About menopause

Menopause is a natural event for women.

In the lead-up to menopause, your ovaries may not produce an egg each month. This can lead to changes in the hormones circulating in your body. Specifically, oestrogen levels may be increased and progesterone levels may be lower. After menopause, oestrogen levels also fall considerably. Women are considered ‘postmenopausal’ one year after their final menstrual period. Menopause usually occurs naturally at around age 50 but may happen earlier due to chemotherapy, radiation treatment or surgery.

What is the menopause?

Menopause consists of three stages:

• The menopause transition (also called perimenopause). These are the years leading up to the final menstrual period and the year after the final menstrual period. During this time, changes in your hormones may lead to symptoms such as hot flushes and changes in menstrual bleeding patterns. Night sweats (hot flushes occurring at night) can cause sleep disturbances and affect your mood and concentration during the day. Some women are still able to conceive during the menopause transition so you should continue to use contraception until at least twelve months after your final period if you don’t wish to become pregnant.
• Natural menopause is the spontaneous, permanent end to menstrual periods that is not caused by medical treatment or surgery. It is confirmed by twelve consecutive months of no menstrual bleeding.
• Postmenopause is the time beyond one year after your final menstrual bleeding and lasts for the rest of your life.

How will menopause affect me?

Menopause affects every woman differently. Most women (around 85 per cent) get some hot flushes and/or night sweats but are able to manage these without treatment. Around 20 per cent of women have symptoms which are troublesome and/or prolonged and these women may consider treatment. The experience of menopause and symptoms differ in women from different ethnic groups, for example, for some Asian women, body and joint aches and pains are the most troublesome symptom.

Factors that may affect your experience of menopause

• Your age at menopause. Younger women who were not expecting to go through menopause may have more difficulty than women at the average age.
• What you are expecting of menopause. Women who expect to have troublesome menopausal symptoms are more likely to experience troublesome symptoms when they go through menopause. So, a positive and informed approach to menopause may help.
• Many women are relieved that they no longer have menstrual periods and are no longer fertile. 

When does menopause begin?

Menopausal symptoms (hot flushes, night sweats, menstrual changes) usually start from around age 47 years. The final menstrual period is usually about age 51 but can vary considerably. There is currently no reliable way to predict when you will experience menopause and what your menopausal symptoms will be like.

When menopause happens before 40 years it is called ‘premature’, and when it happens before 45 years it is called ‘early’. Menopause after age 45 years is considered normal and there is no upper age limit to when it can begin. However, most women have experienced menopause by age 55 years.

Why does menopause happen?

The reasons for menopause are not well understood. Currently, we think that menopause happens because the ovaries run out of eggs. This leads to changes in the hormones produced by the ovaries and the hormones from the brain that control the ovaries. Eventually, the ovaries stop producing eggs and menstrual periods stop permanently. After menopause, the ovaries continue to produce oestrogen at lower levels and also testosterone.

When menopause comes early

There are risks associated with early menopause:

• Loss of fertility at a younger age.
• An increased risk of osteoporosis and fracture in women who do not take menopausal hormone therapy (MHT).

Early menopause is particularly difficult for women who have not yet started or completed their families. 

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