What is Menopause?

Menopause is a natural part of life for almost every woman between 45 and 55 in the world. However, menopause is hardly discussed in society, with many women having to persevere through symptoms with little support. Whilst the average age for menopause in the UK is 51, one in every hundred women start the menopause before the age of 40.

What is the menopause?

Menopause refers to the time in a woman’s life when her menstrual cycle ceases. Menopause is a natural occurrence, and the term usually describes when a woman has not had her period for more than a year.

Menopause refers to the end of monthly menstrual cycles, but also describes any of the symptoms that a woman experiences in the lead-up to having no periods. The word menopause has Greek origins, with ‘menos’ meaning ‘month’, and pause meaning ‘cease’. The term was first coined in 1821, although Aristotle is known to have referred to menopause, describing the cessation of menstrual cycles around the age of 40.

When a woman is born, she has all the eggs she will ever have, which are kept in the ovaries. Each month, due to the production of oestrogen and progesterone in the ovaries, the lining of the uterus thickens and women ovulate, releasing an egg which is ready to be fertilised. If the egg is not fertilised, the lining of the uterus sheds, which is what we know as a period.

At a certain point in a woman’s life, the levels of oestrogen and progesterone change, which stops the ovaries from releasing eggs, thus ceasing menstruation. This means that once a woman reaches menopause, she is no longer fertile and cannot conceive children. However, In Vitro Fertilisation (IVF) has given menopausal women the opportunity to have children. You can read more about IVF by visiting our knowledge base.

When does the menopause happen?

A woman usually has her period monthly, for a duration that lasts anywhere between 12 and 45–50 years old, although the ages at which the menstrual cycle and menopause begin are different in each case. Menopause is a normal, expected part of the ageing process for women, and for the majority of women, will begin in their late 40s and early 50s. Menopause for women in the UK usually occurs between 45 and 55 years old, with the average age being 51.

Some women experience menopause in their early 40s, and a small number of women may have an even earlier menopause, before the age of 40. This is called premature menopause, premature ovarian insufficiency (POI). Currently, this affects 1% of women under 40 and 0.1% of women under the age of 30 in the UK.

The name was changed from Premature Ovarian Failure to Premature Ovarian Insufficiency as a woman may still have menstrual bleeding, and may even be able to become pregnant, as ovulation does not necessarily cease entirely.

Factors that might cause menopause to start early can be linked to instances of family members who have also started menopause early, but is usually due to environmental factors such as:

• Surgery where the ovaries have been removed.
• Medical conditions that affect chromosomes.
• HIV/AIDS.
• Autoimmune diseases.
• Smoking.
• Hysterectomy (removal of the uterus entirely).
• Infections.

What are the signs and symptoms of the menopause?

The symptoms of menopause can onset months or years before the menstrual cycle actually stops.

Common signs of menopause include:

• Hot flushes – These very sudden sensations of warmth are a common symptom of menopause, and are usually experienced in the upper body.
• Night sweats – This refers to intense sweating during the night.
• Vaginal dryness.
• Low libido.
• Breast sensitivity/soreness.
• Bloating.
• Irregular periods/lighter periods.
• Headaches/migraines.
• Fatigue.
• Fluctuation in mood.
• Depression (read more about depression by visiting our knowledge base).
• Anxiety (read more about anxiety by visiting our knowledge base).
• Joint pain.
• Thinning hair.
• Poor sleep.
• Change in sense of taste.
• Itchiness.
• Changes in the digestive system.
• Body aches.
• Weight gain.
• Change in body odour.
• Poor memory and concentration.
• Dizziness.
• Incontinence.
• Brittle nails.
• Heart palpitations.
• Bleeding gums.
• Burning mouth.
• Osteoporosis.
• Dry skin.

Someone who is of menopausal age may not experience many of these symptoms, and others may experience each one.

What are the stages of the menopause?

There are three main stages of menopause which every woman goes through at varying lengths to others.

The three stages are:

Perimenopause

Perimenopause refers to the phase before menopause, where the ovaries begin to fluctuate the levels of oestrogen, progesterone and testosterone being produced. During perimenopause, symptoms are usually intense as the body transitions into menopause, as hormonal levels are inconsistent.

The first symptoms, such as irregular periods, can be noticed even in the late 30s, but usually perimenopause begins in the 40s. Due to the fluctuation of hormone levels, women may experience longer or shorter menstrual cycles, or cycles without ovulation. It is common for hot flushes, mood changes, vaginal dryness and sexual drive to change during perimenopause. Once a woman has not had a period for 12 months, the perimenopause is finished.

Menopause

Once a woman has reached menopause, her periods have naturally stopped. Her ovaries do not release eggs, and oestrogen is very low. The time between the onset of perimenopause through to menopause can last between 1 and 3 years.

During menopause, hot flushes are the most commonly reported symptom. Women may start to notice that their heart rate is faster, their hair is thinning, and they have less control over their bladder.

Postmenopause

After a period has not been seen for 12 months, a woman is considered to be postmenopausal. The symptoms that are experienced during perimenopause and menopause start to settle down.

It may be possible that the permanent reduction of oestrogen in women can lead to skeletal complications such as osteoporosis and heart disease. It may be necessary to use hormone replacement therapy to artificially increase oestrogen levels.

