What is the menopause?

Menopause is the medical term used for the last menstrual period a woman will ever have. However, the term is more often used to describe the years leading up to this time, also called the ‘change of life’ or just ‘the change’. This period is more accurately known as climacteric.

Menopause is a natural process that every woman goes through and every woman’s experience of the menopause is different.

When does the menopause happen?

The menopause usually happens between the ages of 45 and 55, although it can be earlier or later. The average age in Britain for the menopause to occur is 51 years old. There can sometimes be a family pattern so it may be worth asking your mother, sister or grandmother when it happened to them.

No matter what age you are, having a hysterectomy (in which both ovaries are removed) causes the menopause to happen instantly. If the ovaries are destroyed by chemotherapy or radiotherapy for cancer of the cervix, this can also bring on an immediate menopause. The symptoms of the menopause can be more severe when the menopause takes place prematurely or abruptly.

Cigarette smokers often reach the menopause earlier than non-smokers.

What causes the menopause and why does it happen?

Every baby girl is born with all the eggs in her ovaries that she will ever produce in her lifetime. There is a steady reduction of these eggs over time as some never mature and others are released each month as your period. By the time most women have reached their late 40's the supply of eggs remaining in the ovaries has fallen to low numbers.

The pituitary gland produces a substance called follicle stimulating hormone (F.S.H.), which is the main hormone involved in producing mature eggs but the eggs that now remain are unable to respond as well to F.S.H. as they did when they were younger. As a result the ovaries will start failing to release eggs and there will be a greatly reduced production of the sex hormones. oestrogen and progesterone. However, the hormone F.S.H. which is always present in the body, will increase dramatically as the pituitary gland makes more F.S.H. in an attempt to encourage the ovaries to respond and cause the remaining eggs to mature. At this time your periods will probably become irregular and unpredictable (until they stop altogether).

The hormones oestrogen and progesterone control your monthly cycle and prepare your body for pregnancy every month. When pregnancy does not occur, your body releases an egg and you have a period. It is the reduced levels of these hormones, which produce the symptoms of the menopause. The menopause is simply a period of adjustment to lower hormone levels in your body.

Oestrogen has many functions, it is needed to keep your body ready for a possible pregnancy and controls sexual development of female characteristics such as the breasts, genitals and womb development. When the supply of eggs runs low, oestrogen is no longer required and so the levels drop causing many effects on the body.

What are the symptoms of the menopause?

Around 80% of women will experience some symptoms of the menopause with only around 20% of women not having any symptoms at all, except for the fact that their periods might become irregular. The symptoms of the menopause result from reduced levels of oestrogen and some women might have severe problems that affect their lifestyle. Symptoms of the menopause may include any of the following:

• Periods - most women's periods will become unpredictable for several months and in some cases for a few years before they actually stop. The blood flow may also vary from light one month to heavy the next.
• Hot flushes - the most common symptom of the menopause. Hot flushes are sudden intense waves of heat, sometimes accompanied by redness and sweating. They can occur at any time and some women find that these flushes disrupt their sleep. Hot flushes can last anything from a few seconds up to several minutes and at the start of the menopause can occur as frequently as several times an hour. Hot flushes can be triggered by spicy foods and alcohol. Hot flushes can be uncomfortable, but they are not harmful.
• Vaginal dryness - your vagina may become dryer and much thinner, making sex painful and uncomfortable. The thinning of the vagina walls also puts you at an increased risk of vaginal infections like thrush and cystitis. Remember, if you do notice any unusual discharge or bleeding from your vagina, a visit to your doctor may be needed.
• Feeling emotional and depressed - the menopause can make many women experience headaches, forgetfulness and make them irritable - having unexpected mood swings. Many women go through similar emotions and even though you may not think so, people will understand and make allowances.
• Tiredness - this can often be due to difficulties in sleeping.

It is important to realise that when most women go through the menopause they could also be trying to cope with problems at home. For example, adolescent teenagers, children that are growing up and leaving home, elderly relatives, boredom at work or in personal relationships or they just be finding it difficult coming to terms with their reduced fertility. The menopause does not cause these problems though it can make them seem worse, it is important to try and keep a sense of proportion about what is going on around you. If you are feeling depressed no matter what the reason you should seek your doctors help.

The menopause does not happen overnight and symptoms of the menopause can continue for an average of 4 years. However, the majority of women continue to function well during the menopause. For some women the menopause brings a sense of freedom since the end of fertility means no more birth control and dealing with periods, which may have been heavy or painful.

After a woman has had her last menstrual period she can no longer bear children naturally.

Are there any long term effects?

As oestrogen levels fall, a woman's skin becomes thinner so you may find your skin is more dry and your hair may also become thinner. As mentioned previously the lining of the vagina will become thinner and the womb will also become smaller and the lining thinner. This thinning can also affect the bones and a condition called osteoporosis can develop, approximately 1 in 4 women are at risk. Osteoporosis tends to occur after the menopause when the bones have lost much of the calcium they need to remain strong and firm. For more detailed information on osteoporosis click here.

After the menopause you are also more at risk of heart disease as oestrogen appears to protect the blood vessels, as oestrogen levels fall so does this protection.

How is the menopause diagnosed?

Doctors will usually diagnose the menopause from your symptoms and age alone. Doctors may also check your hormone F.S.H. levels.

If you are experiencing problems or are unsure of your symptoms you should always discuss these with your GP.

We have a test available on this website which looks for raised levels of F.S.H. in urine, for more information or to buy click here.

What treatment is available for the menopause?

Many symptoms of the menopause can be reduced with certain lifestyle changes such as exercise and diet. Exercise, such as walking for 20-30 minutes, 3-4 times a week, will help maintain general fitness, reduce the risk of you developing heart disease and will strengthen the bones.
You should ensue that you eat a well balanced diet containing foods which provide calcium, such as milk products, cheese, sardines, salmon and green leafy vegetables. A good intake of calcium will slow down bone thinning and help to prevent bone fractures. In moderation a small glass or 2 of red wine can reduce the risk of heart disease and cancer.

If you are suffering from vaginal dryness, try using a vaginal lubricant like KY jelly™ available from most pharmacies.

If you are suffering from hot flushes and sweating you should wear layers of clothes that you can peel off when hot. If you experience night sweats ensure you bring a glass of water to bed with you, wear cotton night wear and sleep with the window open.

You should also get out in the sun when you can. Exposure to the sun stimulates the production of vitamin D in the skin, however, ensure you don't get burnt! Vitamin D helps the body absorb calcium from foods and so is essential for healthy bones and teeth.

If you smoke you should now stop, smoking can make menopause symptoms worse and increase the loss of bone density.

The menopause can can be relieved with treatment. Speak to your pharmacist or doctor about taking supplements, (e.g. evening primrose oil and vitamin D) as these can help some women cope with symptoms of the menopause.

Medical treatment which is designed to make up for the loss of oestrogen is available for women who are troubled by symptoms of the menopause. This treatment is called Hormone Replacement Therapy (H.R.T.) and can help ease or prevent some of the symptoms of the menopause. For more information on H.R.T. click here.

Other treatments that are available for the menopause include, antidepressants, tranquillisers and sleeping pills. If you have any symptoms that are causing you concern or discomfort then you should seek your doctors advice.

What about contraception?

Plenty of women stop using contraception before their periods have completely stopped and although fertility decreases with age, it is important to use adequate contraception until the risk of pregnancy no longer exists. An unplanned pregnancy at an older age can be devastating. Generally your periods are considered to be over, one year after your last period if you are a woman over 50 and two years if you are under 50 years of age.

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