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Menopause

The menopause is the time when a woman’s periods permanently stop. The age this happens varies. However, it’s usually between the ages of 40 and 60. The average age for women to reach the menopause in the UK is 51.

The menopause happens when your ovaries stop producing eggs. Your ovaries make the hormone oestrogen, so when they stop functioning there is a drop in the levels of oestrogen in your blood. This fall in hormone level disrupts your menstrual cycle and causes the symptoms associated with menopause.

The menopause usually happens gradually. For a few years before the menopause, your periods may become irregular, happening more or less often than they used to. You may also have slightly heavier periods. This stage is called the perimenopause and can last for about four years.

When it has been a year since your last period, you’re said to be through the menopause, or post-menopausal. You can still become pregnant while going through the menopause, so it’s important to keep using contraception for one year after your last period if you're over 50 and for two years if you're under 50.

When the menopause happens before the age of 40, it's considered premature (early) menopause. If you have an early menopause, there is a chance that you may still ovulate intermittently, so your GP may recommend that you continue to use contraception.

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Details

  • Symptoms Symptoms of the menopause

    The menopause usually happens gradually. Your periods may become irregular and infrequent before they stop completely. You may also have other symptoms. Some of these can begin up to six years before your final menstrual period and continue for several years after your last period. Symptoms of the menopause can include:

    • hot flushes and night sweats
    • feeling your heart racing (palpitations)
    • changes to your vagina, such as dryness, discomfort, itching and pain during sex
    • difficulty sleeping (insomnia)
    • loss of interest in sex (libido)
    • changes in your mood, such as feeling tired, irritable, depressed or anxious
    • having difficulty concentrating or poor memory
    • urinary problems – such as recurrent urinary tract infections, loss of bladder control (urinary incontinence)

    Your symptoms may be worse if the menopause happens suddenly (for example if you have your ovaries removed or after chemotherapy).

  • Diagnosis Diagnosis of the menopause

    Your GP will ask about your symptoms and your medical history. Your GP will often be able to make a diagnosis based on this information.

    If you’re under 45, your GP may ask you to have a blood test. This is to measure the level of follicle stimulating hormone (FSH) and oestrogen in your blood. The test can help confirm if your symptoms are caused by the menopause.

  • Treatment Treatment of the menopause

    Self-help

    Take practical steps to deal with hot flushes by keeping cool and avoiding possible triggers such as spicy foods, caffeine, smoking or stress.

    Regular exercise may help improve some symptoms of the menopause, including hot flushes and night sweats, difficulty sleeping and mood changes. Pelvic floor exercises can help strengthen your pelvic muscles and improve your bladder control. Physical activity that stresses the bones, such as running and walking, can help strengthen your bones and reduce your risk of osteoporosis. Physical activity can also help protect against heart disease and stroke. You should aim to do 30 minutes of moderate exercise five days a week.

    A healthy diet can help protect your body against some of the long-term effects of the menopause. It’s important to balance your diet with foods from each food group. Because the menopause causes you to lose calcium in your bones, the foods you eat can help protect you from osteoporosis. Try to include two to three portions of calcium-rich foods in your diet daily, such as 200ml of semi-skimmed milk, or a small yoghurt. Your GP may advise you take a calcium supplement. It's also important that you stay a healthy weight for your height.

    Vitamin D is important for your bone health. Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

    Always read the patient information leaflet that comes with your supplements. Talk to your GP before taking vitamin D supplements if you are taking diuretics (water tablets) or have a history of kidney stones or kidney failure.

    Hormone replacement therapy (HRT)

    Hormone replacement therapy (HRT) can be prescribed to help some of the symptoms of the menopause, such as night sweats and hot flushes, or the symptoms of vaginal dryness. HRT can help reduce your risk of osteoporosis but only after four or five years of use.

    HRT helps to restore the level of the circulating hormone oestrogen. It usually includes a combination of oestrogen and progesterone, rather than just oestrogen. This is because taking oestrogen on its own can thicken the lining of your womb and increase your risk of endometrial cancer. It’s safe to take oestrogen-only HRT if you have had an operation to remove your womb (a hysterectomy).

