Menopause: what you can expect
What is menopause?
Menopause is defined as the time when your periods stop for good. It is a natural part of ageing and happens when your ovaries stop producing the female sex hormones oestrogen and progesterone. Oestrogen plays a key role in shaping your body and preparing it for pregnancy. It also has a number of other physiological effects — it stimulates the growth of your skeleton and helps maintain healthy bones, and also helps protect your heart and blood vessels.
At menopause, when oestrogen production stops, changes occur in the parts of your body that are oestrogen-dependent. This leads to symptoms which can be uncomfortable for some women. For those women who do get significant symptoms, a range of effective treatments is available, so it is important to talk to your doctor about your needs.
What is the perimenopause?
The period of time from when you start to get symptoms to when your periods eventually stop is known as the perimenopause. During the perimenopause the ovaries start to function erratically and decline in function. Your periods may become irregular and you may have symptoms of oestrogen deficiency, such as hot flushes, vaginal dryness and sweats. The perimenopause lasts about 4 years on average, until a woman’s very last period.
When does menopause occur?
The menopause itself is said to have occurred after 12 consecutive months of no periods. It happens between 45 and 55 years of age for most women, with an average age of 51. However, about 1 per cent of Australian women experience menopause before 40. Menopause before the age of 40 is called ‘early menopause’.
Certain factors are associated with early menopause. These include:
- being a smoker;
- having a family history of early menopause;
- never having had a baby;
- having a hysterectomy;
- having previous chemotherapy or radiation therapy for cancer; and
- early failure of the ovaries (this may be caused by certain genetic abnormalities, autoimmune disorders or metabolic disorders).
As opposed to natural menopause, an artificial menopause can occur if your ovaries are removed surgically, or if you have some types of chemotherapy or radiotherapy for cancer that can damage your ovaries. Sometimes in these cases menopause occurs suddenly rather than gradually and this can be distressing if you have not prepared yourself.
What are the signs of menopause?
The first thing you might notice is that your periods may become irregular — shorter or longer, with heavier or lighter bleeding, or varying lengths of time between periods. Of course, if you are noticing any changes in your bleeding, it is important you see your doctor to rule out any abnormal medical conditions.
You might notice your skin becomes drier or your waistline becomes thicker at the expense of your hips and thighs. The symptoms most people associate with menopause, however, are the following.
These are the most common reason women seek treatment. They are sudden sensations of heat that often rise from your chest to your face or neck. They can last anywhere from a few seconds to several minutes and often induce a sweat — sometimes they are followed by a chill. They often occur at night and disrupt sleep because your body temperature is constantly changing. Some women have them several times a day and they may go on for up to 5 years or more. They often start occurring before your periods stop and continue for a year or 2 afterwards. Some women find that hot weather, confined spaces, hot drinks, spicy foods or alcohol make them worse, while avoiding these things can help. Wearing layers of clothing that can easily be removed or replaced, learning meditation and relaxation techniques and cognitive behavioural therapy techniques can also help.
Vaginal dryness and urinary problems
Falls in oestrogen levels can cause the walls of your vagina to become drier and thinner, which can lead to itching, irritation or pain during intercourse. Weakening of the bladder and thinning of the opening of the bladder (the urethra) can also occur, resulting in leaking of urine when you laugh, cough or sneeze. Or you may get painful urination or the urge to go to the toilet more often. Your doctor or physiotherapist can show you pelvic floor exercises that should help improve muscle tone and reduce these problems. You may need to use a personal lubricant to make having sex easier and more comfortable. Hormone therapy (HT), also known as hormone replacement therapy (HRT), is also useful for relieving vaginal dryness.
Doctors believe oestrogen is important for memory and nerve functioning, with some (but not all) studies showing hormone therapy helps improve brain activity. Although many women experience mood changes around menopause, it is not clear whether these changes are linked to lower oestrogen levels or other issues which can coincide with this time in your life, such as career pressures, children leaving home or suddenly finding yourself caring for elderly parents. At present HT is not recommended for preventing or treating depression or dementia.
Other symptoms you may notice are:
- achy joints;
- disturbed sleep patterns;
- crawling feelings under the skin;
- light-headed feelings;
- weight gain;
- new facial hair; and
- changes in sexual desire.
