Menopause: frequently asked questions
What is menopause?
Menopause is the end of menstruation and fertility and is a natural stage of every woman's life. Doctors define menopause as occurring when a year has passed since your last menstrual period. Once you've reached menopause, your ovaries produce much less of the female hormones oestrogen and progesterone, and you are no longer able to become pregnant.
A transitional stage, known as the 'perimenopause', can start several years before menopause, during which time women have declining fertility and fluctuating hormone levels. Many of the symptoms associated with menopause, such as hot flushes and mood swings, are caused by these fluctuating hormone levels.
Post-menopause refers to the time following menopause, and lasts for the rest of your life.
When does menopause occur?
Menopause usually occurs between the ages of 45 and 55 — the average age is 51. However, it can occur earlier or later than this — every woman is different. If you are a smoker, you may reach menopause a year or 2 earlier than non-smokers. Also, there are certain medical conditions and treatments that can cause premature menopause (menopause before the age of 40) or early menopause (menopause between 40 and 45).
Causes of premature and early menopause include:
- cancer treatments such as chemotherapy and radiotherapy;
- premature ovarian failure, which sometimes runs in families; and
- surgery that involves removal of the ovaries. (Removal of the uterus means that you no longer have periods, but you shouldn’t experience menopausal symptoms if your ovaries are intact. Nevertheless, women who have had their uterus removed may experience menopausal symptoms a year or 2 earlier than expected.)
Is it possible to become pregnant during the perimenopausal stage?
While the chances of becoming pregnant during perimenopause are fairly low, it is possible. Until you have reached menopause (i.e. at least a year has passed since your last period, or at least 2 years if you are aged under 50), you should use contraception (birth control).
If you have been taking the oral contraceptive pill (OCP, or 'the pill'), you should talk to your doctor about whether this is still appropriate, because it may be associated with health risks when taken during the postmenopausal years. What's more, you may not realise that you've reached menopause, because taking the pill can mask the symptoms. Consider stopping the pill if you’re older than 50 years of age.
And remember, even if you’ve been through menopause, it's still possible to contract sexually transmitted diseases (STDs). If you have a new sexual partner, consider using condoms to protect yourself.
Do I need to keep having cervical cancer screening tests after menopause?
It’s important for women who've ever had sex to continue having regular cervical cancer screening tests after menopause, especially since the risk of cervical cancer increases with age. This is what Pap smears were for, but they have been replaced by Cervical cancer screening with human papillomavirus (HPV) tests. These new tests are generally recommended once every 5 years until the age of 74 years.
What are some of the common symptoms associated with menopause?
A change in your periods - irregularity and heavier or lighter blood flow - is one of the main indications that you are heading for menopause. Other common symptoms include hot flushes, sleep disturbances and vaginal dryness.
Vaginal dryness can cause pain or discomfort during intercourse, as well as increase your risk of developing a vaginal infection. A water-based vaginal lubricant or oestrogen cream or tablet can be used to treat vaginal dryness. Maintaining an active sex life can also help with vaginal discomfort because it helps maintain the elasticity of the vaginal walls. And although your libido may decrease, most women who enjoyed an active sex life before menopause continue to enjoy sex afterwards.
Urinary symptoms, including problems with bladder control, a burning feeling when you urinate, and an increased risk of urinary tract infections, are also common. Performing pelvic floor muscle exercises may help if you are having trouble with bladder control.
Some women suffer from mood swings, concentration problems or trouble with their short-term memory, but these symptoms are not always due to hormonal changes - they may also be related to stress and sleep deprivation. Also, some major life changes that often occur around the age of menopause (e.g. death of elderly parents, children leaving home, and retirement) can contribute to you feeling irritable and down.
Do all women experience troublesome menopausal symptoms?
Most women experience at least some symptoms around the time of menopause, but the type, frequency and severity of symptoms can vary considerably from woman to woman.
What is a hot flush and what can I do to treat it?
A hot flush is described as a warm or hot feeling that often starts in the chest or shoulders and moves up to the face and neck. Hot flushes sometimes result in red and flushed skin, or heavy sweating followed by chills. They usually last from 30 seconds to about 5 minutes.
To prevent hot flushes, avoid triggers such as alcohol, caffeine and spicy food. Regular exercise and some herbal remedies may also help. Hormone replacement therapy (HRT) - also known as hormone therapy (HT) - can be used to treat hot flushes in the short term, and is generally regarded as the most effective treatment.
Will I put on weight around the time of menopause?
Many women put on a small amount of weight around the time of menopause, especially around the abdomen (rather than around the hips and thighs). But this is not necessarily due to the hormonal changes alone - diet and reduced physical activity can play a big part.
What can I do to improve my sleep?
Try to get at least 30 minutes of physical activity each day, but don't exercise just before you go to bed. Also, avoid caffeine and alcohol in the evenings, because they can disrupt your sleep. Try not to sleep during the day, and make an effort to go to bed around the same time every day.
How can mood swings be treated?
Lifestyle adjustments such as fitting some physical activity into each day and getting enough sleep can help. You might also want to try relaxation techniques. If lifestyle changes on their own aren't enough, ask your doctor about trying a mood-stabilising medicine or going to a support group.
How long will my symptoms last?
Menopausal symptoms may last from several months to several years. While some symptoms, such as hot flushes and mood swings, should disappear with time, urinary symptoms and vaginal dryness can continue to be a problem throughout the postmenopausal years.
Can menopause cause depression?
