Menopause

During menopause your body stops preparing for a baby every month – 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 (sex drive), sleep problems and vaginal dryness. 

Image credit: Canva

There are three types of menopause:

• 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 to be ‘postmenopausal’ 1 year after her 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 below. 

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.

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. 

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.
• Sleep problems.
• 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 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 (lose 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.

The average duration of menopausal symptoms is five years although some women will have symptoms for longer.

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 you are less than 50 years, the general advice is you still need contraception for two years after your final menstrual period (FMP).
• If you are 50 years or older when you reach menopause, you need to continue to use contraception for at least one year after your final period.

Video: Menopause what are the symptoms?

Professor Susan Davis explains how the onset of menopause may affect one's health. 

(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

Video: Menopause – how will it affect my health?

Professor Susan Davis explains how the onset of menopause may affect one's health. 

(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

Video: Menopause – what is menopausal hormone therapy (HRT)?

Professor Susan Davis discusses the basics of menopausal hormone therapy (HRT). 


(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

Video: Menopause – is menopausal hormone therapy (HRT) safe?

Professor Rod Baber discusses the safety of menopausal hormone therapy (HRT). 


(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

Video: Menopause – complementary therapies

Dr Anna Fenton discusses complementary treatment therapies for menopausal symptoms.

(International Menopause Society, 2023)

Video also available in Vietnamese(external link) and Cantonese(external link)

Video: Menopause – non-hormonal treatment options

Dr Anna Fenton discusses a variety of non-hormonal treatment options for menopausal symptoms. 


(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

Video: Menopause – will it affect my sex life?

Professor Susan Davis discusses how the onset of menopause may affect your sex life, as well as various treatment options. This video may take a few moments to load.


(International Menopause Society, 2023)

Video also available in Mandarin(external link), Vietnamese(external link) and Cantonese(external link)

If you have ongoing symptoms which are not relieved by self-care measures, see your doctor for advice. 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.

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. Read more about menopausal hormone therapy (MHT).

For vaginal dryness, you can be offered topical oestrogen which works well and comes as pessaries or cream to apply directly to your vagina. 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 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 doctor.

Read more about menopause treatment and management.(external link)

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 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'.

If you're concerned that your quality of life is being affected by your menopause symptoms, try the measures 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. 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.

Ways to ease symptoms of menopause:

• Relaxation and stress-relief techniques, eg, meditation and mindfulness.
• Using a lubricant to help with vaginal dryness, or your doctor may prescribe an oestrogen-based vaginal cream or pessary.
• Exercising regularly and keeping fit. Weight-bearing exercises (e.g. walking) are good for your bones. Doing pelvic floor exercises can help improve any incontinence.
• Keeping your weight down and eating a diet low in sugar, salt and saturated fats but high in calcium, fibre and healthy fats 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.
• Stopping smoking.
• Getting more sleep.
• Some women may find some alternative therapies such as acupuncture, massage, homoeopathy or herbal remedies help. (It's 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.

In the long term, you can lower your chance of getting osteoporosis and of developing heart disease by having a healthy lifestyle:

• good diet
• regular exercise
• staying in a healthy weight range
• not smoking
• consuming alcohol only in moderation.

If you are at particular risk for developing these conditions, your doctor may recommend additional measures. 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.

Clinical resources

Menopausal hormone therapy – where are we now?(external link) BPAC, NZ, 2019
Diagnosing and managing primary ovarian insufficiency(external link) BPAC, NZ, 2019
The Australasian Menopause Society(external link) provides a range of educational material and resources on midlife and menopause for the benefit of health professionals.
Information for health professionals(external link) including Cochrane reviews, education, information sheets, GP and HP resources - The Australasian Menopause Society, 2013
A useful toolkit to guide clinicians with managing menopausal symptoms is now available:
A practitioner's handbook for the management of the menopause(external link) Monash University, Australia, 2014.

Continuing professional development

Webinar: Menopause – getting it right for your patients(external link) Professor Bev Lawton, Founder/Director of Te Tatai Hauora o Hine

This presentation covers:

• Menopause symptoms and treatment options.
• The benefits and risks of using MHT.
• Treatment disparities for Maori and Pacific women.
• How to have a conversation about menopause.
• GU and vaginal health.

Video: He Ako Hiringa - Menopause Webinar

You can watch the video, answer questions and claim hours with a certificate. 

(My Health Hub, NZ, 2023)

Podcast: Menopause – Anna Fenton(external link) Goodfellow Podcast, NZ, 2019

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.

Webinars

Premature ovarian insufficiency – Dr Megan Ogilvie (external link)(PHARMAC seminars, NZ, 2019) 
Menopause and menopausal hormone therapy – (parts 1 & 2) Drs Megan Ogilvie and Stella Milsom (external link)(PHARMAC seminars, NZ, 2019) 
Managing menopause – myths and misconceptions (external link)(Goodfellow Unit Webinar, NZ, 2018)