What is menopause?
Menopause is something a lot of women dread, however, it is a natural biological process and should not be seen as an adverse condition, but rather a period of transition. Menopause may mark the end of fertility, but this does not mean it will end your health and vitality, in fact, sticking to a healthy exercise regime during this time can actually keep you feeling fit and fabulous as well as help to improve the symptoms of menopause.
With your fertility coming to an end, this means that your menstruation will end permanently and you will no longer be able to have children. During menopause, the ovaries stop producing eggs and the body starts to produce less progesterone and oestrogen (the two main hormones needed to maintain a healthy pregnancy). The diagnosis of menopause is confirmed when a woman is of a certain age (usually the forties or fifties) and has not had a menstrual period for 12 consecutive months.
If you have reached this stage, it is a turning point in your life and should not be seen as a disease or health issue, however, many women have said that menopause has a great impact on their overall feelings of well-being both physically and mentally. This is often due to the adverse symptoms associated with menopause, some of which include night sweats, hot flushes, headaches and other forms of physical discomfort. These symptoms can often trigger feelings of sadness, loss, depression and anxiety in a lot of women. But menopause may also be seen as a relief as you will not have to worry about any unexpected pregnancies or your period anymore.
Menopause tends to occur when you are in your 40s or 50s, although the average age is a woman’s early 50s. There are a number of treatment options, both medical and lifestyle orientated, to help you through this period of change.
In the article that follows we will discuss all that you need to know about menopause, from the symptoms through to treatment in order to make this journey an easier one for you and those around you. Be advised that this is not to be seen as a professional diagnosis, but rather a guideline.
What are the stages of menopause?
From the moment you start puberty, up until the time you enter menopause, you will typically have your period around the same time every month, with the exception of the odd irregular period, any medical conditions you may experience or pregnancy.
What is a menstrual cycle?
If you’re reading this because you’re going through menopause, you probably feel as though you’ve had enough menstrual cycles in your life to not require any further explanation on these, but bear with us, this information will help make the discussion that follows easier to understand. So here goes…
The first half of your menstrual cycle involves your ovaries, which are two organs and endocrine glands, found on the sides of your uterus, producing the hormones progesterone and oestrogen. In this phase, they will produce higher levels of oestrogen. This results in the uterine lining thickening in order to prepare for the possibility of pregnancy. At the same time, an egg will begin to mature in one of your ovaries.
Around day seven to day 22, or day 14 if you have a 28-day cycle, the egg that has now matured in your ovary, will be released, this process is referred to as ovulation. Once the egg is released, your ovaries will begin to secrete more progesterone, another sex hormone. If this egg does not go through the fertilisation process with a sperm cell, then your levels of progesterone and oestrogen will begin to decrease, resulting in your body shedding the uterine lining – resulting in bleeding, known as a period.
When you begin to approach menopause, your ovaries will start to produce less oestrogen, this results in irregular periods. Thus, the term menopause is defined as your last and final menstrual cycle. You will be diagnosed with menopause when you are of a certain age and haven’t had your period for a year.
The three stages of menopause
Menopause is divided into three stages which can occur over a number of months or years. These stages are:
This is the first stage of menopause and typically begins a few years before menopause when you are still having your menstrual periods. Your hormone levels may start to fluctuate due to your ovaries starting to produce less of the hormone oestrogen. This can result in hot flushes, amongst a few other symptoms. Your periods will start to become irregular and may be longer, shorter, heavier or even lighter than what you have regarded as normal over the years. Perimenopause can last up to five years or even longer until your menstrual period stops and menopause starts. It is possible to still get pregnant during this stage, although quite unlikely.
Menopause begins when you are in your 40s or 50s and it has been 12 consecutive months since your last period. At this stage, your ovaries would have stopped releasing their eggs and the production of the sex hormones oestrogen and progesterone, will significantly decrease. This is the stage that indicates the end of fertility.
The years that follow the menopausal changes in your body are known as postmenopause. During this period of time, your symptoms such as hot flushes and night sweats may ease up.
What are the symptoms of menopause?