However, you may not get all of these symptoms — or even any of them! Some women do not experience these adverse effects and aren’t aware of any other changes in their body.
For most women, symptoms do not last long, but you should be aware that the lower oestrogen levels after menopause do have long-term effects on some parts of your body and can contribute to some health problems.
What health problems are associated with menopause?
Osteoporosis (literally, porous bones) means the loss of bone mass and thinning and weakening of bone. Bone is a living tissue in a constant state of flux; the state of our bones at any time is a balance between the amount of bone being laid down and the amount of bone being re-absorbed into the body. Everybody has a slight imbalance after about the age of 30 due to the fact that the amount of bone being formed is not as much as the amount that is re-absorbed into the body. This leads to us slowly losing bone density. In women, however, at the menopause, bone turnover increases. This exacerbates the loss and the amount of bone formed cannot keep up with the amount lost and so the bones become thinner.
Other factors that increase your risk of osteoporosis include low calcium intake (for example, if you do not eat much cheese, milk and green vegetables), smoking, drinking lots of alcohol, and a lack of weight-bearing exercise. Watching your diet and doing weight-bearing exercise such as walking, jogging, and dancing can help prevent loss of bone mass. Hormone therapy reduces the risk of fractures due to osteoporosis, however, because of the risks associated with its long-term use, it is not a first-line treatment for preventing or managing osteoporosis.
Risk of heart disease
Women who have not gone through the menopause have a lower risk for heart disease than men of the same age. This is because oestrogen helps to lower a woman's cholesterol levels and improve the flow of blood through the blood vessels. But this advantage disappears after menopause when women stop producing oestrogen and their risk of coronary heart disease becomes almost the same as men’s. Because of the results of some studies which suggest that HT may increase the risk of heart disease in some women, HT is no longer recommended to help prevent or treat heart disease in menopausal women.
Hormone therapy (HT)
Hormone therapy (HT), also known as hormone replacement therapy (HRT), involves replacing the oestrogen and often the progesterone that your body is no longer producing, with pharmaceutical formulations of these hormones. Doctors may recommend HT for the short-term treatment of the symptoms of the perimenopause. HT is available in various forms — as tablets or skin patches for general symptoms, or as vaginal cream or pessaries for local vaginal and urinary symptoms. If you are considering trying HT, you should discuss your individual and family medical histories with your doctor, who will help decide whether treatment might suit you.
How can I make my menopause easier?
Each woman will experience menopause differently and there is no one treatment that will suit everyone. Menopause is an entirely natural phenomenon, not a disease, and many women experience no or minimal symptoms and require no specific treatment. However, for some women it can be a very unpleasant time. There are many things you can do to help yourself and make the transition easier. Here are some of them.
- Understanding that this is a normal part of life and allowing yourself time to adjust, and pamper yourself.
- Relaxing and doing anything which helps cut down stress.
- Exercising regularly and keeping fit. Weight-bearing exercise is particularly helpful for your bones.
- Eating a well-balanced diet and maintaining a healthy body weight.
- Talking to a counsellor if you feel it would help.
As menopause is a natural event, some women don’t want any medical intervention, while others try complementary and natural remedies. These include foods rich in plant oestrogens, foods rich in vitamins B and E, black cohosh, evening primrose oil and isoflavone supplements from either soy or red clover. Research into the possible benefits of such remedies is ongoing and some may not have any benefit at all. Also, ‘natural’ or ‘herbal’ remedies can have serious side effects just like other medicines. Black cohosh, for example, has been linked with several reports of liver damage.
Talk to your doctor and ensure he or she understands how you are feeling at this time. If you don’t feel comfortable talking to your usual doctor, you might prefer to visit a women’s health centre or Family Planning clinic. Discussing the options available to you will help you decide on the path that’s best for you based on your symptoms and needs.
Although some parts of the media and TV still seem determined to show menopausal women in a negative light, you should try to see inaccurate stereotypes for what they are and concentrate on taking control of your life. You may well find, as many women do, that you discover a new sense of freedom and enthusiasm at this time.
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5. BMJ Group [website]. Menopause: should I take HRT? (last published 2009, Mar 23). http://clinicalevidence.bmj.com/ceweb/index.jsp (accessed 2009, Nov 6)