    HRT comes in tablets, patches, skin gels and implants. Vaginal creams, pessaries or a vaginal ring may be helpful for vaginal problems such as dryness. HRT is generally recommended to be taken at the lowest effective dose for a short duration and reviewed at least yearly. Symptoms can come back in some women for a short time after stopping HRT.

    HRT can have side-effects, including vaginal bleeding, tender breasts, water retention, changes in your mood, feeling sick and headaches. Changing the type and dose of HRT may reduce these.

    Taking HRT for a long time may slightly increase your risk of having a stroke, developing breast or ovarian cancer and blood clots (deep vein thrombosis). Contrary to popular belief, HRT has shown to have no effect on body weight.

    Talk to your GP to help you understand the risks and benefits of taking HRT.

    Other medicines

    Depending on your symptoms, your GP may suggest other treatment options. For example, to treat hot flushes and night sweats, your GP may suggest the following.

    • Selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine (noradrenaline)-reuptake inhibitors (SNRIs). These are antidepressant medicines and can also help with mood changes. Side-effects include dry mouth, loss of appetite, feeling sick, constipation and drowsiness.
    • Gabapentin. This is used to treat epilepsy and migraine. It can be used short-term to treat hot flushes and night sweats. Side-effects include dizziness and drowsiness.
    • Clonidine. If you’re prescribed this treatment, you will need to have your blood pressure closely monitored as it can cause a drop in blood pressure (hypotension). Side-effects include dry mouth and dizziness and depression.

    If you lose your libido and have vaginal dryness, vaginal lubricants may help. Or your GP may suggest you take a medicine that contains the hormone testosterone.

    Complementary therapies

    There is little scientific evidence for complementary therapies improving symptoms of the menopause.

    For example, there isn't enough evidence for doctors to recommend taking phytoestrogens, which are naturally occurring oestrogen-like compounds found in plants. Dietary sources include roasted soy beans, soy milk, tofu and miso. Some studies have found that one type, called isoflavone, may reduce hot flushes, but others have found no effect or no evidence that they don’t increase your risks or side-effects in the same way oestrogen medicines do.

    There is little evidence to show that herbal remedies such as black cohosh, red clover, angelica and evening primrose oil, work. Herbal remedies are medicines and can have side-effects and interact with other medicines. For example, there have been reports of black cohosh causing damage to your liver. Ask your GP or pharmacist for advice if you plan to try any herbal treatments.

    Other complementary therapies that promote relaxation, exercise, and wellbeing (such as aromatherapy, acupuncture, yoga and reflexology) may help reduce hot flushes in some women, but there is limited scientific evidence.

    If you feel depressed or anxious, your GP may recommend counselling or cognitive behavioural therapy. Support groups can help deal with the emotional aspects of menopause.

    If you’re considering a complementary therapy, ask your GP or pharmacist for advice.

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  • Causes Causes of menopause

    The menopause is a natural part of ageing. All women go through it.

    However, there are some things that can cause the menopause to happen early, such as:

    • surgery to remove your ovaries (oophorectomy) which may be carried out during surgery to remove your womb (hysterectomy)
    • chemotherapy
    • radiotherapy to the pelvic area
    • autoimmune disease
    • medical conditions, such as Turner syndrome
  • Complications Complications of menopause

    The drop in oestrogen levels during and after the menopause causes your bones to lose calcium. This increases your risk of osteoporosis (thinning of the bones).

    Your risk of having cardiovascular disease and urinary incontinence also increases.

  • Living with the menopause Living with the menopause

    The menopause affects every woman differently. You may not have any symptoms at all or they may be severe. Discuss your personal circumstances with your GP to ensure that you get the treatment and support that you need.

  • FAQs FAQs

    How long do I take HRT for?

    Answer

    Your GP will recommend that you use HRT at the lowest dose for the shortest time as possible. This varies between women because your symptoms may be different from another woman.

    Explanation

    The symptoms of the menopause differ between women. How long they last and the severity of symptoms also varies widely. Your GP will recommend that you use HRT for as short a time and at as low a dose as possible. This is because it's linked to a small increase in the risk of breast and ovarian cancers, stroke and blood clots.

