The term menopause is commonly used to describe the years when a woman's ovaries gradually begin to produce fewer eggs and less of the female hormones oestrogen and progesterone.
This reduction in hormone production causes periods to become less regular until they stop altogether, and produces physical and psychological symptoms in many women. Depending on the severity of symptoms and risk of developing other health conditions, treatment and/or lifestyle changes may be recommended.
Menopause is a normal part of ageing for a woman and literally means "last period". It is generally considered to be complete when a woman has not had a period for one year. Menopause, often referred to as "the change of life", usually occurs between the ages of 45 and 55 years. Premature (early onset) menopause is when periods stop before the age of 40 years.
Why does menopause occur?
At birth a woman's ovaries contain a lifetime supply of eggs. At puberty, the ovaries begin releasing eggs each month (ovulation). This prompts oestrogen and progesterone to be released by the ovaries, which in turn stimulate the lining of the uterus (endometrium) to thicken in preparation for the implantation of a fertilised egg. If an egg is not fertilised the endometrium is shed and a period occurs. This entire process is known as the menstrual cycle.
Menopause occurs when the ovaries fail to produce enough hormones to stimulate the monthly growth of the endometrium, and periods stop permanently.
The time frame from when symptoms first appear to when menopause occurs may be several years. This time frame is medically referred to as the climacteric or the perimenopause.
After menopause a woman's risk of coronary heart disease (including high blood pressure, heart attack and stroke) increases and becomes as high as it is for men. The risk of developing osteoporosis (bone thinning) is also increased.
There are three types of menopause:
- Natural menopause occurs when levels of oestrogen and progesterone decline naturally.
- Premature (early) menopause is when periods stop before the age of 40 years. This can be due to many reasons including medical conditions such as diabetes or underactive thyroid (hypothyroidism), and surgery or medications that have affected the blood supply to the ovaries. Genetic factors may also play a part as premature menopause can run in families. Women who smoke are also more likely to go through premature menopause. Sometimes, however, there is no identifiable cause.
- Artificial (surgical) menopause is a consequence of surgical removal of both ovaries or destruction of the ovaries by some cancer treatments. With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause.
Signs and symptoms
Often the first symptom of impending menopause is a change in bleeding patterns. Periods may become lighter or heavier, longer or shorter, the time between periods may increase and there may be occasional missed periods. These changes may occur gradually in some women, and more abruptly in others.
There are also a wide range of physical and psychological signs and symptoms associated with menopause. In some women they are very mild while in others they are more severe. They may last for only a few months or may continue for several years. The average length of time for menopausal symptoms to be experienced is three to five years.
Physical signs and symptoms may include:
- Hot flushes (occurring in approximately 60% of women)
- Sweats (often at night)
- Joint and bone pain
- Thinning hair
- Dry skin
- Unusual skin sensations
- Vaginal dryness, incontinence and infections of the urinary tract and vagina may occur due to the thinning of the vagina and bladder walls.
Psychological signs and symptoms may include:
- Reduced interest in sex
- Irritability and mood swings
- Difficulty concentrating
- Loss of confidence
- Difficulty sleeping
There is no one test to diagnose menopause. Symptoms may indicate that menopause is imminent but menopause can only be confirmed retrospectively after periods have been absent for one year. Blood tests may be taken at to look for indicators of menopause.
A change in bleeding patterns, particularly where periods become heavier, and an absence of periods can indicate various medical conditions. It is therefore advisable to consult a doctor before assuming that the changes are menopausal symptoms. Also, if bleeding occurs after periods have been absent for a year, a doctor should be consulted, as this is not considered normal.
The intensity and frequency of menopausal symptoms vary from woman to woman. If symptoms are problematic, or a woman is at high risk of developing osteoporosis or heart disease, medical treatment may be recommended. Ultimately, the decision to have treatment is a very personal one and should be made by the woman only after receiving a full explanation from her doctor of the advantages and disadvantages of the various treatment options.
Treatment options include:
Menopausal Hormone Therapy (MHT)
Menopausal Hormone Therapy (previously known for many years as Hormone Replacement Therapy) involves replacing hormones previously produced by the ovaries. It can be effective in relieving the symptoms of hot flushes, night sweats and dryness of the vagina. MHT can also help to reduce the risk of osteoporosis following menopause. See Menopausal Hormone Therapy for more information.
Women need a higher intake of calcium and vitamin D after menopause to help reduce the risk of osteoporosis. Excellent dietary sources of calcium include low-fat dairy products (milk, cheese, yoghurt), nuts, dark green vegetables (eg: broccoli, spinach) and fish with bones in (eg: sardines, salmon). An intake of at least 1000mg of calcium daily is recommended for women after menopause. Vitamin D, which helps the body to absorb calcium, is manufactured by the skin after exposure to sunlight; small quantities are also found in foods such as dairy products and eggs. If the diet contains insufficient amounts of calcium and vitamin D, dietary supplements may be required. Eating a healthy balanced diet that is low in fat and refined sugars, and maintaining a healthy body weight, is recommended. Limiting alcohol and caffeine, and not smoking, are also important.
Regular weight-bearing exercise such as walking, dancing, tennis, aerobics and golf helps in maintaining a healthy weight, fitness and general wellbeing. Exercise also helps to decrease the risk of osteoporosis by strengthening the bones and may assist in reducing the severity of menopausal symptoms such as hot flushes. Specific pelvic floor exercises can help to reduce urinary problems such as incontinence and pain on urination. Rest and stress reduction also play an important role in managing menopause symptoms. Fatigue and stress can worsen symptoms, so employing strategies to ensure adequate rest is attained and stress is managed will assist in alleviating symptoms.
For more information on menopause please contact a doctor or a local branch of the Family Planning Association of NZ. The Association runs education courses about menopause, can provide information about treatment options, and offers support and advice. Clinic locations and contact details to make an appointment can be found on their website at www.familyplanning.org.nz.
Australasian Menopause Society (2018). Menopause basics (Web Page). Healesville, Victoria: Australasian Menopause Society. https://www.menopause.org.au/hp/management/menopause-basics [Accessed: 18/04/19]
Australasian Menopause Society (2018). Complementary and herbal therapies for hot flushes (Web Page). Healesville, Victoria: Australasian Menopause Society. https://www.menopause.org.au/hp/information-sheets/734-complementary-and-herbal-therapies-for-hot-flushes [Accessed: 18/04/19]
Australasian Menopause Society (2018). Menopause treatment options (Web Page). Healesville, Victoria: Australasian Menopause Society. https://www.menopause.org.au/health-professionals/management/treatment-options [Accessed: 18/04/19]
Mayo Clinic (2017). Menopause (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 [Accessed: 18/04/19]
O’Toole, M.T. (Ed.) (2017). Menopause. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Last Reviewed - May 2019
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