About the menopause
The menopause is a natural change in a woman’s life; it happens when your ovaries stop producing eggs. Your ovaries also make the hormone oestrogen (a chemical substance). So when they stop working, there’s a drop in your blood level of this hormone. This change disrupts your periods and causes the symptoms associated with the 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. You can still become pregnant while going through the perimenopause, so you need to keep using contraception if you don’t want to get pregnant. Doctors usually recommend stopping contraception at 55, because most women are in the menopause by this age.
You’re said to have reached the menopause if you haven’t had a period for at least a year. When the menopause happens before the age of 40, it's considered to be premature (early) menopause. An early menopause can happen naturally because your ovaries stop working. But it can also happen if you’ve had one or both of your ovaries removed as part of a hysterectomy (an operation to remove your womb).
Symptoms of the menopause
Most women develop symptoms at some point during the menopause. In some women, symptoms may last for only a few months, whereas other women may continue having symptoms for several years.
Symptoms of the menopause can include the following.
- Irregular periods – you may get your periods more or less often, before they stop completely.
- Hot flushes and night sweats – during a hot flush, your head, face and neck can become very hot for several minutes. At the same time, you may have heart palpitations and feel anxious or irritable. Hot flushes can be followed by chills. When flushes happen during the night, they’re known as night sweats.
- Difficulty sleeping (insomnia) – you may find it hard to sleep because of the night sweats. This lack of sleep may cause you to feel tired during the day.
- Changes in your mood (eg, feeling irritable, depressed or anxious) – lack of sleep can make these symptoms worse, and can also cause difficulty in concentrating, and poor memory.
- Vaginal symptoms (eg, dryness and pain during sex) – these symptoms are due to your vagina becoming fragile and thinner. You may also have some itching and irritation.
- Loss of interest in sex (reduced libido) – the hormonal changes of the menopause can affect your sex drive. You may also have less interest in sex if you have vaginal symptoms that make you uncomfortable (eg, vaginal dryness or pain).
- Urinary problems – these symptoms include repeated urinary tract infections, leaking urine and needing to go to the toilet more often.
You may also have other symptoms, such as breast pain, headache, bloating and gaining weight.
The changes that occur in your body as you approach and reach the menopause can affect your emotions and how you feel. You may find you have mood swings, get anxious or irritable, or feel down. These symptoms can be worse if you’re not sleeping enough because of night sweats. Small changes to your lifestyle may be able to help ease these effects. Your GP may be able to recommend treatments that can help. See our section below for more information on treatments that can help emotional symptoms of the menopause.
Bleeding after the menopause
If you start to have bleeding after you’ve reached the menopause (when you haven’t had a period for a year or more), see your GP. Many women experience this, and there’s usually a simple explanation. For instance, the normal changes that happen to your vagina after menopause can cause bleeding. But bleeding after the menopause can also be a key symptom of certain cancers, including womb cancer, so your GP will want to rule this out.
When to seek help for the menopause
If you’re able to manage your symptoms yourself, you may not need to see a doctor for symptoms of the menopause. But you may want to see a doctor if you’re finding your symptoms hard to deal with, or if you’re getting symptoms before the age of 40.
If you’re under 45, your GP may suggest that you have a blood test. This is to measure the level of follicle stimulating hormone (FSH) in your blood. The blood level of this substance increases as you approach the menopause. By measuring your blood level, it’s possible to tell if your symptoms might be caused by the menopause.
Treatment of the menopause
Here are some things to try that may help to ease some of your symptoms.
- Take practical steps to deal with hot flushes by keeping cool and avoiding possible triggers, such as spicy foods, caffeine, smoking or stress. It may also help to dress in layers, so you can take off some of your clothes when you feel too warm.
- Regular exercise may help improve some symptoms of the menopause. There’s no proof that exercise can reduce hot flushes and night sweats, but it may help you to sleep better and to lift your mood. Aim to do 30 minutes of moderate exercise, at least five days a week.
- Pelvic floor exercises can help strengthen your pelvic muscles (squeezing and releasing the muscles that support your bowel, bladder and vagina) and can improve your bladder control.
Hormone replacement therapy (HRT)
If you’re finding it hard to manage your symptoms, your GP may suggest you try hormone replacement therapy (HRT). HRT can help some symptoms of the menopause, such as night sweats and hot flushes, mood swings and vaginal dryness. It can also help reduce your risk of osteoporosis. Most symptoms improve within three months of starting HRT.
HRT works by helping to restore your blood levels of the hormones oestrogen and progesterone. The therapy can be oestrogen alone or a combination of oestrogen and progesterone. HRT comes in tablets, patches, skin gels and nasal sprays, as well as vaginal rings.
You may have heard of some potential risks associated with taking HRT. These include increased risk of heart disease and certain types of cancer. These risks are greater for women aged over 60, and are more of a concern if you have taken HRT for a long time. Nowadays, your doctor is likely to prescribe HRT only for short-term relief of symptoms. For women under the age of 60 who take HRT for only a short time, the benefits usually outweigh any potential risks. However, it’s important that you discuss this with your doctor.
If you don’t want or are unable to take HRT, your GP may suggest other treatment options. These will vary depending on your symptoms, and may include the following.
- Counselling or antidepressants to help with low mood and mood changes.
- Clonidine, for hot flushes and sweats. This treatment may not be suitable if you’re taking medications to lower your blood pressure, or if you have depression, heart problems or constipation.
