What is menopause?
Menopause is the time in a woman’s life when her periods stop for good. Menopause is said to have occurred after a woman goes 12 full months without having any periods. The time when you still have periods but also start to get menopause symptoms until the time when you eventually have no periods at all is known as the perimenopause.
There are 2 main ways that menopause occurs.
- Natural menopause usually happens between the ages of 45 and 55 years (the average age is 51). However, early (premature) menopause can occasionally happen before 40 years of age.
- Artificial menopause occurs when the ovaries have been removed surgically or are affected by cancer treatment.
What happens during menopause?
During menopause, your body stops preparing for a baby every month: your ovaries stop releasing eggs, they make less and less of the female hormones oestrogen and progesterone, and eventually your periods stop. The ovaries do not decline at a steady rate, with the ovarian decline being interspersed with episodes of normal function. This explains why the menstrual cycle can become irregular and why other symptoms of the menopause might fluctuate.
What will I feel?
For one-third of women, the only effect they will notice when they are approaching the menopause is a change in their periods. Their periods may get shorter, longer, lighter or heavier. They may occur closer together, or further apart. Eventually, periods will stop altogether. However, because the female hormones affect other parts of your body, you may also have some of the following symptoms.
- Hot flushes: these feel like someone has poured hot water into your veins. They usually rise from your chest and cover your face and neck, or you may experience a sudden feeling of heat all over. Many people feel embarrassed and think others will notice, but it’s not usually obvious.
- Sweats often go with flushes and are common at night.
- The walls of your vagina and vulva may become thinner due to lack of oestrogen. This can lead to dryness in your vagina and can result in uncomfortable sex.
- You may experience more bladder infections and find that you occasionally wet your pants (incontinence), especially when you laugh or sneeze, or find that you have to urinate more urgently or more often.
- You may have disturbed sleep, especially if you experience night sweats.
- You can feel tired, irritable, depressed, tearful or angry. This can be from hormonal changes, because you are not sleeping well or because you are adjusting to change.
- Your skin may look more tired and be less firm and the hair on your head, armpits and legs may get thinner.
Other effects of reduced oestrogen levels
- The reduction in oestrogen levels in your body can lead to bone loss, often resulting in osteoporosis. Although you will probably feel no symptoms, as you get older, your bones start to get thinner and more brittle and may be more likely to fracture as a result of a fall.
- Before menopause, oestrogen may help protect the heart from disease. After menopause, when the body’s levels of oestrogen decrease, the risk of heart disease and stroke increases. However, it is not known if this increased risk is solely due to reduced oestrogen levels.
How do I know I am going through the change?
Your periods will change and eventually stop and you may have some or all of the problems mentioned above. A lot of women notice these problems, even before there have been changes in their periods. Your doctor may do a blood test to see what is happening to your hormones; however, because the decline in the function of the ovaries can fluctuate, a blood test does not always truly reflect whether or not you are experiencing the menopause.
What makes menopause symptoms better?
The main treatment for menopause symptoms is hormone replacement therapy (HRT), also called hormone therapy (HT), prescribed by your doctor. HRT is available as tablets, patches, implants and gels. Although there are some concerns about the effects of long-term use of HRT, it is still recommended as an effective and safe treatment for short-term use for relief of menopause symptoms, that is, 3 to 5 years.
Other approaches that may help alleviate menopause symptoms are:
- understanding that menopause is a normal part of life and allowing yourself some time to adjust, think about things and pamper yourself;
- having support from others, especially your partner — help them understand what is happening;
- using relaxation and stress-reducing techniques such as meditation;
- using a cream from the chemist or doctor to help control vaginal dryness;
- exercising regularly and keeping fit — weight-bearing exercise (such as walking) is good for your bones, while pelvic floor exercises can help incontinence;
- keeping your weight down and eating a diet low in fat, sugar and salt but high in calcium and fibre — this could help protect your bones, joints and heart;
- stopping smoking;
- getting more sleep; and
- counselling — this may help if you are emotionally distressed.
