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. Symptoms of perimenopause can begin in the early 40s.
- Early menopause happens between the ages of 40 and 45.
- Premature menopause starts before age 40. It is also referred to as premature ovarian failure or primary ovarian insufficiency.
- Artificial menopause happens when your ovaries have been surgically removed or stop working because of cancer treatment.
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
Sometimes you will have physical and emotional symptoms during perimenopause and menopause. These are caused by the falling level of estrogen in your body. Symptoms can vary, with some women having no symptoms at all while for others they can last for several years.
Common symptoms include:
- irregular periods
- hot flushes and night sweats
- trouble sleeping (insomnia)
- vaginal dryness (atrophic vaginitis)
- low interest in sex (low libido)
- poor memory and concentration
- anxiety, irritability or other mood changes
- weight gain.
Menopause can also increase your likelihood of getting osteoporosis.
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 well
- making sure you stay physically active
- 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 doctor 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
- limit spicy foods, caffeine (coffee, tea, cola, chocolate) and alcohol
- create a cooler environment by using fans, having cool drinks and using a water facial spray
- removing some the covers on your bed.
Complementary therapies you could try include:
- relaxation techniques to help minimise stress and anxiety and improve your sleep
- hypnotherapy, yoga 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. It is available as a tablet or a patch.
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.
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.