environment
- Have fans throughout the house and always carry a little hand fan
- Use a water facial spray when having a hot flush
- Have cool drinks available when experiencing flushes
- Wear layers of clothing, so you can take off as much as you need when hot
- Women who smoke may reach menopause 1-4 years earlier than women who don’t smoke.
- Women who smoke are more likely to have menopausal hot flushes
- Giving up smoking is important because after menopause women have an increased risk of osteoporosis, heart disease and lung cancer
Look after your emotional health
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)
This can help with symptoms of irregular and/or heavy blood loss, some symptoms and provide contraception.
- Hormone replacement therapy (HRT)
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 increase in breast cancer and blood clots for women using HRT so it is important that this treatment is discussed with a doctor. The doctor will talk to women about any other risks they might have for these health conditions and make sure any screening is completed to check a woman’s health first 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, because of their medical history, cannot have HRT. 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, one group used for menopausal symptoms are 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 following treatments can be used with/instead of HRT including 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 to tell 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:
- 1 year without a natural period if she is over the age of 50
- 2 years without a natural period if she is under 50 years
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. 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 or over, and have no breast changes, should have a free 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.
What else can happen after menopause?
Libido or sexual desire can be affected by many things including hormone levels and some women find when they reach menopause that they no longer feel like having sex any more. This can cause problems in the relationship with her 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 to get help for these symptoms if they are having an effect on her life and relationship. 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 or 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:
- a healthy and nutritious diet
- regular exercise
- maintaining a healthy weight
- not smoking
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.
Bone health & osteoporosis
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, 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.
Weight gain or redistribution
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:
- lifestyle changes
- decreasing activity levels
- less muscle and slowing metabolism
- imbalance between the amount of calories being eaten compared to energy being used
- diet – choosing cheaper calorie-dense foods instead of healthier food
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 and increase blood fat and increased 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.
Information for partners of women going through menopause
It is not only women who experience the symptoms of menopause – the effects the symptoms have on their partners will often create challenges for relationships. Symptoms may include low mood, emotional changes, irritability, effects on libido and desire to have sex which will impact on those close to the woman.
It is important that partners have information about the effects of menopause so they can understand the changes they may notice. They may need to be more understanding and encourage their partner to see a doctor if the symptoms are effecting her quality of life.
Things partners should know:
- Menopause can have a major effect on a woman – as well as the symptoms she may have, it is a stage of change and the end of her fertility can affect how she feels about herself
- Treatment such as HRT may help some symptoms but the changes that menopause brings will still occur
- Sex may be very uncomfortable for a woman because the hormonal changes can make her vagina very dry, so extra lubrication may be required – because of the symptoms and a lower libido she may not feel like having sex as much, or at all (couples may need to find other ways to remain intimate)
- Hot flushes experienced at menopause can make a woman very uncomfortable and sleep can be difficult so a woman may prefer to sleep alone
- This can be a difficult time for both partners and it’s important for the relationship for partners to keep communicating – it may be helpful for partners to show extra care and support
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2013.