Menopause simply means the end of a woman’s menstrual periods. It is a significant hormonal milestone that offers a good opportunity to assess your health and plan for the next phase of your life.
Menopause is a normal part of life; you are said to have reached menopause after 12 months in a row of no further periods.
The usual age is between 45 to 55 years. The average in NZ is 52 years.
About 70% of women have significant symptoms with menopause and 40% will see a doctor because of their symptoms.
Symptoms vary hugely in severity with some women having very little discomfort, while others are affected to the extent of being unable to carry out their normal everyday activities.
In the long term, after menopause you are more at risk of developing osteoporosis (thinning of bones) and heart disease, though lifestyle measures help to reduce this risk.
Discuss ongoing symptoms or particular concerns with your doctor.
What happens during menopause?
During menopause your body stops preparing every month for a baby: your ovaries stop releasing eggs, they make less and less of the female hormones oestrogen and progestogen, and eventually, your periods stop.
The reduction in female hormones can cause symptoms such as hot flushes, mood swings, night sweats, anxiety, palpitations, depression, decreased libido, sleep problems and vaginal dryness.
Natural menopause, which happens between the ages of 40 and 55 (usually late 40s or early 50s).
Early or premature menopause, which happens before 40 years of age. This can be due to genetics, is more common in women who smoke, who have been ill or had surgery or drug treatments that affect the blood supply to their ovaries, however it can also occur for no obvious reason.
Artificial menopause, which occurs when the ovaries have been removed or after cancer treatment.
Menopause can be divided into two stages:
Perimenopause: during the year or years before your periods stop completely (perimenopause) your periods will change; they may get shorter, longer, lighter or heavier. They may be closer together, or further apart. This may go on for a year or more. Eventually, your periods will stop altogether.
Postmenopause: a woman is considered "postmenopausal" one year after her last menstrual period.
What are the signs of menopause?
For some women, a change in their periods is all they notice as they go through menopause. However, because the female hormones affect other parts of your body, you may also have any of the following symptoms:
Hot flushes; these feel like someone has poured hot water into your veins. They can start in your face and neck and spread all over your body or be a sudden feeling of heat all over. Many people feel embarrassed and think others will notice, but it's usually not noticeable.
Sweats, which often go with flushes and are common at night.
Loss of libido (sex drive).
Dryness in your vagina and around your urethra can lead to uncomfortable sex, bladder infections or wetting your pants sometimes.
Palpitations – your pulse or heart may feel like they are racing, or you may feel faint or dizzy from time to time or get ringing in your ears.
Mood changes – you may feel tired, irritable, depressed, tearful or angry; this can be from hormonal changes, because you are not sleeping well or because you are adjusting to change.
Skin – your skin may look more tired and be less firm, and the hair on your head, armpits and legs may get thinner.
Bones – you won't feel it, but your bones may start getting thinner (osteoporosis). Much later you may break them more easily or start to get shorter (loose some of your height) or find it hard to straighten up.
Note: if you have very heavy periods or bleeding between your periods you must contact your doctor.
Looking after yourself during menopause
Menopause is a normal part of life. Allow yourself time to adjust to what you are experiencing and try to get support from others, especially from your partner and family. If they understand what you are going through it will help them know how they can best support you.
Don't forget about contraception!
If aged less than 50 years, the general advice is you still need contraception for two years after your final menstrual period (FMP).
If you are aged 50 years or more when you reach menopause, you need to continue to use contraception for at least one year after your final period.
If you have ongoing symptoms which are not relieved by self-care measures, see your doctor for advice.
You may be offered hormone replacement therapy (HRT), now called menopause hormonal therapy (MHT) to reduce the menopausal symptoms. While this has been less popular over the last ten years, it is still one of the best treatments for menopausal symptoms and is considered safe for most women less than 60 years old.
For vaginal dryness, you can be offered a topical oestrogen cream which works well and comes as pessaries or cream. If you are at risk of thinning bones (osteoporosis) you may be given calcium supplements or other treatments.
Menopause is a good time to have a general health examination, including checks for your blood pressure, having a cervical smear, breast examination, mammogram and possibly a bone density scan. You should also discuss ways to look after your health over the coming years with your doctor.
Going through menopause can make you feel as if you're not in control of your own body, but there are ways to ease the symptoms. If you have tried the self-care options below and are still not getting the relief you need, talk to your doctor for further advice and treatment options.
Keeping your weight down and eating a diet low in fat, sugar and salt but high in calcium and fibre will help protect your bones, joints and heart.
Researchers are looking at whether eating phytoestrogens (natural oestrogens contained in foods such as soy, beans, grains and some fruit and vegetables) can help menopause symptoms. We don't know yet. However, these foods are healthy and low-fat, so are generally good choices.
Some women may find some alternative therapies such as acupuncture, massage, homoeopathy or herbal remedies help. (It is recommended that you discuss with your doctor before taking 'natural' or 'herbal' remedies as some of these can interact with other medicines you may be taking, or can have unwanted side effects).
Counselling may help if you have trouble with mood changes.
Reducing your risk of osteoporosis & heart disease
When you go through menopause, your periods will change and eventually stop. You may have some or all of the symptoms mentioned on the overview page.
Menopause is diagnosed based on your symptoms and changes in menstruation. You do not need to have a hormonal test to “prove” you are menopausal.
Do I need to see a doctor if I'm going through menopause?
Menopause is a normal process that does not always require medical intervention. However, you may wish to discuss your symptoms with your doctor – especially if they are affecting your quality of life.
Your doctor may recommend tests if there is concern that physical changes are a sign of illness, such as thyroid disorder or if spontaneous menopause occurs at an early age.
How long does menopause last?
The average duration of menopausal symptoms is 5 years although some women will have symptoms for longer.
Will menopause affect my quality of life?
Menopause affects women in different ways and symptoms vary hugely in severity. Some women have very little discomfort, while others find their symptoms interfere with them carrying out their normal daily activities.
While some women have a sense of loss at going through menopause, many others feel they get a new lease on life. They enjoy having no periods and no more worries about pregnancy. Many feel more confident and that they have 'come into their own'.
If you are concerned that your quality of life is being affected by your menopause symptoms, try the measures listed on the self care tab or see your doctor for further advice.
Are my symptoms normal?
Menopause can make you feel like you are loosing control of your body. Understanding what symptoms to expect may help reassure you that what you are experiencing is normal.
Read more about symptoms of menopause on the overview page.
Information for health professionals
The content on this page will be of most interest to clinicians (doctors, nurses, pharmacists, specialists, etc) or those seeking more detail.
Anna Fenton discusses the management of menopause. Anna is a gynaecological endocrinologist at Canterbury DHB where she is clinical lead for bone densitometry. She is a member of the pharmacology and therapeutic advisory committee for endocrinology and is past president of the Australasian Menopause Society.
1. Premature ovarian insufficiency – Dr Megan Ogilvie (20 minutes)