About menopause


Menopause means you have had your final menstrual period, but how do you know when your last period has occurred? The different stages of menopause including perimenopause, menopause and postmenopause are discussed along with what is happening with your hormones and what is the best way of diagnosing menopause. 

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What is menopause?

The word 'menopause' comes from the Greek words 'menos' meaning month and 'pause' meaning to cease. So menopause means the monthly (the period) stops.

Menopause is the final menstrual period. You only know you have had a final menstrual period if you have had no period for 12 months.

What happens at menopause?

By menopause, there are no active eggs left in a woman's ovaries

Women are born with about a million eggs in each ovary. At puberty approximately 300,000 eggs remain, and by menopause there are no active eggs left.

On average, a woman in Australia will have 400-500 periods in her lifetime. From about 35-40 years of age, the number of eggs left in your ovaries decrease quickly and you ovulate (release an egg from the ovary) less regularly until your periods stop.

Hormones & menopause

Hormones are chemicals made in your body, which relay messages through the blood stream. They alert the body that it is time to do something. They help control many body functions such as growth, energy, repair of cells, reproduction, sexual function, digestion and the body's temperature. They alert the body to eat, to stop eating, to sleep, to wake up, to grow, or when hormone levels decrease, to stop growing.

The three hormones of particular relevance at menopause are:

  • oestrogen
  • progesterone
  • testosterone

Menopausal symptoms are created by changes in the levels of these hormones. These changes usually happen over months or years as you approach menopause. If you have menopause induced by surgery or cancer treatment, there can be a sudden drop in some of these hormones, causing symptoms to be more severe.

Oestrogen

The hormone oestrogen is made up of a group of three hormones: oestradiol, oestrone and oestriol. It is produced from the cells around the eggs in your ovaries.

Oestrogen acts in the vagina, uterus, skin, bowel, liver, heart, blood, brain and throughout most of the body. Oestrogen also helps to maintain muscle tone, the endometrium (lining of the uterus or womb), cervix (the lower, narrow part of the uterus where it joins the vagina), ducts in the breast, and it helps in the protection of our bones.

The production of oestrogen fluctuates during the transition to menopause (perimenopause). The production of oestrogen can increase because ovulation can occur twice in some perimenopausal cycles. This can lead to very high hormone levels. As the final period is near and egg numbers decrease, oestrogen levels drop, falling by as much as 90% at menopause.

Progesterone

Progesterone, another natural female hormone, decreases toward menopause. This is because progesterone is produced only if an egg is released (ovulation). The release of progesterone usually prepares the uterus for a fertilised egg and pregnancy. With menopause, ovulation stops and so progesterone levels drop.

Progesterone is responsible for changes to mucus in the cervix, from thin to thicker. It reduces acidity levels in the vagina, works on milk cells in the breast, and also can make us more moody.

Approaching menopause, progesterone levels fall and during these anovulatory (no ovulation) cycles women may experience heavy irregular bleeding because of the hormonal fluctuations along with menopausal symptoms.

hormone variations cause menopausal symptoms

Testosterone

Testosterone is produced by the ovaries and in other parts of the body, such as the adrenal glands (which sit above the kidney).

We often think of testosterone as more of a male hormone, particularly because of its influence on hair growth and vocal tone. However, testosterone is also an important female hormone and has a role in women's sexual desire and arousal, overall emotional wellbeing, bone and muscle strength.

Rather than a sudden or dramatic drop at menopause, testosterone decreases gradually with age. In some women, levels fall by half between the ages of 20-40 years.

There is still a lot to learn about testosterone, particularly how it works in women and its impact on sexuality.

When does menopause occur?

Most women reach menopause at between 45-55 years of age, and the average age of menopause for women in Australia is 51-52 years.

Menopause will sometimes occur earlier than expected as a result of cancer treatment, surgery or unknown causes. This will be discussed further in causes of menopause.

The stages of menopause

Menopause is often considered in stages:

stages of menopause

Perimenopause

Features:

  • The transition to menopause
  • Can last 4-6 years
  • Periods start to 'wind down' and become less regular
  • Periods may be lighter or heavier, last for longer or finish earlier than they used to
  • Menopausal symptoms often gradually begin during this time

Many women talk of perimenopause as a time of hormonal 'chaos'. Hormone levels, particularly oestrogen, can swing erratically from high to low. This is because the ovaries are beginning to run out of eggs, which affects hormone levels. During this time ovulation (the release of an egg) can occur twice in a cycle, the second time during a period. This can lead to very high hormone levels. At other times, ovulation is less likely, which causes hormone levels to fall.

