The menopause is sometimes known as the 'change of life' and is marked by the ending of menstruation (when a woman's periods stop).
A woman's periods do not usually stop suddenly. They generally become less frequent, the odd period is missed and then they stop altogether.
When it happens
The average age for a woman to reach the menopause is 52.
A woman is said to have reached the menopause once she has not had a period for one year. After this point, she can be described as post-menopausal.
If the menopause occurs in a woman who is under 45 years of age, it is known as premature menopause. It is estimated that premature menopause affects 1% of women under the age of 40 and 0.1% of women under the age of 30.
During the time leading up to the menopause (perimenopause), the hormonal and biological changes that are associated with the menopause begin. As a result of these hormonal changes, many women experience both physical and emotional symptoms, such as hot flushes, night sweats and irritability (see Symptoms of menopause for more information).
The menopause is the end of egg production (ovulation). This occurs as a result of falling levels of the female sex hormone oestrogen, which regulates a woman's periods.
Most women reach the menopause without seeking medical advice. However, treatments are available that can ease menopausal symptoms that are severe or distressing (see Treatment for menopause for more information).
- You cannot get pregnant after the menopause
FALSE. It can and does happen, so carry on using contraception for two years after your last period if you are under 50 and for one year if you are over 50.
- You are going to put on weight
FALSE. Middle-age spread is often linked to the hormonal changes at this time of life but, as yet, there is no proof of this. Those extra inches could just be part of growing older and being less active.
- Your menopause will be difficult because your mum’s was
FALSE. There is no evidence that this is the case, although the age at which your mum went through the menopause could give you a clue as to when to expect symptoms. This is because the age of menopause tends to be similar in mothers and daughters.
It is estimated that 8 out of 10 women experience symptoms leading up to the menopause. Of these, 45% find their symptoms difficult to deal with.
In most cases, the first symptom is a change in the usual pattern of your periods. Your period may start every two to three weeks, or you may not have one for months at a time. The amount of menstrual blood lost may also change, and most women find it increases slightly.
Other common symptoms of the menopause (and the months just before and after this) are detailed below.
Without treatment, most menopausal symptoms gradually stop naturally. This usually happens two to five years after the symptoms start, although some women experience symptoms for many more years.
Hot flushes and night sweats
A hot flush is a sudden feeling of heat in your upper body, which can start in your face, neck or chest, before spreading upwards and downwards.
The skin on your face, neck and chest may become red and patchy, and you may start to sweat. You may also experience a change in your heart rate. It may become very rapid, or it may be irregular and stronger than usual (known as palpitations).
Hot flushes that occur at night are called night sweats. Most hot flushes only last a few minutes and are most common in the first year after your final period.
Many menopausal women have trouble sleeping due to night sweats, but sleep disturbance may also occur as a result of anxiety.
You may find that a lack of sleep makes you irritable, and that you have problems with your short-term memory and ability to concentrate.
During the time leading up to the menopause, you may experience vaginal dryness, itching or discomfort. This can make sex difficult or painful (known as dyspareunia). These symptoms combined are known as vaginal atrophy.
Approximately one-third of women experience the symptoms of vaginal atrophy shortly after the menopause, and slightly more women have them later on. It is possible to experience vaginal atrophy more than 10 years after your final period.
If you experience vaginal symptoms, it is likely that they will persist or worsen over time unless they are treated.
During the menopause, you may become prone to recurrent lower urinary tract infections, such as cystitis. You may also experience an urgent need to pass urine and need to pass it more often than normal.
Protecting your bones from osteoporosis
Loss of bone bulk and osteoporosis are natural features of ageing, but loss of oestrogen accelerates the process in women who have gone through the menopause.
You can reduce your risk of osteoporosis by doing short, frequent sessions of weight-bearing exercise, eating plenty of calcium, giving up smoking and moderating alcohol consumption. If you cannot get enough calcium from your diet, it may be worth trying calcium supplements. See your doctor before you start taking these.
If your menopausal symptoms are not severe, it may not be necessary to treat them using medication. Many women who experience menopausal symptoms find they can ease them by making changes to their lifestyle and diet.
Some of the various menopausal symptoms and how they can be improved by lifestyle changes are outlined below.
To improve hot flushes and night sweats:
- take regular exercise
- wear light clothing
- keep your bedroom cool at night
- try to reduce your stress levels
- avoid potential triggers, such as spicy food, caffeine, smoking and alcohol
To improve sleep disturbance:
- avoid exercise late in the day
- go to bed at the same time every night
To improve mood disorders:
- get plenty of rest
- take regular exercise
- try relaxation exercises, such as yoga
The menopause results from a fall in the level of the female hormone oestrogen in your blood. Oestrogen regulates your menstrual cycle, and a fall in this stops you producing an egg every month (ovulation).
Causes of premature menopause
In rare cases, a woman may begin to approach menopause before the age of 45 because her ovaries are failing earlier than they normally would. This is known as premature ovarian failure. Although it is rare, premature ovarian failure can occur at any age, and in many cases no cause will be found.
However, not all women who go through premature ovarian failure find that their periods stop. A small number of these women still have intermittent ovarian function, which means that their ovaries release eggs once in a while and they may still be able to conceive.
