Menopause
Menopause is a natural process that happens to all women. It happens when your ovaries stop releasing eggs. This means your levels of estrogen and progesterone change. The lining of your womb (uterus) stays thin and eventually your periods stop. This can happen suddenly or over several years as your periods become more irregular and then stop completely.
Types of menopause
There are 4 types of menopause.
- Natural menopause happens between the ages of 45 and 55. It usually follows a gradual transition known as perimenopause. Symptoms of perimenopause can begin in your early 40s.
- Early menopause happens between the ages of 40 and 45.
- Premature menopause starts before age 40. It can be triggered by medical treatments, genetic factors or autoimmune conditions. It can also be referred to as primary ovarian insufficiency (POI) — previously known as premature ovarian failure (POF).
- Induced menopause is triggered by medical treatment, such as surgical menopause and chemical menopause. Surgical menopause is the removal of both ovaries (bilateral oophorectomy). Chemical menopause is caused by chemotherapy, radiotherapy or certain medications. It can be either temporary or permanent. Induced menopause is caused by a range of conditions, not only cancer.
Stages of menopause
Menopause can be divided into perimenopause and postmenopause.
Perimenopause
This is when your periods become irregular before they finally stop. This usually lasts between 4 and 8 years. You can have all the same symptoms as menopause, but you will still get your periods. Your periods may become heavier or irregular. The treatment for perimenopause is the same as the treatment for menopause.
Postmenopause
You are considered to be postmenopausal:
- one year after your last period, if you are not pregnant and older than 50
- after 2 years if you are not pregnant and younger than 50.
Symptoms of menopause
During perimenopause and menopause, many women experience physical and emotional symptoms caused by the falling level of estrogen in the body. These can vary widely in type and severity.
- 20% do not experience any symptoms.
- 60% have mild to moderate symptoms.
- 20% have symptoms severe enough to interfere with daily life.
Symptoms can begin during perimenopause and may continue for several years after menopause.
Common symptoms include:
- irregular periods (during perimenopause)
- hot flushes and night sweats
- tiredness (fatigue)
- joint and muscle pain (musculoskeletal syndrome of menopause)
- trouble sleeping (insomnia)
- dry skin and hair changes
- vulvo-vaginal dryness and urinary changes (genitourinary syndrome of menopause)
- low interest in sex (low libido)
- poor memory and concentration (sometimes called ‘brain fog’)
- anxiety, irritability or other mood changes
- weight gain (especially around the middle), changes in body composition or both.
Menopause also increases the risk of developing osteoporosis and heart problems.
Diagnosing menopause
Your symptoms and the changes in your periods (menstruation) are usually all that is needed to diagnose menopause. But you may need some blood tests to check your hormone levels if you are younger than 40 and have menopause symptoms.
Treating menopause
You can manage many symptoms of menopause through self care. But you may need more help if your symptoms are more severe or if you are concerned about any symptoms.
You may be able to reduce the effects of menopause on your body by:
- quitting smoking
- staying a healthy weight and eating a high-quality diet rich in whole foods
- being physically active most days and doing at least 2 sessions of muscle strengthening exercises (resistance training) per week
- taking steps to keep your bones healthy and strong to reduce your risk of getting osteoporosis
- using a lubricant if you have vaginal dryness, or your healthcare provider may prescribe an estrogen-based vaginal cream.
For hot flushes, you can:
- dress in layers that you can remove when you get a hot flush
- wear clothing made of natural fibres that breathe
- be aware of triggers such as spicy foods, hot drinks, caffeine (coffee, tea and cola) and alcohol
- create a cooler environment by using fans, having iced water and using a water facial spray
- removing some the covers on your bed.
Complementary therapies you could try to include:
- relaxation techniques such as yoga, Tai Chi and calming breathing to help minimise stress and anxiety, and improve your wellbeing and sleep
- hypnotherapy, acupuncture and cognitive behavioural therapy.
As you go through menopause, your ovaries produce less estrogen. This is what causes most of the symptoms of menopause. Menopause hormone therapy (MHT) replaces some of those hormones. MHT used to be called hormone replacement therapy (HRT).
MHT may be an option for you if you:
- have moderate to severe symptoms that are affecting the quality of your life
- have premature (younger than 40) or early (younger than 45) menopause.
Your healthcare provider will talk to you about the risks and benefits of MHT so you can decide if it is right for you.
There are 2 types of MHT. These are estrogen-only MHT and combined MHT, which includes estrogen and progesterone.
Estrogen-only MHT
Estrogen-only (no progesterone) MHT is suitable if you have had a hysterectomy and no longer have a womb (uterus). This means you do not need progesterone to protect the lining of your womb. Estrogen is available as a patch, gel or tablet.
Combined MHT
Combined MHT includes estrogen and progestogen. If you still have a uterus, you need to take combined MHT. This is because only taking estrogen can increase your risk of getting cancer of the uterus.
If you need combined MHT and still have a uterus, an intrauterine device, like Mirena, can be used to provide the progestogen component. This can be combined with oestrogen (patch, gel or tablet). Mirena also provides effective contraception if you are still perimenopausal.
Testosterone MHT
Testosterone can be helpful for some women, particularly those in surgical menopause who are experiencing a low libido. It can also help support bone density, muscle mass and energy levels.
- Androfeme is a testosterone cream made for women. It is available on private prescription but is not funded.
- Testogel is a product funded for men and may be used in very low doses (a quarter of a male dose) under medical supervision.
Talk to your healthcare provider to see if testosterone MHT is right for you.
Contraception
If you are under 50, you still need to use contraception for 2 years after your last period. If you are over 50, you need to use contraception for one year after your last period.
Menopause hormone therapy is not a contraceptive.
If you are over 55, you do not need to use any contraception, even if you still have periods.