Menopause

Menopause

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly.

The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman’s oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.

But around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.

Common symptoms include:

Menopausal symptoms can begin months or even years before your periods stop and last around 4 years after your last period, although some women experience them for much longer.

It’s worth talking to a GP if you have menopausal symptoms that are troubling you or if you’re experiencing symptoms of the menopause before 45 years of age.

They can usually confirm whether you’re menopausal based on your symptoms, but a blood test to measure your hormone levels may be carried out if you’re under 45.

Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life.

These include:

  • hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
  • vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
  • cognitive behavioural therapy (CBT) – a type of talking therapy that can help with low mood and anxiety
  • eating a healthy, balanced diet and exercising regularly – maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms

Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.

The menopause is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Premature or early menopause can occur at any age, and in many cases there’s no clear cause.

Sometimes it’s caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome or Addison’s disease.

Symptoms

Most women will experience some symptoms around the menopause. The duration and severity of these symptoms varies from woman to woman.

Symptoms usually start a few months or years before your periods stop, known as the perimenopause, and can persist for some time afterwards.

On average, most symptoms last around 4 years from your last period. However, around 1 in every 10 women experience them for up to 12 years.

If you experience the menopause suddenly rather than gradually – for example, as a result of cancer treatment – your symptoms may be worse.

The first sign of the menopause is usually a change in the normal pattern of your periods.

You may start having either unusually light or heavy periods.

The frequency of your periods may also be affected. You may have them every 2 or 3 weeks, or you may not have them for months at a time.

Eventually, you’ll stop having periods altogether.

About 8 in every 10 women will have additional symptoms for some time before and after their periods stop.

These can have a significant impact on daily life for some women.

Common symptoms include:

The menopause can also increase your risk of developing certain other problems, such as weak bones (osteoporosis).

See your GP if you’re finding your symptoms particularly troublesome, as treatments are available.

Read about how to manage symptoms of the menopause

Treatment

The main treatment for menopausal symptoms is hormone replacement therapy (HRT), although other treatments are also available for some of the symptoms.

HRT replaces the hormones that are missing. Most symptoms are caused by low oestrogen levels, so this is the most important hormone to replace. If you have a womb you also need a progestogen to protect the lining of the womb.

HRT is extremely effective at relieving menopausal symptoms.

HRT is available as tablets, skin patches, a gel to rub into the skin or implants.

Benefits and risks of hormone replacement therapy (HRT)

The main benefit of HRT is that it can help relieve most menopausal symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.

It can also help prevent thinning of the bones, which can lead to fractures (osteoporosis). Osteoporosis is more common after the menopause.

Some types of HRT can slightly increase the risk of breast cancer and blood clots in some women. You need to discuss whether you have any risk factors with a doctor or nurse.

Evidence says that the risks of HRT are small and usually outweighed by the benefits.

Your GP can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.

Find out more about HRT

If you experience hot flushes and night sweats as a result of the menopause, simple measures may sometimes help, such as:

  • wearing light clothing
  • keeping your bedroom cool at night
  • taking a cool shower, using a fan or having a cold drink
  • trying to reduce your stress levels
  • avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
  • taking regular exercise and losing weight if you’re overweight

If the flushes and sweats are frequent or severe, your GP may suggest taking HRT.

If HRT isn’t suitable for you, or you would prefer not to have it, your GP may recommend other medicines that can help, such as clonidine (a high blood pressure medicine) or certain antidepressants.

These medicines can cause unpleasant side effects, so it’s important to discuss the risks and benefits with your doctor before starting treatment.

Some women experience mood swings, low mood and anxiety around the time of the menopause.

Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medicine and other treatments are also available, including HRT and cognitive behavioural therapy (CBT).

CBT is a type of talking therapy that can improve low mood and feelings of anxiety. Your GP may be able to refer you for CBT on the NHS, or recommend self-help options such as online CBT courses.

Antidepressants may help if you’ve been diagnosed with depression.

It’s common for women to lose interest in sex around the time of the menopause, but HRT can often help with this. If HRT is not effective, you might be offered a testosterone gel to apply to an area of skin, such as your tummy or the top of your leg.

Testosterone is the male sex hormone, and it can help restore sex drive in some women. It’s not currently licensed for use in women, although it can be prescribed after the menopause by a specialist doctor if they think it might help restore your sex drive.

Possible side effects of using testosterone include acne and unwanted hair growth.

Read more about loss of libido and female sexual problems.

If your vagina becomes dry, painful or itchy as a result of the menopause, your GP can prescribe oestrogen treatment that’s put directly into your vagina as a pessary, cream or vaginal ring.

This can safely be used alongside HRT.

You’ll usually need to use vaginal oestrogen indefinitely, as your symptoms are likely to return when treatment stops. However, side effects are very rare.

You can also use over-the-counter vaginal moisturisers or lubricants in addition to, or instead of, vaginal oestrogen.

Read more about vaginal dryness and sex as you get older.

Women who have been through the menopause are at an increased risk of developing weak bones that may break more easily (osteoporosis) as a result of the lower level of oestrogen in the body.

You can reduce your chances of developing osteoporosis by:

  • taking HRT – HRT can help to prevent your bones getting weaker, although this effect does not tend to last after treatment stops
  • exercising regularly – including weight-bearing and resistance exercises
  • eating a healthy diet that includes plenty of fruit, vegetables and sources of calcium, such as low-fat milk and yoghurt
  • getting some sunlight – sunlight on your skin triggers the production of vitamin D, which can help to keep your bones strong
  • stopping smoking and cutting down on alcohol
  • taking calcium and/or vitamin D supplements if you do not feel you’re getting enough of these – discuss this with your GP

Read more about menopause and bone health and preventing osteoporosis.

If you’re having treatment for your menopausal symptoms, you’ll need to return to your GP for a follow-up review after 3 months, and once a year after that.

During your reviews, your GP may:

  • make sure your symptoms are under control
  • ask about any side effects and bleeding patterns
  • check your weight and blood pressure
  • review the type of HRT you’re taking and make any necessary changes
  • discuss whether you should continue it or if you decide to stop, how this should be done

Many women will need treatment for a few years, until most of their menopausal symptoms have passed.

Some women may wish to take HRT for many years. Their individual benefits and risk should be assessed every year.

Complementary and alternative treatments, such as herbal remedies and bioidentical (“natural”) hormones, are not recommended for symptoms of the menopause. This is because it’s generally unclear how safe and effective they are.

Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronised progesterone, can be prescribed to treat menopausal symptoms.

Some complementary and alternative therapies can also interact with other medicines and cause side effects.

Ask your GP or pharmacist for advice if you’re thinking about using a complementary therapy.