    Visit your GP for a check up three months after you start taking HRT. He or she can check if the treatment is effective for you. After this, your GP may want to see you every six to 12 months to discuss your symptoms and decide if you need to continue treatment. While you are on HRT, you will need a yearly check-up to assess your risk of complications. The check-up may include a breast, and pelvic examination. You will also be offered regular mammograms. If you decide to stop taking HRT, discuss the best way to do this with your GP. You may wish to stop immediately or more gradually.

    If you stop taking HRT abruptly, your symptoms may come back for a short time but they should then go away. If your symptoms persist for several months after stopping HRT or if they are severe, you can start taking HRT again or take a lower dose. There isn’t any limit on how long you can take HRT, but it’s important to consider the risks of the treatment as well as the benefits.

    I'm 35 and getting hot flushes. Does this mean I am going through an early menopause?

    Answer

    You could be but discuss this with your GP. There are other conditions that cause hot flushes and your GP will arrange for you to have appropriate tests.

    Explanation

    If you are having hot flushes and night sweats, talk to your GP.

    It’s possible you may not be going through the menopause and your symptoms are being caused by a different condition. Certain endocrine disorders such as an overactive thyroid, tuberculosis (TB), anxiety disorders, medicines and drinking too much alcohol can all cause hot flushes.

    Your GP will ask you about your symptoms, and may take a blood test to check the level of FSH and oestrogen in your blood. These tests can help confirm if you are going through a premature (early) menopause.

    If your GP thinks you’re going through an early menopause, you may be referred to a gynaecologist – a doctor who specialises in women’s reproductive health for further tests. You may be offered HRT treatments that will help ease your hot flushes. Your GP or gynaecologist will advise you about your specific treatment.

    Your ovaries may release eggs from time to time even if you are going through an early menopause. If you don’t want to get pregnant your doctor may advise you to continue using contraception.

    I’m thinking about taking hormone replacement therapy (HRT). Does it increase my risk of cancer?

    Answer

    Taking HRT can slightly increase your risk of ovarian, womb and breast cancer, but the risk varies depending on the type of HRT.

    Explanation

    There are two basic types of HRT: oestrogen-only and combined, which contains oestrogen and another hormone called progesterone.

    There is a small increase in your risk of ovarian cancer if you take either form of HRT. However, this disappears a few years after you stop taking it.

    Oestrogen-only HRT can increase your risk of womb (endometrial) cancer but is only prescribed if you have had a hysterectomy (your womb has been removed). Taking a progesterone containing HRT reverses this risk for women who haven’t had a hysterectomy.

    Your risk of breast cancer has been shown to be slightly higher when taking either type of HRT over several years. Combined HRT is thought to increase your risk more than oestrogen-only HRT. The risk is higher the longer you take HRT. Your risk decreases within five years of stopping HRT to what it would have been without HRT.

    If you have had breast cancer, you won't usually be prescribed HRT, but this does depend on the type of breast cancer you have had.

    It’s your decision whether to take HRT and it will depend on how severe your symptoms are. Discuss your options and your concerns about cancer risk with your GP. He or she will explain how this risk applies to you.

  • Resources Resources

    Further information

    Sources

    • Menopause. Medscape. www.emedicine.medscape.com, published 23 May 2012
    • Menopause. BMJ Best Practice. www.bestpractice.bmj.com, published 18 October 2012
    • Menopause. Map of Medicine. www.mapofmedicine.com, published 18 January 2013
    • Menopause – Food Factsheet. British Dietetic Association. www.bda.uk.com, published December 2012
    • Menopause: lifestyle and therapeutic approaches. RCN guidance for nurses, midwives and health visitors. Royal College of Nursing, 2010. www.rcn.org.uk,
    • Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No: CD000333. doi:10.1002/14651858.CD000333.pub2.
    • Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD004143. doi:10.1002/14651858.CD004143.pub4.
    • Menopause and osteoporosis. Better Health Channel. www.betterhealth.vic.gov.au, published April 2013
    • Menopause – hormone replacement therapy. Better Health Channel. www.betterhealth.vic.gov.au, published September 2012
  • Related information Related information

  • Author information Author information

    Reviewed by Natalie Heaton, Bupa Health Information Team, 09 September 2013.

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