Menopause

The menopause is when the ovaries stop working and your periods stop. It causes symptoms such as hot flushes, night sweats and mood changes. Menopause is a natural stage of life. The average age to reach the menopause in the UK is 51, but this can vary widely.

About the menopause

You’re said to have reached the menopause if you haven’t had a period for at least a year, usually between the ages of 45 and 55.

The menopause usually happens gradually. For a few years before the menopause, your periods may become irregular. This usually means they happen less often than they used to, but sometimes they happen more frequently. If you have periods occurring frequently all the time, contact your GP for advice. You may also have slightly heavier or lighter periods. This stage is called the perimenopause (or menopausal transition) and can last for about four years, sometimes longer.

You may still be able to get pregnant while going through the perimenopause, so you need to keep using contraception. Doctors usually suggest you can stop contraception at around age 55 if you haven’t had a period for a year.

Premature and early menopause

If you reach the menopause before you are 40, it's called premature menopause. When the menopause happens between 40 and 45, it’s called an early menopause.

Causes of the menopause

The menopause is a natural part of ageing. It happens when your ovaries run out of eggs. Your ovaries also make the hormone oestrogen, 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 of the menopause.

Some things can cause the menopause to happen early. These include the following.

• Surgery to remove your ovaries (oophorectomy), which may be done during a hysterectomy.
• Some types of medicine, including chemotherapy.
• Radiotherapy to your pelvic area.
• Premature ovarian insufficiency – when your ovaries stop working earlier than 40 years of age. Doctors don’t know why this happens but it can run in families. And it may not always be permanent.

Signs and symptoms of the menopause

Some people find their symptoms don’t cause them much trouble. But around 1 in 4 people will have more significant problems.

The timing of menopausal signs and symptoms can vary widely. They may begin 8–10 years before your periods stop or they may start a year or more after your last period.

Menopausal symptoms may go on for seven years or more after your periods stop. But everyone is different. Up to a third of people experience long-term menopausal symptoms.

The possible signs and symptoms of the menopause include the following.

• Irregular periods. You may get your periods more often or less frequently before they stop completely. You may bleed less heavily than usual.
• 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.
• Joint and muscle pain or stiffness.
• Difficulty sleeping (insomnia). You may find it hard to sleep because of the night sweats.
• Vaginal symptoms (for example, 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.
• Urinary problems. These symptoms include repeated urinary tract infections, leaking urine and needing to go to the toilet more often.

Emotional effects of the menopause

The changes that happen in your body as you approach and reach the menopause can affect how you feel. You may find you get anxious or irritable or have mood swings. These symptoms can be worse if you’re not sleeping enough because of night sweats. You may also have difficulty concentrating, and have a poor memory.

If you are going through the menopause, you may have an increased chance of developing depression. This is more serious than mood swings. If you find your mood stays low for two weeks or more, contact your GP.

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), contact your GP. Many people get this, and there may be a simple explanation. For instance, the hormonal changes that happen to your vagina after menopause can cause bleeding. But bleeding after the menopause can also be a symptom of certain cancers, including womb cancer. So, your GP will want to make sure there isn’t a cancer.

When to seek help for the menopause

If you can manage your symptoms yourself, you may not need to see a doctor. But you may wish to see one if you’re finding your symptoms hard to deal with or if you get symptoms before you are 40. You might find it difficult to talk about some of the symptoms you’re having. But remember, your GP is there to help and will have helped many others in your situation before. Your GP can support you with lifestyle modifications and medicines if need be to help your symptoms.

If you’re under 45 and have symptoms of the menopause, your GP may suggest that you have blood tests to see if there are any other reasons for your symptoms.

Self-help for symptoms of the menopause

Many people cope with their symptoms without having any specific medical treatment. There’s a lot you can do to help yourself.

• Take practical steps to deal with hot flushes. Keep cool, use a fan and avoid possible triggers, such as spicy foods, caffeine, alcohol, smoking or stress. Dress in layers, so you can take off some of your clothes when you feel too warm.
• Regular exercise may help you to reduce hot flushes, sleep better and lift your mood.
• Pelvic floor exercises can help strengthen your pelvic muscles. (These involve squeezing and releasing the muscles that support your bowel, bladder and vagina). This may improve your bladder control. You can get guidance on pelvic floor exercises from a physiotherapist. Or the British Association of Urological Surgeons (PDF, 0.2MB) provide information on these too.
• Lifestyle changes – for more information, see our section: Managing your health.

