The menopause


The menopause is the time in a woman's life when her periods become less frequent, and then eventually stop. It's a normal part of the ageing process, which is triggered when your ovaries no longer release an egg each month. When this happens, the ovaries stop producing as much of the female sex hormone, oestrogen. 

This is often a gradual process, taking place over months or even years, but periods might also stop suddenly. Women usually reach menopause aged between 45 and 55, although sometimes it happens sooner. In the UK, the average age a woman reaches the menopause is 51.

How do I know if I'm going through the menopause?

Like all women, you'll experience changes to your periods during the menopause. They'll become less frequent, or erratic. They might also be unusually light or heavy. Eventually, they'll stop altogether. For some women, the menopause will pass with no problems, but around eight in 10 women will experience one or more of the following symptoms:

  • Hot flushes – a sensation of sudden heat, usually in your upper body – or night sweats
  • Sleeplessness, leading to tiredness and irritability
  • Mood swings or depression
  • Reduced sex drive
  • Memory and concentration problems
  • Vaginal dryness, pain, or itching, or discomfort during sex
  • Headaches
  • Palpitations (unusually rapid or irregular heartbeat)
  • Stiff joints and aching muscles
  • Recurrent urinary tract infections, such as cystitis
  • Dry, itchy skin
  • Light-headedness
  • Breast tenderness or slight shrinkage of the breasts

It's worth bearing in mind that any of these symptoms can be caused by things other than the menopause, so it's a good idea to have a chat with your Doctor if you have any concerns, or if you have menopause symptoms before the age of 45. Your doctor may be able to determine whether you've started the menopause, based on your symptoms. They may also carry out some blood tests to measure your hormone levels.

If you're struggling with low mood or generally feeling negative or anxious, you can try some self-help measures. A healthy and balanced diet, having plenty of rest, regular exercise and relaxation activities such as yoga may help alleviate some of these symptoms. Your Doctor may also be able to help. These mood symptoms aren't uncommon in women going through the menopause, and various treatments are available. This includes medicines, as well various 'talking therapies' such as cognitive behavioural therapy. Antidepressant medicines can also help if you have been diagnosed with depression.

How long does the menopause last?

The menopause has three distinct stages:

  • Peri-menopause: this is the time from the onset of menopausal symptoms to the final period. This may be months or years, or it may be almost immediate
  • Menopause itself: many of us think of the peri-menopausal stage as 'the menopause' but it's actually defined as the time when the final menstrual period occurs
  • Post-menopause: the time following the last period. This is usually defined as more than 12 months with no periods

Early menopause

If you reach the menopause before you're 45, this is known as early menopause, or premature ovarian failure (POF). It can be caused by a number of things, including:

  • Autoimmune conditions, such as hypothyroidism (an underactive thyroid)
  • Infections such as tuberculosis, malaria and mumps (although it's rare for these to cause POF)
  • Surgery – if you have your ovaries removed (because of ovarian cancer or ovarian cysts, for example), this will always cause the menopause (known as a 'surgical menopause') to follow immediately, regardless of your age
  • Cancer treatments such as radiotherapy and chemotherapy
  • Chromosomal disorders, such as Downs syndrome and Turner syndrome

Your Doctor can advise you on coping with early menopause. Sometimes, women can mistake a missed period caused by an unexpected pregnancy for symptoms of early menopause – so it's a good idea to take a pregnancy test if you miss a period unexpectedly and pregnancy is a possibility.

What happens after the menopause?

As well as your periods stopping, your body may undergo other changes. A drop in oestrogen levels can affect your bone density, leading to a risk of osteoporosis, so talk to your Doctor to find out what you can do to help prevent this. Some women may also continue to experience hot flushes and night sweats even in the post-menopause phase.

How can I manage menopause symptoms?

It's often possible to help manage some of the symptoms – such as tiredness, hot flushes and weaker bones – by exercising regularly, including strength exercises, and eating healthily. Maintaining your optimum weight will help boost your energy levels, as well as placing less stress on your heart and bones. Exercising in short 'bursts' as part of your daily routine (for example, by taking the stairs instead of the lift, or walking short distances instead of driving) are good ways of fitting a little exercise into a busy day. If you're able to get to the gym from time to time, weight training can help maintain bone density. You should aim for at least 150 minutes of moderate activity, such as brisk walking, or 75 minutes for vigorous activity, such as aerobics or fast swimming, per week. You should also try to fit into your routine muscle strength exercises, on two or more days of the week.

The following can also help reduce your chance of developing osteoporosis:

  • Ensure you get sufficient calcium and vitamin D, both of these are vital for bone health. Sources of calcium include dairy products, greens and nuts. To absorb calcium, you also need vitamin D, which you can get from sunlight, oily fish, eggs and red meat. You could also consider taking a daily supplement. The government recommends that everyone should think about taking a daily supplement containing 10 micrograms of vitamin D in the autumn and winter, when the sun is at its weakest, to top up your vitamin D levels
  • Make sure you're getting at least your 'five a day'! Fruit and vegetables are a vital source of vitamins and minerals and are an important part of a varied and balanced diet. Adding fruit to your cereal and a side salad to your lunch are easy ways to help get your daily intake
  • Keep your diet low in saturated fats, sugar and salt to help maintain your optimum weight
  • Keep an eye on your alcohol intake and stay within government guidelines for alcohol consumption – not regularly drinking more than 14 units a week
  • Finally, if you smoke, it's worth giving up – both for your general health and wellbeing, and to help reduce your risk of developing osteoporosis which increases after menopause. Your pharmacist can advise on ways to do this

Hormone Replacement Therapy (HRT)

One of the most common treatments for menopausal symptoms is HRT, a treatment that replaces the hormones which levels drop during the menopause. Prescribed by your Doctor, HRT can help relieve many menopause symptoms, including hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive. It can also help prevent osteoporosis.

While it can be very beneficial, HRT is a complex treatment with possible side effects, so your Doctor is the best person to talk through this option with you and help you to decide if it'd suit you.

Next steps

  • To help cope with this life change, eat a healthy and balanced diet, and exercise regularly
  • If you currently smoke, give up or at least cut down. Your pharmacist can help you with this
  • Visit your Doctor if you're struggling with menopause symptoms, or if you develop menopause symptoms before the age of 45