During the few months or even years that lead up to the start of menopause, the period known as perimenopause, you may experience some of the following symptoms:
- Irregular periods - As menopause is fast approaching, your menstrual period will begin to change, these changes are normal. However, if you experience heavy bleeding for more than a week or have any uncomfortable changes, then speak to your doctor or gynaecologist.
- Vaginal dryness – Declining oestrogen levels mean less lubrication ‘down there’ which can lead to vaginal dryness. If this becomes a problem or makes sexual intercourse uncomfortable, discuss it with your doctor who may prescribe vaginal oestrogen (in tablet - Vagifem, cream – Premarin and Estrace or a vaginal oestrogen ring – Estring) or advise the use of a vaginal moisturizer like Lubrin or Replens or a lubricant like Astroglide or KY before sex.
- Hot flashes - Hot flashes, also known as hot flushes, are the most common symptom of menopause. A hot flush is a brief sensation of heat that may make your neck and face become flushed and result in a flushed complexion, temporary red patches or blotches appearing on your arms, back and chest area. This may also be followed by chills and sweating. These are caused by complex interactions in the body involving a variety of function from fluctuating hormone levels that affect brain chemicals and receptors in the region of the brain, known as the hypothalamus, that controls temperature as well as blood vessels and sweat glands in the body. Hot flushes will vary in their intensity and tend to last about 30 seconds or even 10 minutes and may cause some concern or irritation, especially if you cannot find a way to get cool quickly enough. It can help to dress in light layers of clothing which can be easily removed and while it may seem counterintuitive, to also get regular exercise which has been proven to ease hot flashes. It also helps to avoid any hot or spicy foods. Some women have also noted that managing their stress levels can also be beneficial.
- Night sweats – As with hot flushes, night sweats are primarily due to fluctuating hormone levels and their effect on the body which result in sweating that leads to chills, an increased heart rate as well as a feeling of anxiety. Relaxation breathing techniques may help to reduce incidences of night sweats.
- Sleep issues – Hormones are responsible for a whole lot more than reproduction, they also play a role in sleep regulation. Changes in hormone levels, coupled with night sweats and hot flushes all contribute to difficulty in falling and staying asleep.
- Mood changes - These are due to the change of hormones in your body. A variety of women have reported feelings of depression, irritability and mood swings that range from extreme highs to episodes of severe lows over a short period of time, feeling highly irritable from time to time is also common. It is important to note that these fluctuations in your hormones are normal and feeling down or irritable is not an unnatural thing to go through.
- Thinning hair and dry skin - As you get older, you will start to notice some changes in your hair and skin. This is as a result of the loss of collagen and fatty tissue, making your skin thinner and drier. The loss of these elements will affect the lubrication and elasticity of your skin near your urinary tract and vagina. A reduction in the oestrogen levels may also contribute to hair loss and can make your hair feel dry and brittle. Try to avoid using any harsh chemicals on your hair that can further damage it and it may also be beneficial to take collagen supplements. Speak to your doctor about what is best for you if you encounter these symptoms.
- Slowed metabolism resulting in weight gain - Your metabolism will naturally slow down as your get older. The biggest changes in your body that result in weight gain are the decreasing levels of oestrogen and progesterone. We will get into more detail about this in the next section.
- Breasts losing their fullness – Again this is attributed to the aging process and lowering of hormone levels.
- Sexual discomfort - With less oestrogen, which often leads to vaginal dryness, intercourse may become painful or uncomfortable. It can help to use a water-based lubricant. Speak to your doctor about what options are available to you and what other factors such as health and lifestyle may be contributing to your sex drive.
- Headaches - These are typically experienced leading up to menopause, during the perimenopause phase, due to the fluctuations of hormones. Some relief lies in the period of postmenopause as migraines tend to stop as your hormones levels stabilise and remain consistently low.
When to see a doctor
When you start to experience perimenopause, it is advisable to begin regular visits with your doctor in order to receive preventive healthcare and clear up any medical concerns you may have. You are likely to have to continue these appointments during as well as after menopause.
Preventive healthcare can include a number of screenings during menopause such as:
- Lipid screening
- Thyroid testing
If you experience any vaginal bleeding after menopause then you should consult with your doctor immediately.