Depression can affect some women around the time of menopause, but it does not seem to be any more common than in other age groups. There is no evidence that a fall in your oestrogen level on its own causes depression. However, some women do experience transient mood swings, and hormonal fluctuations can make you more vulnerable to stress.
Are there any tests that can determine whether symptoms are due to menopause or another medical condition?
Usually, a history of typical menopausal symptoms is all that is needed to determine whether you are heading for menopause. Blood tests to check the levels of various hormones can be done, but many need to be done at certain times of the month to be of any value, and in most cases are not necessary. However, tests are used to determine whether younger women with symptoms are going through menopause prematurely, or whether there is another explanation for their symptoms.
Are there any treatments for menopausal symptoms?
There are many treatments available to help relieve troublesome symptoms associated with menopause, including medicines that your doctor can prescribe, lifestyle changes, and herbal or complementary therapies. But many of the herbal and alternative therapies have unproven safety and effectiveness, so make sure you talk to your doctor, who can recommend the best treatment options for you.
Sometimes, it can take a bit of trial and error before finding the treatment that works best for you - every woman is different and experiences her own range of symptoms, so a treatment that works for one woman may not work for another.
What is HRT?
Hormone replacement therapy (HRT), which replaces the hormones that your ovaries are no longer producing, is well recognised as the most effective treatment for menopausal symptoms. HRT can be taken as a pill, skin patch, implant or gel. There are also intra-vaginal hormone replacement treatments (creams or tablets) that specifically treat vaginal dryness.
Most women need to take combined hormone replacement therapy - HRT that contains both oestrogen and progestogen (the synthetic form of the hormone progesterone), because oestrogen on its own may increase the risk of developing cancer of the lining of the uterus. (Women who've had their uterus removed can take oestrogen on its own.)
Is HRT safe?
HRT can be used for a short period (1-5 years) to treat symptoms such as hot flushes, vaginal discomfort, sleep disturbances and mood swings. It was previously thought that longer-term use of HRT could help prevent certain conditions that are more common in women who've been through menopause. But evidence has since demonstrated that long-term use of HRT may slightly increase your risk of some health problems, including breast cancer and blood clots. It has also been suggested that long-term HRT might be associated with an increased risk of heart disease, but this is still unclear, so the true effect of HRT on the heart remains unknown at this stage.
So while short-term use of HRT is generally considered safe for most women, it is no longer recommended for long-term use because the potential for harm outweighs any benefits.
Can all women try HRT?
Some women should generally not take HRT because of pre-existing medical problems, such as breast cancer, previous stroke or heart attack, blood clots or liver disease. Talk to your doctor about whether or not HRT is a suitable treatment option for you.
Are there any other medicines that I can take for my symptoms?
Tibolone (brand names Livial, Xyvion), a hormonal treatment, may improve hot flushes, urinary symptoms and sexual function. Clonidine (Catapres), a medicine typically used to treat high blood pressure, may reduce the frequency of hot flushes.
What are phytoestrogens and can they help treat menopause symptoms?
Phytoestrogens are weak oestrogen-like substances that occur naturally in certain plants. There are 2 main types - isoflavones (which are found in soybeans, chickpeas and other legumes) and lignans (which occur in flaxseeds (linseeds), whole grains and some fruits and vegetables). Phytoestrogen supplements are also available (e.g. Promensil tablets, which are based on active isoflavones extracted from red clover; and Phytolife and Menopause Support which are based on soybean extract). While some women find that phytoestrogens help relieve hot flushes, studies have not proven their effectiveness or safety for long-term use.
What about other complementary therapies?
Other complementary and alternative (CAM) treatments that claim to relieve menopausal symptoms include dong quai, evening primrose oil, ginseng and wild yam (natural progesterone cream). Black cohosh is a herbal remedy that is reported to relieve hot flushes and improve mood, and vitamin E supplements may help mild hot flushes. At the time of writing, there is no proof of long-term effectiveness or safety with any of these therapies. In addition, black cohosh has been associated with liver problems in some people.
Always check with your doctor before taking any alternative treatments, because some herbs and plants have drug-like qualities, and can cause side effects or interact with other medicines you may be taking.
Am I at risk of any medical conditions after going through menopause?
After menopause, there is an increased risk of developing certain conditions such as osteoporosis and heart disease. This is both because of reduced oestrogen levels (which decrease dramatically after menopause) and increasing age.
While HRT is no longer recommended to prevent these conditions, there are steps you can take to help protect yourself. Getting plenty of exercise, eating a balanced diet (i.e. one that’s low in saturated fats, oils and sugar, and high in fruit, vegetables and whole grains), giving up smoking and maintaining a healthy weight all reduce your risk of heart disease.
You can reduce your risk of developing osteoporosis by including plenty of calcium in your diet - 3 to 4 serves of dairy per day is recommended - and participating in weight-bearing exercise (e.g. walking). Calcium and vitamin D supplements can also lower the rate of bone loss, and there are medicines available that can be used to prevent and treat osteoporosis. These include bisphosphonates, such as alendronate (e.g. Fosamax, Adronat, Alendro), risedronate (e.g. Actonel) and zoledronic acid (Aclasta, Zometa), and raloxifene (Evista).
Is it normal to have vaginal bleeding after menopause?
While it's common to have changes in the frequency and flow of your periods leading up to menopause, you should see your doctor if you experience any bleeding or spotting once you have reached menopause. You may need to have some tests to find out what's causing the bleeding.
A good understanding of menopause symptoms and the different treatment options available can help you better manage and cope with menopause.
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