- Vaginal lubricants, to help with vaginal dryness.
There is little scientific proof that complementary therapies such as aromatherapy, acupuncture and reflexology can improve the symptoms of the menopause. The same is true for plant or herbal remedies. For example, there isn't enough proof for doctors to recommend taking soy products, even though some studies have found that one type, called S-equol may reduce hot flushes. Herbal remedies, such as black cohosh and red clover, are not recommended.
Like medicines, herbal remedies can have side-effects and can interact with other drugs. For example, there have been reports of black cohosh causing damage to the liver. Ask your pharmacist for advice if you plan to try any herbal treatment.
Causes of menopause
The menopause is a natural part of ageing – it happens when your ovaries stop producing eggs, and your blood levels of the female sex hormone oestrogen drop. However, there are some things that can cause the menopause to happen early. These include:
- primary ovarian failure – when your ovaries stop working
- surgery to remove your ovaries, which may be carried out during surgery to remove your womb (hysterectomy)
- radiotherapy to the pelvic area
Living with the menopause
The drop in your level of oestrogen that happens during and after the menopause can increase your risk of developing certain diseases. For example, post-menopausal women are at greater risk of developing a condition called osteoporosis (thinning of the bones). Your risk of developing heart and circulation problems, including stroke, also increases after menopause.
For these reasons, it’s more important than ever to try to stay healthy after menopause. Two of the most important things you can do are keeping active and maintaining a healthy diet.
Exercises that stress the bones, such as running and walking, can help strengthen your bones and reduce your risk of osteoporosis. Being physically active can also help to protect against heart disease and stroke.
The menopause causes you to lose calcium from your bones, so it’s particularly important to try to include two to three portions of calcium-rich foods in your diet daily. Examples of one portion include 200ml of semi-skimmed milk or a small yoghurt. Your GP may advise you take a calcium supplement. You should also aim to maintain a healthy weight for your height.
It’s important that you get enough vitamin D because vitamin D is vital for bone health. Your body produces vitamin D when your skin is exposed to sunlight. In summer, you may get enough vitamin D just by spending a few minutes in sunlight every day, without wearing sunscreen. It’s important not to let your skin burn though. If you don't get much exposure to sunlight, particularly during winter, you may want to think about taking a vitamin D supplement.
FAQ: How long do I take HRT for?
Your GP will recommend that you use HRT at the lowest effective dose for the shortest possible time. What this means in practice varies between women because every woman has different symptoms, and some women’s symptoms are more severe than others.
The symptoms of the menopause differ between women. How long they last and how serious they are also vary 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 there’s some research to show HRT may be linked to a small increase in the risk of certain cancers, as well as stroke and blood clots. This risk goes away once you stop HRT.
You should visit your GP for a check-up three months after you start taking HRT. He or she can check if the treatment works for you. After this, your GP may want to see you at least once a year to discuss your symptoms and decide if you need to continue treatment. This check-up will also help assess whether or not you are developing side-effects. If you decide to stop taking HRT, discuss the best way to do this with your GP. HRT should be stopped gradually, over a period of up to six months.
When you stop taking HRT, your symptoms may come back for a short time but then they usually go away within two to three months. If your symptoms don’t go away and are severe, you can start taking HRT again, under your GP’s supervision. 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.
FAQ: I’m 35 and getting hot flushes. Does this mean I’m going through an early menopause?
You could be, but you may want to discuss this with your GP. There are other conditions that cause hot flushes. Your GP will arrange for you to have some tests to find out exactly what’s causing them.
If you’re having hot flushes and night sweats and you’re not sure whether these are caused by the menopause, talk to your GP.
There can be a number of reasons for your symptoms. For instance, conditions such as an overactive thyroid and panic attacks can cause hot flushes. They can also be a reaction to certain medicines or foods.
Your GP will ask you about your symptoms, and may take a blood test to check the levels of follicle stimulating hormone (FSH) and oestrogen in your blood. You’ll need to have the test twice, a few weeks apart. These tests can help determine if you are going through a premature (early) menopause.
If your GP thinks you’re going through an early menopause, you’ll probably be referred to a gynaecologist (a doctor who specialises in women’s reproductive health) for further tests. Your GP or gynaecologist will advise you about specific treatments that can help ease your hot flushes. You may be offered hormone replacement therapy (HRT), for example.
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.
FAQ: I’m thinking about taking hormone replacement therapy (HRT). Does it increase my risk of cancer?
There are two basic types of HRT:
- oestrogen-only HRT, which contains only the hormone oestrogen
- combined HRT, 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 returns to normal a few years after you stop treatment. Oestrogen-only HRT can increase your risk of womb (endometrial) cancer, but is only prescribed if you have had a hysterectomy, which means that your womb has been removed.
Your risk of breast cancer increases if you take combined HRT, but not if you take oestrogen-only HRT. The risk is higher the longer you take HRT. It decreases within five years of stopping HRT to what it would have been without treatment.
Your GP will explain the risks of HRT to you before you start taking it, and will help you to weigh up the risks and benefits. It’ll be your decision whether or not you take it. That decision will depend on a number of factors – including how severe your symptoms are.
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Reviewed by Pippa Coulter, Bupa Health Content Team, December 2015.
Peer reviewed by Shirin Irani, MD, FRCOG, Consultant Gynaecologist, Heart of England NHS Foundation Trust
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