Diagnosis of perimenopause

There is no test to diagnose perimenopause. It is best identified by considering:

  • Changes in the cycles of your periods:
    • How frequent are your periods now and how has that changed?
    • How long do they last and has that changed?
    • How light or heavy are your periods and how has that changed?
  • Symptoms of menopause, e.g. are you experiencing:
    • hot flushes?
    • mood changes?
    • increasing forgetfulness?
    • migraines?
    • increasing aches and pains?
    • Are they getting worse?

Signs & symptoms of perimenopause

Because of the hormonal imbalances during perimenopause, this is the time many women experience the most menopausal symptoms.

Talk to your doctor about changes in your periods such as:
  • changes in the pattern of your period
  • increasingly heavy periods
  • long periods of more than 8 days
  • periods that come less than 3 weeks apart
  • periods that come more than 2-3 months apart
  • painful periods causing you to stay home
  • bleeding between periods

Most importantly, please see your doctor if you have any bleeding after intercourse and it is not related to your period.

Management of perimenopause

Depending on your symptoms and medical history, the following may be suitable treatment and management options:

  • Combined oral contraceptive pill (OCP)
  • Hormone replacement therapy (HRT)
  • Mirena  – progestin-releasing intra-uterine device (IUD) for heavy bleeding
  • Natural therapies (see an accredited naturopath)

For more information go to menopause management.

Menopause

As menopause is defined as the final menstrual period you only know you have had a final menstrual period if you have not had a period for 12 months.

Menopause
Final menstrual period 1 2 3 4 5 6 7 8 9 10 11 12
No periods for 12 months

Postmenopause

Postmenopause is the time after menopause
It occurs 12 months after the final period

A woman may experience menopausal symptoms in postmenopause, how long this continues varies for each woman.

Menopause Postmenopause
Final menstrual period 1 2 3 4 5 6 7 8 9 10 11 12
No periods for 12 months

Diagnosis of menopause

It can be difficult to know when it is your last period. You may not have a period for some months and have symptoms of menopause such as hot flushes, a dry vagina, crawling feelings under the skin or mood swings. This means you are probably perimenopausal (i.e. in the time before menopause) but then you have another menstrual period and the 12 month count to menopause starts again. 

Is there a test to diagnose menopause?

Blood tests

Unfortunately blood tests are not a reliable measure of whether a woman has reached menopause. Blood tests measure for two hormones in the blood:

  • Follicle Stimulating Hormone (FSH) because FSH levels rise significantly during menopause
  • Oestradiol (a form of oestrogen) because oestradiol levels drop by up to 90% at menopause

A definite diagnosis of menopause is not possible because oestradiol and FSH levels can differ depending on the time of the day, and day of the cycle, that the blood sample is taken. One day the levels may indicate you are menopausal but the same test the next day could indicate you are not. 

In addition, hormone changes are unpredictable and vary from one cycle to another.

A new blood test to measure a different hormone, anti-Müllerian hormone (AMH), is being studied to see if measuring egg or follicle activity is an effective way to predict menopause. Currently, it is able to tell women if menopause is 2-4 years away, but more results are still needed to see how helpful this test is.

Saliva tests

Saliva tests are not accurate and are not worth buying. Once again the level of hormones tested can differ from day-to-day and cycle-to-cycle.

The best test so far

Currently the best way to predict menopause is to use the symptoms you have as a guide to whether you are close to menopause. If your periods are irregular or have stopped for some time, if you are experiencing symptoms such as hot flushes and they are gradually getting worse, these signs are likely to be better indicators you are getting closer to menopause than blood or saliva tests.

When to see your doctor

  • If you are troubled by shortened cycles
  • If you are worried about heavy bleeding
  • If you have increased PMS pain
  • If you have some of the symptoms of menopause like hot flushes that interfere with your daily life

Last updated 27 September 2017 — Last reviewed 02 March 2014

** Currently under review **

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 March 2014.

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