Menopause is a normal part of getting older and happens when your body stops preparing for a baby each month. You stop menstruating (having periods) due to changes in hormones (oestrogen and progesterone) made by your ovaries. You are said to have reached menopause when you haven't had a period, or spotting, for 12 months. The years leading up to menopause are called perimenopause and during this time you may notice changes in your periods – how often you have them, how long they last and how heavy they are.
The reduction and fluctuation in hormones can cause other symptoms such as:
Not everyone experiences these, but you may find they have quite an impact on your quality of life. If you do, talk to your healthcare provider about getting some help to manage your perimenopause.
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There are 3 types of menopause based on the age when it happens and another type based on the cause:
Natural menopause happens between the ages of 45 and 55. Symptoms of perimenopause can begin in the early 40s.
Early menopause happens between the ages of 40 and 45.
Premature menopause happens before 40 years of age. It's also called premature ovarian insufficiency. Usually, no cause is found for this. Premature menopause can run in families. Other less common causes include chromosomal problems, such as Turner syndrome, and autoimmune disease when your body's immune system attacks the developing eggs.
Artificial menopause can be caused by surgery on your ovaries or having them removed. It can also be caused by chemotherapy, or radiotherapy to your pelvis.
Menopause can be divided into 2 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. Be aware that you can still get pregnant during this time so it's important to use reliable contraception. Eventually, your periods will stop altogether. Perimenopause is when you may start to experience anxiety, insomnia, brain fog and other symptoms. Because you're still having periods you may not realise it's due to hormonal fluctuations and sometimes healthcare providers don't either!
Postmenopause – you're considered to be ‘postmenopausal’ 1 year after your last menstrual period.
When you go through menopause, your periods will change and eventually stop. You may have some or all of the symptoms mentioned in the section above.
Menopause is diagnosed based on your symptoms and changes in menstruation, along with being over 40 years of age. You don't need to have a hormone test to 'prove' you are menopausal unless you are under 40.
Hormone levels vary from person to person and can even vary from day to day for the same person. This is why it's rarely helpful to get a hormone level blood test during perimenopause. If you're taking contraceptives they can also affect your results.
Menopause can make you feel like you are losing control of your mind and your body. Understanding what symptoms to expect may help.
You may find a change in your periods is all you notice as you 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 fatigued, irritable, depressed, tearful or angry. This can be from hormonal changes, because you're not sleeping well or because you're adjusting to change.
Skin changes – your skin may look more tired and be less firm, and the hair on your head, armpits and legs may get thinner. Your breasts may become more droopy.
Joint pains.
Bones – you won't feel it, but your bones will start to reduce in density – this happens very slowly but over the next 30 or 40 years can cause problems such as osteoporosis. Menopausal hormone therapy (MHT) is recommended if:
you have a family history of hip or wrist fractures
you have premature menopause, or
you're taking long term steroids.
Note: if you have very heavy periods, or bleeding between your periods or after intercourse, you must contact your healthcare provider.
The average duration of perimenopausal and menopausal symptoms is 5 years although you may have symptoms for longer.
Menopause is a normal part of life. Allow yourself time to adjust to what you're experiencing and try to get support from others, especially from your partner and whānau. If they understand what you're going through it will help them know how they can best support you. Watch the videos below together. Seek help if you think MHT could help you.
Don't forget about contraception!
If you're under 50, the general advice is you still need contraception for 2 years after your final menstrual period (FMP).
If you're 50 or over when you reach menopause, you need to continue contraception for at least one year after your final period.
Video: Menopause what are the symptoms?
Professor Susan Davis talks about menopause signs.
If you have ongoing symptoms which are not relieved by self-care measures, see your healthcare provider for advice. They may recommend you have some tests if there is concern that physical changes are a sign of illness, such as thyroid disorder, or if menopause occurs at an early age.
You may be offered menopause hormonal therapy (MHT, used to be called HRT) to reduce the menopausal symptoms. This is the best treatment for menopausal symptoms and is considered safe for most women. Read more about menopausal hormone therapy (MHT). If you would prefer not to take MHT, or it's not advised for you, there are other prescribed medicines that may help relieve some symptoms. Talk to your healthcare provider about these.
For vaginal dryness, you can be offered 'topical' oestrogen which works well and comes as pessaries or cream to apply directly to your vulva and vagina. This is not absorbed so is safe if you've had breast cancer. It will also reduce your risk of bladder problems.
If you are at risk of thinning bones (osteoporosis) MHT is an excellent treatment. You may be offered bisphosphonates.
Menopause is a good time to have a general health check, including blood pressure, a cervical screening test, 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 healthcare provider
Menopause affects people in different ways and symptoms vary hugely in severity. You may have very little discomfort, or you may find that your symptoms interfere with your normal daily activities.
While some people have a sense of loss when 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'.
As you move further past menopause, the vulva, vagina and urethra (genital area or 'perineum' – the area between your legs) becomes more uncomfortable and fragile due to loss of elasticity and lubrication. This is called genitourinary syndrome of the menopause or GSM. This increases your risk of urinary infections (UTIs) as well as pain and difficulty with vaginal penetration, and difficulty 'holding on' to urine. Oestrogen preparations that are applied to the area are recommended as you get older. They can help reduce your risk of UTIs as well as helping with vaginal symptoms. They are very safe, even if you've had breast cancer.
If you're concerned that your quality of life is being affected by your menopause symptoms, try the ideas listed in the self-care section below or see your healthcare provider for further advice.
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.
Keep your weight healthy and eat a diet low in sugar, salt and saturated fats but high in calcium, fibre and healthy fats. This 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.
You may find some alternative therapies such as acupuncture or hypnosis help. Phytoestrogens (eg, soy products) may be helpful for hot flushes during perimenopause but there's not enough evidence over the longer term. Phytoestrogens are not safe if you have breast cancer. There's no alternative therapy that's as good as MHT.
If you've tried these self-care options you're still not getting the relief you need, talk to your healthcare provider for further advice and treatment options.
In the long term, you can lower your chance of getting osteoporosis and of developing heart disease by having a healthy lifestyle. This includes:
a good diet
regular exercise
staying in a healthy weight range
not smoking
consuming little or no alcohol.
If you're at particular risk for developing osteoporosis or heart disease, your healthcare provider may recommend additional measures such as menopausal hormone therapy (MHT). Be well informed – it will help you understand why you are feeling the way you do and to decide whether or not you need treatment.
Being stressed, overtired and anxious.
Too much coffee, tea or alcohol.
Smoking.
Hot drinks and spicy foods can make the hot flushes worse.
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.