What do hormones have to do with menopause?
As your ovaries begin to produce less oestrogen, your body will try to get it from other places. Your fat cells are also capable of producing oestrogen, therefore, the body will work extra hard to convert any calories into fat in order to increase the oestrogen levels. Because your fat cells do not burn calories in the same way that muscles do, your body may automatically gain weight as a result.
Menopause is often linked to water retention due to the fact that bloating and water weight are a result of progesterone levels decreasing. This does not result in actual weight gain, but can give the appearance of being bigger.
This hormone will typically increase with the onset of menopause as it is responsible for redistributing the weight to the midsection instead of the hips, it has also been shown to help ease the symptoms of menopause.
What causes menopause?
The leading cause of menopause is age. Menopause, as mentioned, marks the end of your childbearing years and is the result of your ovaries starting to gradually slow down. However, there are also a number of specific surgeries, as well as medical treatments that can induce menopause as a side effect. These surgeries and treatments include the removal of ovaries, which is known as bilateral oophorectomy, pelvic radiation therapy and chemotherapy. If you have undergone a hysterectomy, which entails removing the uterus surgically, and your ovaries were not removed, this does not result in menopause, but you will still not experience your menstrual period.
The below factors can cause menopause:
- Hysterectomy – Having a partial hysterectomy means that your uterus, and not your ovaries, will be removed. This will not result in the immediate onset of menopause, however, as stated, you will no longer have your period. In still having your ovaries intact, they will continue to release eggs and produce the sex hormones oestrogen and progesterone. Having a complete removal of your uterus and ovaries, known as a bilateral oophorectomy and total hysterectomy, will result in menopause without the transitional phase. Your period will stop immediately and you are likely to experience the typical symptoms of menopause, which can sometimes be severe as hormonal changes are abrupt and have not occurred gradually over a number of years as is naturally the case.
- Primary ovarian insufficiency – This is a condition where your ovaries will not be able to produce the normal levels of hormones needed for reproduction before you turn 40. This is often the result of an autoimmune disease or a genetic factor, however, the cause is often unknown as doctors are unable to find it. Roughly 1% of women will experience menopause before they turn 40, this is known as premature menopause. The treatment for women with primary ovarian insufficiency is hormone therapy until they reach the natural age that menopause is supposed to start in order to prevent osteoporosis.
- Natural decline of reproductive hormones – Your ovaries will start to make less oestrogen and progesterone as you get closer to your late 30s in life. These are the hormones that regulate your menstruation. As well as this, your fertility will also decline. As you reach your 40s, you will find that your menstrual cycle may be shorter or longer, lighter or heavier and overall seem to be irregular. This will eventually get to the point, around the average age of 51, where your period will stop entirely.
- Chemotherapy and radiation therapy – These are cancer therapies that have been known to induce menopause as a side effect and cause symptoms such as hot flushes which can occur shortly after or during the treatment. Even though these therapies halt your menstruation, and in turn, your fertility, this does not mean that you should discontinue birth control as this halt can be a temporary thing.
What are the complications associated with menopause?
Once you have gone through menopause, the risk of the development of a number of medical conditions increases. Some examples of these include:
- Cardiovascular disease (heart and blood pressure related disease) – As your oestrogen levels begin to decline, your risk of developing cardiovascular disease will increase. The leading cause of death amongst men and women is heart disease. It is therefore vital that you follow a routine of regular exercise, a healthy and nutritious diet and maintain a healthy weight. Speak to your doctor or dietitian about your risks and how you can reduce cholesterol levels or your blood pressure should these be an issue.
- Urinary incontinence – In menopause, the tissues of the urethra and vagina will begin to lose their elasticity, as this happens, you may start to experience a sudden, frequent and strong need to urinate. This is sometimes followed by urge incontinence, which is the involuntary loss of your urine, or you may experience the loss of urine through laughing, coughing or even lifting something, this is known as stress incontinence. You may also suffer from UTIs (urinary tract infections) more frequently. It may help if you perform Kegel exercises to strengthen the muscles of your pelvic floor. Using a topical form of vaginal oestrogen may also help in relieving the symptoms of incontinence.