How long does the menopause last?

As mentioned, the transitional period can begin between 45 and 55 years old, and even earlier in a small number of women. Menopause in its entirety can last up to 14 years, as symptoms usually start a long time before the cessation of the menstrual cycle.

However, for many women, menopause will last somewhere between 2 and 7 years. There is no predictor for how long menopause will last, though some women look to the women in their family as an indicator of the age of menopausal onset and the duration.

What lifestyle changes need to be made to help with the menopause?

Menopause can be extremely uncomfortable for some women, and cause a lot of disruption to daily life and self-perception. Some women report not feeling entirely themselves. There are a number of things a woman can do, which involves changes to day-to-day life, that can help to ease the symptoms of menopause.

Keeping cool

There are many ways that a woman might adapt to keep cool, such as wearing layers that can be taken off, or wearing clothes made from breathable materials. Some women invest in a hand-held fan and sleep with an ice pack under their pillow at night.

Exercise

Weight gain is a common symptom of menopause, and regular exercise can help to combat weight gain, and increase mood. It can also help to improve memory and heart function. Experts recommend cardiovascular exercises, such as walking and running. Yoga may also be useful for relaxation and aiding sleep disturbances.

Avoiding certain foods

Spicy food, alcohol and fatty foods (other than fish) have all been associated with making symptoms of menopause worse. Spicy foods can increase the intensity of hot flushes, and alcohol can interfere with sleep and also increase hot flushes. Dietitians recommend following a Mediterranean diet, rich in fruit and vegetables, fatty fish, protein and lots of water.

To help reduce the intensity of hot flushes, experts recommend eating naturally cooling foods such as apples, broccoli, bananas, soy, eggs, green tea and spinach. Foods with phytoestrogens have been shown to help menopausal women decrease the frequency of hot flushes and improve sleep and bone health.

Vitamins

Vitamins can help with some of the side effects of menopause, though the evidence for some supplements is medically unfounded.

It is recommended to use the following vitamin supplements during menopause:

• Calcium for treating bone loss.
• Vitamin D for bone health.
• Wild Yam for natural oestrogen.
• St John’s Wort for improving mood.

Can menopause be treated?

Every woman who has not had her ovaries removed goes through menopause; it is a natural part of life. However, not every woman experiences it in the same way. Some women do not suffer from symptoms intensely, whereas others do, and may need treatments to help manage some of the symptoms.

Aside from changing diet and creating an exercise habit, your GP can offer several therapies to help with menopausal symptoms.

Hormone Replacement Therapy (HRT)

HRT is a treatment that replaces hormones in the body that are low. There are different types of hormone replacement therapy available depending on which hormone is needed.

The oestrogen pill is the most used form of treatment for menopause, which is usually taken once a day, with food. Oestrogen can also be absorbed via a patch that is worn over the abdomen and changed every few days. This is only suggested to help with osteoporosis, as it has a lower dosage than the pill, thus it doesn’t help with other menopausal symptoms.

Oestrogen can also be absorbed through a gel that is applied either on the arms, shoulder, wrist or legs. A specialist may prescribe vaginal oestrogen, which comes in the form of a cream, tablets or vaginal ring.

This will be prescribed specifically for those who have vaginal dryness and irritation, and painful sex. A combined method of hormone therapy which involves oestrogen and progesterone may also be used to help reduce symptoms of menopause.

There are many benefits of hormone replacement therapy, which include:

• Improved quality of sleep.
• Vaginal lubrication.
• Reduced risk of dementia.
• Less painful intercourse.
• Reduced hot flushes and night sweats.
• Reduced risk of heart disease.

However, if hormone replacement therapy isn’t necessary, the following risks should be considered:

• Oestrogen without progestin can increase the risk of endometrial cancer.
• Blood clotting.
• Strokes.
• Breast cancer.

It is important to inform your GP of any natural supplements you are taking, as these can interact with different forms of therapy. If hormone replacement therapy is not an option, there are other treatments available that may help to reduce menopausal symptoms.

Clonidine, a medication that is usually used to regulate blood pressure, is sometimes prescribed for hot flushes, as well as Gabapentin, which is an epilepsy medication.

Cognitive Behavioural Therapy

Your GP may refer you for Cognitive Behavioural Therapy (CBT), which can help with managing low mood, anxiety and physical symptoms. CBT is an evidence-based talking therapy approach, which has been found to be effective in helping to manage hot flushes and night sweats, which are known as vasomotor symptoms.

Additionally, CBT might be useful in providing techniques to assist with the psychological effects of menopause. You can read more about CBT by visiting our knowledge base.

Who can provide support during menopause?

Menopause can be a difficult time for many women, and further challenges can be met in spaces where menopause is not understood, or misunderstood. There are a number of organisations that can offer support and advice during this time, particularly to employers who may be in need of guidance on this matter.

• The Menopause Charity works with menopausal people, professionals and employers to provide support, advice and training. They advocate for awareness around menopause, so that more people can use the right strategies to help to support menopausal people.
• The British Menopause Society helps to educate, inform and guide professionals who work in reproductive health. They offer an education programme, courses and a variety of resources on the management of menopause.
• Menopause Support offers support through virtual consultations for professionals, training days, and support for people with symptoms of menopause.