What is menopause?

Menopause overview

Menopause is when your period stops because the amount of hormones your ovaries make has significantly reduced.
Every person who has periods will go through menopause.
While the age of menopause differs between individuals, it typically occurs between the ages of 45 and 55.
Menopause can happen naturally or as a result of surgery to remove the ovaries or uterus, cancer or other medical treatment, or a genetic reason.
Perimenopause is the stage of life before menopause and is when you experience symptoms of menopause, but your periods have not stopped.
Perimenopausal and menopausal symptoms include hot flushes, night sweats, mood swings, brain fog, fatigue, anxiety and vaginal dryness and urinary changes.
The symptoms of menopause and perimenopause can be disruptive to your life, affecting your work, relationships, and physical and emotional health.
There are lifestyle changes, medicines, and other treatments that can help you to manage the symptoms of menopause.

Menopause is the stage in a woman’s life where she has gone 12 months without a period. The years leading up to menopause are known as perimenopause or the menopausal transition. During perimenopause, you may have changes to your menstrual cycle and experience symptoms but still have periods.

How long the perimenopause lasts varies between individuals as it is a gradual process influenced by other factors. However, the menopausal transition usually lasts about 7 years but can span up to 14 years.

What age does the menopause start?

The average age of menopause is typically between 45 and 55, however, it can occur earlier or later. Menopause before the age of 45 is called early menopause (or perimenopause) and occurs naturally in approximately 5- 10% of people.

Premature menopause, or premature ovarian insufficiency (POI) is when menopause happens before 40. It’s estimated to affect 1-3% of women under 40 and 0.1% of women under 30. It is different from natural menopausal age as premature menopause indicates that the ovaries aren’t functioning as they should be.

Why does menopause happen?

As you age, the change to the hormone levels produced by the ovaries causes menopause. Oestrogen, particularly a form called oestradiol, is one of the main female sex hormones. It is produced by the ovaries and levels of the hormone rise during puberty.

In mid-life, the amount of oestrogen made by the ovaries declines and fluctuates less smoothly, and this triggers perimenopause. The ovaries then stop producing oestrogen altogether and progesterone levels drop, causing the ovaries to stop releasing eggs, your periods to stop and your natural fertility to end.

Menopause can also be induced by medical treatment or surgery. For example, chemotherapy drugs can stop the ovaries from working properly, temporarily or permanently. If you have your ovaries removed, such as during a full hysterectomy, menopause will occur immediately after your operation as the organs responsible for producing oestrogen are now gone.

Factors that can affect the age of menopause

Although most women enter menopause in their 40s, there are a range of factors that can affect the age of menopause including:

The age you were when you had your first menstrual period
Using oral contraceptives
The number of pregnancies you’ve had
Your birthweight
Body Mass Index (BMI)
Smoking
Alcohol consumption
Episodes of significant illness during child or adulthood.

Do all women go through the menopause?

Yes, menopause is a natural part of ageing and will happen to all women who have periods. The exception is women who had their ovaries removed before puberty.

How do I know if I’m in menopause?

You’ll know you are in menopause if you have gone 12 consecutive months without a menstrual period and you are not taking any hormonal medications. However, a range of other physical and mental symptoms can indicate that you have reached perimenopause.

In the UK, a doctor won’t usually carry out tests for menopause if you’re over the age of 45 and showing typical symptoms. However, if under the age of 45, blood tests may be recommended for diagnosing menopause and ruling out any other causes of your symptoms.They are not always reliable at diagnosing perimenopause and the clinical picture must be assessed.

What happens during menopause?

During perimenopause and menopause, your ability to naturally conceive children is ending. This is due to the loss of follicular function and a decline in oestrogen and progesterone.

The menopausal transition affects everyone differently. Some women experience relatively few symptoms while others will be affected more significantly.

Hormone fluctuations during perimenopause can lead to irregular periods or changes in the pattern of periods and this is usually one of the first signs of this stage. The length of time between your periods may be shorter or longer, your flow may be lighter or heavier, and you may have some months where you skip a period.

During the menopausal transition, your body also begins to use energy differently and fat cells change. This may mean you find yourself gaining weight more easily or struggling to manage your weight.