Treatment of the menopause

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. These include 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 hormone oestrogen. The therapy can be oestrogen alone or a combination of oestrogen and progesterone. Your doctor may offer you oestrogen alone if you’ve had a hysterectomy and your womb (uterus) has been removed. You will be offered a combination of oestrogen and progesterone if you still have your womb. HRT comes as tablets, patches, skin gels and nasal sprays, as well as vaginal rings, creams and pessaries.

You may have heard of some potential risks associated with taking HRT. These include an increased risk of developing blood clots (for example, deep vein thrombosis) and certain types of cancer with some types of HRT. Some of the possible risks of HRT are greater if you’re aged over 60. Some are more of a concern if you have taken HRT for a long time.

Whether you wish to take HRT is an individual decision for you. Your GP can talk with you about the possible risks and benefits of taking HRT and the safest option.

Most people take HRT for between 2 and 5 years to treat symptoms such as hot flushes. But you might want or need to take it for longer. Your GP will offer you the choice to gradually reduce or stop taking HRT. Your symptoms may come back for a short time after you stop taking it. Gradually reducing HRT will help prevent this.

Bioidentical hormones

These include hormones that are like your body’s own hormones but are made from plant sources. They are often promoted as being more ‘natural’ than standard HRT, although they’ve been processed in a laboratory.

Bioidentical hormone preparations that are custom-made (compounded) for you are not recommended. This is because they are unregulated, which means doctors can’t be sure they’re safe and effective.

Other treatments

If you don’t want or are unable to take HRT, your GP may suggest other treatment options. These may include the following.

• Talking therapies, like cognitive behavioural therapy (CBT) to help with low mood and mood changes. Your GP may offer you antidepressant medicines if they think you have depression.
• Vaginal lubricants, to help with vaginal dryness.
• Non-hormonal medicines such as antidepressants or a medicine called clonidine, for hot flushes and sweats.
• Testosterone, if you have a low sex drive.

Complementary therapies

There isn’t any evidence that complementary therapies, such as aromatherapy, acupuncture and reflexology, can improve menopausal symptoms. Some people, however, choose to take herbal remedies, such as black cohosh, soya-based foods and red clover for hot flushes.

Remember – like medicines, herbal remedies can have side-effects and can interact with other medicines. Ask your pharmacist for advice if you plan to try any herbal treatment.

Staying healthy during and after the menopause

The drop in oestrogen that happens during and after the menopause can increase your risk of getting certain diseases. These include osteoporosis (thinning of the bones) and heart and circulation problems. So, it’s more important than ever to try to stay healthy during and after the menopause.

Keep active

Exercise that puts some pressure on your bones, such as running and walking, can help strengthen them and reduce your risk of osteoporosis. Being physically active can also help to protect against heart disease and stroke. Although there’s no proof exercise can reduce hot flushes, it will probably improve your feeling of wellbeing and your mood.

Eat well

Aim to eat a healthy diet. If you have hot flushes, you may want to avoid foods that trigger them, such as spicy foods and caffeinated drinks.

The menopause causes you to lose calcium from your bones. So it’s important to include two or three portions of calcium-rich foods in your daily diet. It’s also important to get enough vitamin D because it’s vital for bone health.

Lose excess weight

Some people put on weight while going through the menopause, especially around the tummy (abdomen). This may be linked to lowered oestrogen levels but also to general ageing and lifestyle changes. If you’re getting hot flushes and night sweats, it may help to lose any excess weight you have. This will also help reduce your risk of getting heart disease.

Stop smoking

Smoking can lead to an earlier menopause, and may trigger hot flushes. Ask your GP or practice nurse for advice and support to quit. You can also get information online from the NHS about stopping smoking.

Limit alcohol

Alcohol may trigger hot flushes, and affect sleep quality and mood so it may help to limit how much you drink.