Overview
Menopause is the point at which periods stop for good, because the ovaries no longer release eggs and make much less of the hormone oestrogen. It is confirmed after twelve months without a period. Most women reach it between the ages of 45 and 55.
The years of change leading up to it are called the perimenopause. Periods become irregular and hormone levels swing about, which is when most symptoms begin. Menopause before the age of 40 is called premature ovarian insufficiency and should always be assessed.
Symptoms
- Periods that come closer together or further apart, and are lighter or heavier
- Hot flushes, when the face, neck and chest suddenly feel very hot
- Night sweats and broken sleep
- Low mood, anxiety, irritability or mood swings
- Trouble with memory and concentration
- Vaginal dryness, itching or discomfort during sex
- Needing to pass urine more often, or symptoms like a urine infection
- Aching muscles and joints, headaches, palpitations, thinning hair and reduced interest in sex
Symptoms usually last for seven to nine years, sometimes longer, and they change over that time.
When to see a doctor
See a doctor in the next few days for any vaginal bleeding after twelve months with no period, for bleeding between periods or after sex, for periods that have become much heavier, or if periods stop before the age of 45. Book an appointment too if flushes, sleep, mood or vaginal dryness are affecting daily life, because there is treatment for all of these.
Causes
Natural menopause happens as the supply of eggs in the ovaries runs low and oestrogen falls. It can also be brought on by an operation to remove both ovaries, or by or . Sometimes the ovaries stop working early for reasons linked to the immune system, to genes, or for no reason that can be found.
Risk factors
Menopause comes to everyone who has periods. These are linked with it arriving earlier:
- Smoking
- Surgery to remove both ovaries
- or to the pelvis
- A mother or sister who had an early menopause
- Some autoimmune and genetic conditions
Complications
- Thinner, weaker bones, which raises the chance of fractures later
- A rise in the risk of heart and circulation problems after the menopause
- Vaginal dryness and urinary symptoms, which tend to persist without treatment
- Weakening of the pelvic floor, which can lead to prolapse
- Long-standing low mood, anxiety and poor sleep
Prevention
Menopause cannot be prevented, and it does not need to be. What can be reduced is its effect on the bones and the heart: regular walking or other weight-bearing activity, strength work, enough calcium and vitamin D, not smoking, limiting alcohol and keeping , sugar and in check.
Diagnosis
In a woman over 45, the diagnosis is usually made from her age and her symptoms, without any test. Blood tests that measure hormones such as FSH are used mainly when symptoms start younger, or when the picture is unclear, because levels swing from day to day during the perimenopause. Thyroid problems and anaemia can look similar, so those are sometimes checked too.
Treatment
Treatment is offered when symptoms affect daily life, and it is a choice, not a duty.
- Hormone replacement therapy: oestrogen as a patch, gel, spray or tablet, with a progestogen for women who still have a womb
- Oestrogen used in the vagina as a cream, pessary or ring for dryness and urinary symptoms
- Talking therapy, which is offered for hot flushes, night sweats and low mood
- Non-hormonal medicines, including some antidepressants, for flushes or low mood
- Regular sleep, exercise, cooler clothing and cutting down on alcohol, caffeine and spicy food
- Vaginal moisturisers and lubricants for comfort during sex
Herbal products sold for the menopause have little evidence behind them, their strength varies, and some interact with prescribed medicines, so tell the doctor about anything you are taking. Because periods can still return during the perimenopause, it is worth asking about contraception as well.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Menopause means a woman's health and her interest in life are over.”What is true?
Fact
Menopause is one stage of life, not the end of health or of enjoyment. Symptoms can be treated, sex can stay comfortable with simple measures, and many women feel well once the change settles.
Myth“Hot flushes, poor sleep and low mood are all in the mind.”What is true?
Fact
These come from real changes in hormone levels, not from imagination or weakness. They are recognised symptoms, and there are both hormonal and non-hormonal treatments, including talking therapy for flushes and low mood.
Myth“A little bleeding after the menopause just means the periods are coming back.”What is true?
Fact
Periods do not restart once the menopause is complete. Any bleeding after twelve months without a period, even light spotting, needs to be checked, because it can be a sign of cancer of the womb, which is very treatable when found early.
Myth“Hormone replacement therapy is dangerous for everybody.”What is true?
Fact
The balance of benefits and risks depends on a woman's age, health and the type used, so it is a decision to make with a doctor rather than a blanket rule. Low-dose oestrogen used in the vagina for dryness works differently from tablets or patches taken for whole-body symptoms.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long will the symptoms last?
Symptoms commonly carry on for seven to nine years, and for some women longer. They usually change over that time, often easing as the years pass. Treatment can be started, changed or stopped at any point.
I am 42 and my periods have stopped. Is this the menopause?
It may be, but menopause before 45 is early and before 40 is earlier still, so it should be checked rather than assumed. The doctor will ask about other causes, may do blood tests, and will discuss treatment, because low oestrogen at a young age affects the bones and the heart over time.
I bled a little, eight months after my last period. Is that serious?
Bleeding during the perimenopause is common, but bleeding after twelve months with no period is different and always needs checking. Either way, tell a doctor about it. Most causes turn out to be harmless, and the ones that are not are best found early.
Sex has become painful. Is there anything that helps?
Yes, and this is one of the most treatable menopause symptoms. Vaginal moisturisers and lubricants help, and low-dose oestrogen used in the vagina works well for dryness and soreness. It is worth raising even though many women find it awkward to mention.
