Menopause explained– what to expect and what can help

It's when it's been 12 months since your last period and you can no longer get pregnant naturally. For most people, this happens slowly. In a stage known as perimenopause, periods  become less frequent over a few months or years, and then eventually they stop altogether. Sometimes, this change can be sudden, when your period ends one month and doesn't return.

It’s a natural part of ageing that usually happens when your periods stop due to lower hormone levels. ^{Footnote [2]}

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.

It usually happens between the ages of 45 and 55, with the average age for a woman in the UK being 51. ^{Footnote [2]}

Perimenopause

This stage 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 if for anything from a few months to 10 years. Perimenopause ends when you reach 12 consecutive months without having a period. That is menopause. What comes after is post menopause.^{Footnote [2]}

Early and premature menopause

About 5% of UK women experience early menopause, starting before the age of 45. More rarely, 1% have premature menopause, which happens before the age of 40. This is usually caused by a medical condition or surgical removal of ovaries.^{Footnote [3]}

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

Nearly 75% of women aged 40 to 60 experience symptoms relating to menopause. These can be of varying severity and happen all at once or at different times. Here are some of the symptoms you might experience:

• 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 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. Plus, you can always talk to your GP about treatment options. 

Since many symptoms are caused by low oestrogen levels, hormone replacement therapy (HRT) can help lessen those symptoms. You can take oestrogen as a tablet, a skin gel or patch, or an implant. Alongside progestogen, it can help protect the lining of your womb. Your GP can help you decide if HRT – and which type – is the right option for you.

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 include talking therapies, such as cognitive behavioural therapies (CBT). It’s worth discussing your symptoms and options with your GP.  

• Lower sex drive – HRT can often improve a low sex drive. You could also talk to your GP about whether a testosterone supplement would be suitable for you.  

• Vaginal dryness – There are many options to help you here, from over-the-counter, non-hormonal lubricants to oestrogen creams and pessaries. You can use these alongside HRT tablets or patches, and they are usually safe for women unable to take standard HRT. It’s worth talking to your GP about your options.  

• Weak bones – HRT, regular exercise, vitamin D supplements and a healthy diet, rich in calcium, can help protect against developing osteoporosis, which increases the risk of fractured bones.

There are a number of myths about menopause that can cause worry and stress. Here a few of them:

• Myth - Menopause starts when you turn 50 
  Menopause doesn’t ‘start’ – it’s simply the date that marks 12 months since your last period. Most people start to experience symptoms during perimenopause, and these can continue beyond menopause itself. For most, this stage happens happens between 45 and 55, with the average for UK women being 51.

• Myth – You’ll definitely gain weight during menopause 
  Not everyone puts on weight during menopause. If you do, there are things you can do to help. It’s 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 post-menopausal women due to lack of oestrogen. 

• Myth – You’ll get weak bones during the menopause 
  You may develop osteoporosis due to menopause and ageing, but this doesn’t happen 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. You could also take vitamin D supplements.^{Footnote [4]}