- Sexual function – Your vaginal dryness from loss of tissue elasticity and the decrease in the production of moisture can often result in sexual discomfort and even slight bleeding during intercourse. You may also have a loss of sensation from the loss of vaginal elasticity. It can help to buy lubricants that do not contain glycerine as this ingredient can cause itching and irritation in the vagina.
- Osteoporosis – This is a condition that results in the bones becoming weak and brittle and leads to your risk of fractures being increased. During the period following menopause, you may lose some of your bone density at quite a rapid rate, this will increase your risk of the condition osteoporosis. Women who are postmenopausal and suffer from osteoporosis are extremely susceptible to fractures of their wrists, spine and hips. Speak to your doctor about methods that can help decrease your risks regarding supplements (calcium) and medication.
- Weight gain – A variety of women have noted that their transition into menopause and the period after it has resulted in their metabolism slowing down, this is due to the change of hormones in your body.
**Just to recap on the reason as to why this is: As your ovaries begin to produce less oestrogen, your body will try to get it from other places. Your fat cells are also capable of producing oestrogen, therefore, the body will work extra hard to convert any calories into fat in order to increase the oestrogen levels. Because your fat cells do not burn calories in the same way that muscles do, your body may automatically gain weight as a result.
How is menopause diagnosed?
The symptoms and signs of menopause are normally enough to inform the majority of women and doctors that they have started the transition period into menopause. However, if you have any concerns regarding any symptoms such as hot flushes or irregular periods, then it is best that you speak with your doctor. Some cases may require further evaluation.
Tests are not normally needed in order for menopause to be diagnosed. However, in certain situations, your doctor is likely to suggest that you have blood tests done in order to check your levels of:
- Oestrogen (oestradiol) and follicle-stimulating hormone (FSH) – When menopause occurs your oestradiol levels decrease and your follicle-stimulating hormone levels will increase. Your FSH is a hormone that stimulates the growth of the ovarian follicles of your ovary before it releases an egg from one of the follicles during ovulation. This will also increase the production of oestradiol. Follicle-stimulating hormone is produced by your pituitary gland. Basically, the hormone helps in controlling your menstrual cycles and the egg production of the ovaries.
- Thyroid-stimulating hormone (TSH) – Having an underactive thyroid, known as hypothyroidism, can cause similar symptoms to menopause such as weight gain.
How is menopause treated?
There is no specific medical treatment for menopause. The treatments instead focus on the relief of your symptoms and try to aid in the prevention and management of chronic conditions that often occur with natural aging.
Other treatments can include:
- Hormone therapy – Oestrogen therapy is the most effective form of treatment to relieve the main symptom of menopause, hot flushes. Your doctor may recommend that you take the lowest dose needed in order to provide some relief. You will also need to take progestin if your uterus is still intact (has not been removed through surgery). Oestrogen therapy will also help in preventing bone loss. If you start hormone therapy within a five-year period from your last menstrual cycle, then it may also have some benefits for your cardiovascular health (heart disease).
- Low-dose antidepressants – There are certain antidepressants that are related to a class of drugs known as SSRIs (selective serotonin reuptake inhibitors). These have been known to help decrease hot flushes associated with menopause. This form of treatment is often helpful for women who are unable to undergo hormone therapy for specific health reasons or need antidepressants for a certain mood disorder.
- Gabapentin (Neurontin) – This is a drug that has been approved for the treatment of seizures, however, it has also been useful in reducing the symptoms of hot flushes. It is also helpful for women who cannot use oestrogen therapy and those who suffer from migraines.
- Vaginal oestrogen – Oestrogen can be used to relieve the symptom of vaginal dryness when it is administered directly to your vagina in the form of a tablet, ring or cream. This form of treatment will release a small dosage of oestrogen and the vaginal tissues will then absorb this.
- Medications to treat or prevent osteoporosis – Your doctor may suggest that you treat or prevent osteoporosis, this is dependent on your individual condition. There are a number of medications that are available to help in reducing potential fractures and bone loss.
Before you decide on any form or method of treatment, it is best that you speak to your doctor or gynaecologist about what your risks, benefits and options are. It is also advised that your treatment is reviewed annually as with ongoing medical advances, treatment options are often changing.
