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What is the menopause?

three women smiling with arms linked

Are you feeling in the dark about what to expect with the menopause? Find out what it's all about here.

For a long time, menopause was viewed with dread, often associated with ageing, and feeling less attractive, but things are starting to change! More and more people, including celebrities like Davina McCall, are openly talking about this natural stage in every woman's life and seeing it as a source of empowerment and a meaningful transition.

But, many women are still unsure of what to expect when it comes to dealing with menopause. So, if you’re wondering what is menopause, then this guide has everything you need to know.

What does ‘menopause’ mean?

What does ‘menopause’ mean?

Technically, ‘menopause’ is when you’ve gone at least a year with no menstrual bleeding.1 But the word ‘menopause’ is often used to describe what is – strictly speaking – the perimenopause. This is the period of time leading up to the menopause when levels of the main female hormones (oestrogen and progesterone) start to rise and fall erratically.1

On average, perimenopause lasts for around four years, although it can go on for up to 12 years for some women.2 You’ll likely begin to notice signs of perimenopause in your forties or even your thirties – only 10% of women report that their periods stop suddenly, with no noticeable changes in their cycles beforehand.3 The menopause usually happens between the ages of 45 and 55, while the average age that periods stop in the UK is 51.4

Why does the menopause happen?

It’s because your ovaries’ supply of follicles – needed to make eggs – starts running out.

This starts a cascade of effects: your ovaries become less able to respond to reproductive hormones, like follicle-stimulating hormone (FSH), which means they then stop making oestrogen and progesterone. These are the hormones that regulate menstruation and are needed for fertility, and it’s the lack of these that causes those classic menopause symptoms.5 Sometimes, there can be other causes of menopause too, like certain cancer treatments.

OK, that’s the physical reasons that trigger menopause, but why do women actually go through it?

One theory is that it’s an evolutionary throwback, giving women a chance to care for their grandchildren, pass on their knowledge, and safeguard the next generation of their genes.6

What are the most common signs of menopause?


Not every woman has significant signs and you may find you barely notice the transition.7

If you do find that you're experiencing signs of menopause that are affecting your daily routine, you should head to your GP, who will be able to tell you if you are in the menopause, what stage you’re at and if you might need any tests.

Here are the most common signs of menopause and how to tackle them:

Menstrual changes


A persistent change of seven days or more in the length of your cycle – making it shorter or longer – can indicate you’re in early perimenopause. A stretch of 60 days or more between periods usually happens later in perimenopause. Menstrual changes are caused by ovulation becoming unpredictable as your supply of eggs dwindles.3

What you can do: this is a normal part of the menopause transition, but see your GP if periods are troublesome – if they’re particularly heavy, for example.

Hot flushes

Hot flushes

Hot flushes and night sweats are collectively known as ‘vasomotor symptoms’ and affect between 60 and 85% of women, varying in severity and frequency. They usually last around two years, but for 10% of women, hot flushes can last as long as 15 years.9

Experts still don’t know exactly what causes them, but it’s thought hormone fluctuations affect the way the brain controls body temperature.3

What you can do:

  • ask your GP about hormone replacement therapy (HRT) – HRT replaces your missing hormones and is the most effective way of stopping vasomotor symptoms, as it treats the underlying cause. Taking HRT can also lower your risk of conditions such as heart disease and osteoporosis that increase post-menopause
  • some menopausal women may prefer to use alternative interventions and supplements, such as agnus castus, red clover or soy isoflavones
  • simple lifestyle measures – like wearing natural fibres and reducing stress – can also make a difference to hot flushes, as well as keeping hydrated, doing regular exercise, and maintaining a healthy, balanced diet10
  • reducing (or cutting out) alcohol and spicy foods – these can often make hot flushes worse
  • consider a course of CBT (cognitive behavioural therapy) – it has been shown to reduce the frequency and duration of hot flushes

Mood problems

Mood problems

Anxiety and a low mood are more likely to affect women during perimenopause; if you have a history of low moods, you’re likely to experience it now. Changes in hormone levels may affect the neurotransmitters, such as serotonin, that control mood.3

Of course, your mood can also be affected by other factors at this time, such as loss of fertility and negative social stereotypes around menopause, along with worries about children, work, and elderly parents.3

What you can do: self-help measures can ease low moods and anxiety, including yoga, meditation, and regular exercise. Speak to your GP about a course in CBT too. HRT may be useful,9 but antidepressants are not recommended as there’s no evidence that they work for low mood associated with menopause. However, some women find herbal remedies, such as St John’s wort or valerian, as a natural menopause relief as they may help low moods or anxiety during the menopause.

Sexual issues

Sexual issues

Falling oestrogen levels can thin and dry vaginal walls, leaving you prone to infections and making sex feel uncomfortable. You may also experience irritation and soreness, even if you’re not sexually active. On top of this, you may find you have a reduced libido.1 Stress and relationship problems can contribute to lower sex drive and loss of lubrication, too.1

What you can do: vaginal dryness can be treated very simply with topical oestrogen, used either as a cream, pessary, or vaginal ring. It can be used on its own or with HRT. Or you could try over-the-counter vaginal moisturisers and lubricants,11

And what about post-menopause?


After menopause, a lack of oestrogen means you’re more susceptible to developing osteoporosis and heart disease. You may also find you gain weight, and your skin starts to become dryer. You can support your bone health by upping your calcium and vitamin D intake – the government recommends all post-menopausal women take 10mcg a day – while omega-3 can contribute to the normal function of the cardiovascular system and vitamin C can support your skin.

It may sound like a lot to deal with, but every woman’s experience of going through menopause is different. Some sail through it, while others are floored by their symptoms – either way, it’s a sign that an exciting new chapter in your life has started. And don’t forget you’re in good company!

Written by Charlotte Haigh on December 29, 2018, Reviewed by Dr Louise Newson on January 6, 2019

Disclaimer

Advice is for information only and should not replace medical care. Please check with your GP before trying any remedies.

 

Sources

1. Mayo Clinic. Menopause. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

2. Mayo Clinic. Perimenopause. Available from: https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666

3. Cheung AM, et al. Perimenopausal and postmenopausal health. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096694/

4. Menopause. Available from: https://www.nhs.uk/conditions/menopause

5. Dalal PK, Agarwal M. Postmenopausal syndrome. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/

6. Kevin Arbuckle. The Conversation. Why do women go through menopause? Science offers a new solution to an old puzzle. Available from: https://theconversation.com/why-do-women-go-through-menopause-science-offers-new-solution-to-old-puzzle-54856

7. Symptoms: menopause. Available from: https://www.nhs.uk/conditions/menopause/symptoms/

8. https://www.nice.org.uk/guidance/ng23/ifp/chapter/diagnosing-menopause

9. Menopause Matters. Menopause symptoms. Available from: https://www.menopausematters.co.uk/symptoms.php

10. Treatment: menopause. Available from: https://www.nhs.uk/conditions/menopause/treatment/

11. https://journals.lww.com/menopausejournal/Citation/2018/10000/Factors_associated_with_developing_vaginal_dryness.7.aspx

 
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