The possible causes of premature ovarian failure are outlined below.
- Medical conditions: enzyme deficiencies, Down's syndrome, Turner's syndrome, Addison's disease and hypothyroidism can all make premature ovarian failure more likely.
- Medical treatments and procedures: surgery to remove the ovaries, radiotherapy to your pelvic area, chemotherapy and hysterectomy surgery (removal of the womb) can all cause premature ovarian failure, although this is rare.
- Infections: in very rare cases, certain infections such as tuberculosis or mumps may bring on premature ovarian failure. However, in the case of mumps, the damage to your ovaries is usually only temporary and normal function usually returns. Malaria, varicella (the infection that causes chickenpox and shingles) and shigella can also cause premature ovarian failure, although this is very rare.
If you think you are experiencing menopausal symptoms and find them difficult to deal with, see your GP.
Your GP should be able to confirm that you have the menopause by considering your age, whether or not you are still having periods and by asking about your symptoms.
There is no definitive test to diagnose the menopause, although measuring the level of follicle-stimulating hormone (FSH) in your blood can occasionally help confirm a diagnosis. This is because FSH rises in women who are menopausal. However, a high level of FSH alone is not enough to make a diagnosis.
Only 1 in 10 women seek medical advice when they go through the menopause and many do not need any treatment. However, if your menopausal symptoms are severe enough to interfere with your daily life, there are treatments that can help.
The treatment options are:
- Hormone replacement therapy
- tibolone (similar to HRT)
- vaginal lubricants
The kind of treatment you can take depends on your symptoms, medical history and your own preferences.
HRT and tibolone do not provide contraceptive protection, and although your fertility decreases during the menopause, it may still be possible for you to conceive. Therefore, continue to use contraception:
- for one year after your last period if you are over 50 years of age
- for two years after your last period if you are under 50 years of age
The treatments for menopause are detailed below.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and cystitis.
As the name suggests, HRT works by replacing oestrogen, which naturally begins to fall in the approach to menopause, causing menopausal symptoms. There are three main types:
- oestrogen-only HRT, for women who have had their womb and ovaries removed
- cyclical HRT, for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
- continuous HRT, for women who are post-menopausal
HRT can be taken as a cream or gel, a tablet, a skin patch or an implant.
For more information on HRT, including how it is taken, who can use it, how it works, side effects and risks, go to Health A-Z: HRT.
Tibolone is a synthetic hormone that acts in the same way as HRT. It may be used as an alternative to combined HRT (which contains both oestrogen and progestogen) for post-menopausal women who want to end their periods.
Like HRT, tibolone is effective in treating menopausal symptoms such as hot flushes and night sweats, and it can help prevent fractures of the spine. It may also improve sexual problems, such as a decreased sex drive.
Tibolone carries some small risks, including a small increased risk of breast cancer, cancer of the womb and stroke. It is also not suitable for women over the age of 60.
Clonidine is a medicine that was originally designed to treat high blood pressure, but it may also reduce hot flushes and night sweats in some women.
However, it can sometimes cause unpleasant side effects including dry mouth, drowsiness, depression, constipation and fluid retention. If your GP prescribes clonidine, you will need to take it for a trial period of two to four weeks to see if it will be effective. If your symptoms do not improve during this time or if you experience side effects, the treatment should be stopped and you should return to your GP.
If you experience vaginal dryness, your GP can prescribe a vaginal lubricant or moisturiser, such as ReplensMD, which can be used for as long as you like.
Although they are not licensed for treating hot flushes, there are several antidepressant medications that may be effective for this, including:
Side effects of these antidepressants may include nausea, dizziness, dry mouth, anxiety and problems sleeping.
If you are taking HRT, you will need to return to your GP for a follow-up review three months after starting HRT, and once a year after that. At your three-month review, your GP will:
- make sure your symptoms are under control
- ask you about any side effects and bleeding patterns
- check your blood pressure and weight
At your annual review, your GP will:
- review the type of HRT you are taking and make any necessary changes
- perform a breast examination and show you how to do it yourself
- remind you of the risks and benefits of HRT
If you are on a non-HRT treatment, you will need to return to your GP for a review of your treatment at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest a trial withdrawal of treatment.
Your symptoms may recur for a short while after you stop your treatment, but as long as this does not continue in the long term, you may be able to stop taking it permanently.
There are many unlicensed complementary therapies available for menopausal symptoms, but there is no medical evidence that any of them are effective. These treatments, which may contain products such as soy, red clover, black cohosh and ginseng, can be potentially harmful.
There is very little control over the quality of the products used in complementary therapies, and their long-term safety has not been assessed. They may have unpleasant side effects and can interfere with other medications. Therefore, it is not recommended that you use any complementary therapies for menopausal symptoms.
If you are diagnosed as menopausal and you are under the age of 45, it is known as a premature menopause. If you are under the age of 40, your GP will refer you to a gynaecologist for treatment and to discuss your fertility.
Treatment is needed to ease menopausal symptoms and prevent osteoporosis, which becomes more likely as oestrogen levels in your body fall.
HRT and the combined contraceptive pill are recommended treatments as they both contain oestrogen and progestogen.