What lifestyle and home remedies are there for menopause?
There are a number of symptoms and signs that are associated with menopause that are often temporary. There are some steps you can take in order to help prevent or reduce the effects of menopause:
- Cool down your hot flushes – It is best if you dress in layers so that you can take off a layer of two when you get a hot flush. If you are having a hot flush, then it often helps if you drink a cold glass of water or fan yourself. Some triggers for hot flushes are:
- Hot beverages
- Spicy foods
- Hot weather
- Reduce your vaginal discomfort – You can use OTC (over-the-counter) and water-based lubricants such as K-Y jelly or Astroglide, this will help ease any sexual discomfort during intercourse. Being sexually active can help increase blood flow to the vagina. **Remember not to choose products with glycerine as this may cause an itching or burning sensation in some women.
- Make sure you get enough sleep – You may want to avoid any products with caffeine in them, as well as alcohol as these can often interrupt your sleep. It also helps to exercise during the day and not late at night. If you find that hot flushes are disturbing your sleep, then try sleeping in cooler sleep attire and with a fan in your room.
- Try to practice some relaxation techniques – There are a number of breathing and relaxation techniques available that can help ease your symptoms of menopause.
Some of these include:
- Guided imagery
- Deep breathing
- Progressive muscle relaxation
- Do your Kegels – Try to keep your pelvic floor muscles strong through performing Kegels. This will also help in urinary incontinence.
How to do Kegels:
- You can do these by finding the muscles you use when you want to stop urinating.
- Once you have found these muscles, squeeze them and hold for three seconds.
- Repeat this move 10 to 15 times and do this once a day.
- Try to increase your reps every week.
- Stick to a healthy and balanced diet – Sticking to a balanced meal plan that consists of vegetables, fruit, whole grains and protein will help in easing your symptoms. It is advised that you limit your intake of sugars, saturated fats and oils. Speak to your doctor or pharmacist about any calcium or multivitamin supplements you should be taking with this diet.
- Do not smoke – If you smoke your risk of stroke, heart disease, cancer, osteoporosis, as well as a variety of other health issues is greatly increased. Smoking can also increase your hot flushes and lead to early menopause.
- Stick to a regular exercise regime – By getting regular exercise at least three times a week, your risk of diabetes, heart disease, osteoporosis and other health issues is reduced. Your symptoms of menopause may also be lowered.
FAQ regarding menopause
When does menopause start?
The National Institute on Aging noted that women, on average, at the age of 51 are at the age of natural menopause. Please note that menopause can begin later or earlier than this. There are a few women who have started menopause at the age of 40 or younger, and a small number of women have started menopause when they were in their 60s. There is no way that has been proven to be able to predict the age that you will experience menopause. Only after you haven’t had your menstrual period for a duration of 12 months and you are at the expected age, will you normally be diagnosed with menopause.
What should I expect with menopause?
Every woman will experience menopause differently as it is dependent on one’s current health and lifestyle choices. Some women will go through natural menopause with very little hassle. Other women may have more severe symptoms. When menopause is induced through surgery or treatment, this can be a tough adjustment for the sufferer.
How long does it take for menopause to end?
There are some symptoms, such as those of vaginal dryness and other urinary symptoms that have been known to continue into the postmenopause phase. Most of the symptoms will subside and disappear within 12 months from your last and final period. Women have also reported experiencing hot flushes into their 60s and 70s, albeit with reducing frequency. Hot flushes typically reduce in frequency and stop after approximately five years from the onset of menopause.
What happens when you go through menopause?
When you are born, it is commonly accepted that you have a finite amount of eggs, these are then stored in your ovaries. Your ovaries will also produce the sex hormones oestrogen and progesterone, these aid in controlling your ovulation and menstruation. When menopause occurs, your ovaries are no longer releasing an egg every 28 days (for those on a 28-day cycle) and therefore menstruation will stop.
Can stress bring on early menopause?
It is though that if you suffer from high levels of stress that you may experience symptoms that are similar to menopause such as thinning hair, hot flushes and mood changes, but it is not yet proven that stress can actually lead to early menopause.