All about the menopause

The menopause is when a person stops having periods and can’t get pregnant naturally anymore. Usually it happens slowly. Your periods start becoming less frequent over a few months or years - the perimenopause – and eventually they just stop altogether. Sometimes it can happen suddenly when your period ends one month and then doesn’t return.

The menopause is a natural part of ageing that usually happens when your periods stop due to lower hormone levels. ^{Footnote [1]}  

Your ovaries stop releasing eggs and your body produces significantly lower levels of oestrogen and progesterone.  After this, your menstrual cycle stops and you can't conceive naturally any longer.

Menopause usually occurs between ages 45 and 55, the average age for a woman in the UK being 51. ^{Footnote [1]}    

Perimenopause covers the few years before menopause when hormone levels fluctuate, often causing symptoms. This ‘pre’ menopausal state, usually lasts about four years, but some people can experience it for anything from a few months to 10 years. Perimenopause ends when you reach 12 consecutive months without having a period. That is menopause. After that comes life after menopause. ^{Footnote [2]}  

About 5% of UK women have an early menopause, before the age of 45. More rarely, 1% have premature menopause before age 40, usually explained by surgical removal of their ovaries, or a medical condition. ^{Footnote [3]}  

If you’re aged 45 or under and think you might be going through the menopause, it’s a good idea to speak to your GP. They might decide to do some tests to check your hormone levels and will talk to you about your symptoms and family history.

Nearly 75% of women aged 40 to 60 experience symptoms relating to menopause. These symptoms can be of varying severity and at different times. They include:

• Hot flushes
• Mood swings
• Memory problems (brain fog)
• Trouble sleeping
• Night sweats
• Weight gain
• Fatigue
• Vaginal dryness
• Joint pain/muscle aches
• Lower sex drive
• Headaches 
• Anxiety and depression

Going through the menopause is a natural stage of life but that doesn’t mean it’s trouble-free. If you experience symptoms, there are steps you can take to manage them. You can always discuss treatment options with your GP.

Since many symptoms are caused by low oestrogen levels, hormone replacement therapy (HRT) can alleviate them. Oestrogen can be taken as a skin gel or patch, implant, or tablet, alongside progestogen to protect the uterine lining. Your GP can help you decide if HRT is the right option for you, and, if so, what type. 

There are also a few things you can do to help with specific symptoms:

• Hot flushes and menopause night sweats – Wear lighter clothes, take a cool shower before bed, use a fan, and regularly have cold drinks.  You can also try avoiding spicy food, caffeine, smoking, and alcohol.
• Mood changes – Get plenty of rest, exercise when you can, and try calming activities like yoga or tai chi. HRT can often improve depression and anxiety. Other options are talking therapies such as Cognitive Behavioural Therapy (CBT). It’s worth discussing your symptoms and options with your GP. 
• Lower sex drive – HRT can often improve a low sex drive. If not, discuss with your GP as to whether a testosterone supplement would be suitable for you.
• Vaginal dryness – There are many options to assist here, from over-the-counter non-hormonal lubricants, to oestrogen creams and pessaries. These can be used alongside HRT tablets or patches, and are usually considered safe by women unable to take standard HRT. It’s worth discussing your options with your GP.
• Weak bones – HRT, regular exercise, vitamin D supplements and a healthy diet rich in calcium can all help protect against developing osteoporosis, which increases the risk of fractured bones.

Myth #1: Menopause starts when you turn 50

The menopause doesn’t ‘start’ – it’s simply the date that marks 12 months since your last period. Most people start to experience symptoms during the perimenopause and these can continue beyond the menopause itself. It usually happens between 45 and 55, with the UK average being 51.

Myth #2: You’ll definitely gain weight during the menopause

Not everyone experiences menopause weight gain. If you do, there are things you can do to help. It’s really important to make sure you’re eating healthy, nutritious foods and exercising regularly. This will help protect against heart disease, which is more common in postmenopausal women due to lack of oestrogen.

Myth #3: You’ll get weak bones during the menopause

You may develop osteoporosis due to the menopause and ageing, but this doesn’t apply to everyone. And having osteoporosis doesn’t mean you’ll break your bones – just that there’s an increased risk.

You can reduce the risk of osteoporosis by exercising regularly and focusing on weight-bearing and resistance exercise. You can also eat more calcium-rich foods, like leafy greens, dried fruit, tofu, and yoghurt, as well as foods rich in vitamin-D, like oily fish, eggs, and liver. Vitamin-D supplements are also effective. ^{Footnote [4]}