Symptoms of menopause

There are a range of other common perimenopause and menopause symptoms which can vary in intensity and duration. They may come and go or overlap and come together. These include:

Hot flushes : When you have a sudden hot or cold sensation in your face, neck and chest which can leave you feeling dizzy. You may also feel generally more temperature sensitive.
Night sweats: Night sweats in menopause cause you to feel hot all over your face and body during the night. You may wake up to find your body, clothes and bedsheets covered in sweat.
Mood swings: Hormonal changes during menopause can lead to irritability, anger, stress, anxiety or depression.
Sleep disturbances: Aside from night sweats, you may also experience insomnia, restless legs and increased snoring.
Palpitations: A sensation that your heart is fluttering or beating irregularly.
Headaches and migraines: Hormone-related headaches and migraines can become more severe or first appear during perimenopause and menopause.
Vaginal dryness: You may also have discomfort during sex, pain itching or irritation. Underwear may rub or feel irritating to the vulval tissues.
Urinary symptoms: Urinating more frequently, including in the night and with more urgency. Recurrent urinary tract infections (UTIs) are also more common.
Changes in libido: Some women experience a reduced sex drive or reduced feelings of desire.
Joint and muscle aches: Hormone levels can impact your bones, muscles and soft tissues, causing pain or discomfort.
Fatigue: Feeling unusually tired during the day or having a lack of energy.
Skin changes: Your skin may become more dry, dull, thin and prone to bruising. You may find it more sensitive or develop hormonal breakouts.

How long do menopause symptoms last?

The symptoms of menopause impact everyone differently. Some symptoms can last for a few months, while others may persist for several years. Some symptoms, such as vaginal dryness, libido changes, muscle pain, and urinary incontinence may continue even after your period stops.

Managing menopausal symptoms

Menopause symptoms can be difficult to deal with and it’s not uncommon for them to affect your work, your social life and your mental health. However, there are many ways to help you manage menopause symptoms including lifestyle changes, medical interventions and alternative therapies.

Lifestyle changes

Looking after yourself during perimenopause and menopause can make symptoms more manageable and improve your outlook too.

Get plenty of rest and aim to keep to regular sleep routines.
Adopt a menopause diet that consists of fruit and vegetables, whole grains, fibre, and protein and limits caffeine and alcohol.
Eat calcium-rich and vitamin D-rich foods including milk, yoghurt, kale, oily fish and eggs for bone health and to reduce the likelihood of osteoporosis.
Incorporate exercise into your normal routine. Weight-bearing activities, such as walking, running and dancing are beneficial.
Practice relaxation and stress reduction techniques such as breathing exercises, yoga, and meditation.

Hormone replacement therapy

Hormone Replacement Therapy (HRT) is the best treatment for managing menopause symptoms and in particular, body-identical hormones. These are very similar to those naturally occurring in the body, meaning they are very safe to use and have the lowest risk of side effects. They are designed to replace the hormones your body no longer produces to help flatten out fluctuating hormones and increase those that have declined.

Vaginal moisturisers and lubricants

For vaginal dryness, moisturisers and lubricants can help you feel more comfortable and make sex less painful. Topical vaginal oestrogen is often used to treat these symptoms.

Alternative therapies

Alternative therapies such as massage, acupuncture and aromatherapy can help you to relax. They can also contribute to better quality sleep and alleviate the aches and pains associated with menopause.

Herbal medicines

Supplements will not replace your hormones but some women report that Red Clover, Black Cohosh, St John’s Wort and Evening Primrose Oil may potentially help manage menopause symptoms. However, it’s recommended that if you wish to explore these options, you speak to a specialist first.

Talking therapies

Perimenopause and menopause can take a toll on your mental health, but you don’t have to deal with the situation alone. Even speaking to a friend or family member can help you feel better.

Counselling or Cognitive Behavioural Therapy (CBT) allows you to talk about how you're feeling in a safe space and find tools that help you navigate the emotional aspects of this stage of your life. Evidence supports using CBT and a type of CBT for insomnia to improve symptoms and sleep, both as an add on to HRT or alone.

When it comes to knowing when to speak to a doctor and which doctor to consult for menopause, the answer is down to you. If you’re struggling to manage your symptoms, it’s a good idea to speak to a professional. A menopause specialist will understand what you’re going through and will be able to provide personalised advice and treatment based on your unique experience and concerns about menopause.

At Menopause Care, we have a team of menopause doctors with a wealth of experience in supporting women at this transitional life stage. To speak to one of them either online or in person, you can book a consultation.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

References