The menopause is sometimes called ‘the change of life’. It marks the end of a woman’s reproductive life and all sorts of bodily changes occur. At menopause, ovulation no longer occurs and production of some female hormones ceases.
The word “menopause” refers to the last or final menstrual period a woman experiences. When a woman has had no periods for 12 consecutive months she is said to be “postmenopausal”.
Most women become menopausal as a matter of course between the ages of 45 and 55 years. The average age of onset is around 50.
Premature menopause or premature ovarian insufficiency may occur before the age of 40. This can be due to natural ovarian function ceasing. It may be following surgery to remove the ovaries, or following cancer treatment. Menopause is considered “early” when it occurs between 40 and 45 years.
What is peri-menopause (the menopausal transition)?
Peri-menopause refers to the time leading up to menopause. This is when a woman may start experiencing changes in her menstrual periods. These changes can include irregular periods or changes in flow. Cycles can be shorter or longer in length. Symptoms may also include hot flushes and night sweats. Aches and pains, fatigue or irritability, as well as premenstrual symptoms such as sore breasts an, be common. These changes be asa result of fluctuations in the production of hormones from the ovary. Some women experience menopausal symptoms for 5-10 years before their final menstrual period. There is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last.
Contraception in the peri-menopause
A woman’s fertility declines in her 40s and the risk of pregnancy after the age of 50 years is estimated at less than one per cent. However women may ovulate twice in a cycle and as late as three months before the final period. You are advised to keep using contraception until two years after your last period if you experience the menopause under the age of 50. If you are over 50 you are advised to continue for one year after the last period.
Physical symptoms of menopause
Symptoms commonly reported by peri- and post-menopausal women include:
- hot flushes and night sweats,
- aches and pains,
- dry skin,
- vaginal dryness,
- loss of libido,
- urinary frequency,
- sleeping difficulties
Some women may have unwanted hair growth, thinning of scalp and pubic hair and skin changes. Not everyone finds the symptoms bothersome. Around 60% of women will have some mild symptoms for around 4-8 years. Twenty per cent of women will have no symptoms at all while another 20% will be severely affected, with symptoms continuing into their 60s.
Women live around one third of their lives after menopause. It is important to optimise physical and mental health.
Psychological symptoms of menopause
Hormonal changes and sleep deprivation can contribute to mood changes and anxiety. Other symptoms include irritability, forgetfulness, and trouble concentrating or making decisions. Low levels of oestrogen can be associated with lower levels of serotonin, the chemical that regulates mood, emotions and sleep. Depression is not more common at menopause than at other stages of life. However a past history of depression, particularly post-natal depression, and stress during the peri-menopause may make a woman more likely to succumb to mood problems. If you believe this is you talk to your GP, there are things they can do to help with this.
How is menopause diagnosed?
Doctors diagnose the menopause based on a woman’s symptoms and changes in menstruation. The diagnosis is obvious where a woman has had her ovaries removed surgically.
It is not necessary to have hormonal tests to “prove” a woman is menopausal. However, a doctor may order tests if there is concern that physical changes are a sign of illness. These can include thyroid disorder, rather than natural ageing, or if spontaneous menopause occurs at an early age.
If you want to confirm your thoughts make an appointment with your GP and chat through your symptoms.
How can symptoms be handled?
Being informed about what may happen during the menopause transition is a great starting point.
Women are encouraged to pay attention to their health. Quitting smoking, eating well, exercising regularly and incorporating some relaxation techniques are encouraged. Self-management strategies such as carrying a fan, dressing in layers, always having a cool drink and a facial water spray can be useful. Avoiding spicy foods, caffeine and alcohol will also reduce flushing.
Some women may find relief from menopausal symptoms with herbal or alternative remedies. Most have not been studied or shown to be of benefit scientifically but some do find relief.
MHT, as patches or tablets, has been demonstrated scientifically to reduce menopausal symptoms. However, for each individual woman its benefits must be weighed against the increased risk of side effects. For younger menopausal women (below the age of 60, or within 10 years of menopause), the latest Global Consensus Statement on Menopausal Hormone Therapy states, “The dose and duration of MHT should be consistent with treatment goals and safety issues and should be individualized. In women with premature ovarian insufficiency, systemic MHT is recommended at least until the average age of the natural menopause”. Some women may need to continue MHT if symptoms persist, and they should seek their doctor’s advice to weigh up the risks and benefits.
Doctors may prescribe other drugs to relieve symptoms, such as anti-depressants. These have been shown to reduce hot flushes, gabapentin, and clonidine can also be useful.
Feeling positive about the menopause
Women may experience physical and emotional changes during menopause but that doesn’t mean life has taken a downhill div. Many women are prompted at this time to ‘take stock’ of their lives and set new goals. The menopause occurs at a time when many women may be juggling roles as mothers, as carers of elderly parents, and as members of the workforce. Experts suggest that creating some ‘me time’ is important to maintain life balance.
Menopause can be seen as a new beginning: it’s a good time to assess lifestyle, health and to make a commitment to strive for continuing ‘wellness’ in the mature years.
If you have any concerns or just want to confirm your symptoms speak to your GP.