Menopause

Published by Bupa's Health Information Team, October 2011.

This factsheet is for women who are going through the menopause, or who would like information about it including the symptoms, causes and treatments.

Menopause is when a woman’s periods permanently stop.

About the menopause

The menopause happens when your ovaries stop producing eggs. The eggs you produce stimulate your ovaries to make the hormone oestrogen, so when you stop producing them, there is a drop in the levels of oestrogen in your blood. This fall in hormone levels disrupts your menstrual cycle and causes the other symptoms that are associated with menopause.

The average age of menopause in the UK is 51, although this can vary.

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 several years. In most women it starts between 45 and 47.

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 45, it's considered premature (early) menopause.

Symptoms of menopause

You might not have any symptoms other than your periods ending. If you do have symptoms, they can include:

• hot flushes and night sweats, sometimes with feeling faint or feeling your heart thumping fast (palpitations)
• headaches
• changes to your vagina, such as dryness, discomfort, itching and pain during sex
• urinary tract infections
• 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 – although this may be caused by life changes rather than the menopause itself
• urinary changes – you may find you have less control over urination (incontinence)

Your symptoms may be worse if the menopause happens suddenly rather than gradually. They will usually last for about two to five years and then go away, although some women have symptoms for longer, even beyond their 70s. Symptoms such as vaginal dryness, discomfort, itching and pain during sex can continue or get worse with age.

Complications of menopause

The reduced levels of hormones during and after the menopause can increase your risk of various health problems in the long term. These include:

• osteoporosis (loss of bone density) – your bones may become brittle and break more easily
• heart disease
• stroke
• weakness in your pelvic floor (muscle that lies across the bottom of your pelvis) and vaginal muscles

Causes of menopause

The menopause is a natural part of ageing, signalling the end of your reproductive years. All women go through it.

Some things can cause the menopause to happen early including:

• surgery to remove your ovaries
• surgery to remove your womb (a hysterectomy)
• some types of radiotherapy
• some types of chemotherapy
• infections, such as mumps or malaria
• medical conditions, such as Turner syndrome or Addison’s disease

Diagnosis of menopause

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will often be able to make a diagnosis based on this information.

Your GP may ask you to have a blood test to measure the level of follicle-stimulating hormone in your blood. This will confirm if you have premature menopause or to rule out conditions that may cause similar symptoms.

Treatment of 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.

Physical activity that stresses the bones, such as running and walking, can help prevent osteoporosis. Physical activity can also help protect against heart disease and stroke.

A healthy diet can help protect your body against some of the long-term effects of the menopause. Women under 50 should include at least 1,000mg of calcium per day in their diet, which will help keep bones strong and reduce the risk of osteoporosis. If you’re over 51, you should increase your intake to 1,200mg per day. 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 and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) replaces some of the hormones that are reduced during and after the menopause. 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 cancer. You can have oestrogen-only HRT if you have had an operation to remove your womb (a hysterectomy).

Combined HRT (oestrogen and progesterone) comes in tablets, patches, skin gels and implants. Vaginal creams, pessaries or a vaginal ring may be helpful for vaginal problems such as dryness. You usually take HRT for two to three years. Symptoms can come back in some women for a short time after stopping HRT.

HRT can have side-effects, including tender breasts, water retention, weight gain, changes in your mood, feeling sick and headaches. Changing the type and dose of HRT may reduce these. Ask your GP for information and advice on different forms of HRT.

The long-term benefits of HRT are a reduced risk of osteoporosis, and, for combined HRT, a reduced risk of colorectal cancer. Other benefits include:

• relief from hot flushes and night sweats
• relief of vaginal dryness and urine infections
• maintenance of vaginal muscle tone, which may help to reduce urinary incontinence

Taking HRT for a long time may slightly increase your risk of developing certain conditions, including:

• breast cancer
• endometrial cancer (cancer of the lining of the womb)
• ovarian cancer
• deep vein thrombosis
• gallstones
• stroke
• heart disease

Talk to your GP to help you understand the benefits and risks of taking HRT. For most women, the benefits outweigh the risks.

Other medicines

Other treatment options for the menopause include non-hormonal medicines, such as selective serotonin re-uptake inhibitors (SSRIs) to treat hot flushes and night sweats. However, they aren’t licensed to treat the symptoms of menopause at present. Your GP may prescribe tibolone, which is beneficial for reducing hot flushes and fractures, especially in the spine. Clonidine can also be used for hot flushes during menopause, but it’s not often prescribed.

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.

If you have changes in your moods or feel depressed, your GP may recommend counselling or antidepressant medicines.

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.

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

There is no evidence that progesterone skin cream can be used to control menopausal symptoms.

Other complementary therapies that promote relaxation, exercise, and wellbeing (such as aromatherapy, acupuncture, yoga and reflexology) may help reduce symptoms in some women, but there isn’t any scientific evidence. If you’re considering a complementary therapy, ask your GP or pharmacist for advice.

Living with 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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.