Researchers are looking at whether eating phyto-oestrogens (natural plant oestrogens contained in foods such as soy beans, tofu, whole grains and beans) helps menopause symptoms. So far, they do not seem to reliably alleviate hot flushes. However, these foods are healthy and low fat, so are generally good choices.
Complementary therapies for menopause symptoms
Few good-quality studies have been done to evaluate complementary therapies for menopause symptoms. Despite the advertising claims, very little reliable scientific evidence exists for the effectiveness of many herbal products in relieving menopausal symptoms, including vitamin E, dong quai, evening primrose oil and wild yam cream. Studies of the effectiveness of black cohosh in alleviating the symptoms of hot flushes have had mixed results, and there have been rare reports of liver damage from this product. Ginseng may help with some menopause symptoms such as mood changes and insomnia, but it has not been shown effective for hot flushes.
Isoflavone supplements (a type of phyto-oestrogen derived from soy or red clover) have shown mixed results when it comes to relieving menopause symptoms. These supplements have a weak oestrogen-like effect, and it is not clear whether they are safe for women who have or who have had breast cancer — especially those taking tamoxifen, a medicine that blocks oestrogen. The Cancer Council Australia recommends that women who have or who have had breast cancer should be cautious in consuming large quantities of soy foods or phyto-oestrogen supplements.
Be aware that some herbal products may have adverse effects or interact with prescription medicines.
So far, neither reflexology, acupuncture nor magnet therapy have been proven to benefit menopause symptoms.
What makes menopause symptoms seem worse?
- Being stressed, overtired and anxious.
- Drinking too much coffee, tea or alcohol.
- Consuming hot drinks and spicy foods, which can make the flushes worse.
How can my doctor help?
Apart from HRT given as tablets, patches, gels or implants, your doctor can prescribe oestrogen in the form of creams or pessaries to help vaginal dryness and improve vaginal muscle tone.
Bio-identical hormones are prescribed by some doctors in the form of troches or lozenges. Although the name sounds natural, they are made synthetically by compounding pharmacists using a process similar to that used for making the oral contraceptive pill. The manufacture of bio-identical hormones is not currently regulated by the Therapeutic Goods Administration, and there are concerns that these hormones have not been properly researched and could have similar risks to conventional HRT.
Your doctor may prescribe a low dose of antidepressant medicine to help with disturbed sleep, if required.
If you are at risk of thinning bones you may be advised to take calcium supplements, have a bone mineral density test and possibly be prescribed other medicines to help prevent bone loss. Some people may also need vitamin D supplements if they don’t get enough exposure to sunlight — your doctor will be able to advise on this.
Until your periods have stopped for more than a year, it is still possible to become pregnant, so ask your doctor about birth control. This is a good time to have a general health examination, including checking your blood pressure and having a cervical smear, breast examination, mammogram, and possibly a bone density scan, depending on your level of risk for osteoporosis. You should ask your doctor about how to look after your health over the coming years.
What happens if menopause isn’t treated?
Menopause is a normal part of life, and many women get through this time without treatment. The need for treatment depends how much the symptoms affect your life, and how concerned you are about possible bone or heart problems later. There are many other things that raise or lower your risk of having these problems, so discuss them with your doctor.
Most symptoms, such as flushes and disturbed sleep, decline in time and disappear in a few years. You can lower your risk of osteoporosis and heart problems by living a healthy life with a good diet and regular exercise.
This is an important time for you to plan the next phase of your life. While some women feel sad at this time, many others feel they get a new lease of life. They enjoy having no periods and no more worries about pregnancy. Many feel more confident, that they have ‘come into their own’.
2. Cancer Council Australia. Soy, phyto-oestrogens and cancer prevention [position statement]. Sydney: Cancer Council Australia; 2009. Available from: http://www.cancer.org.au/Healthprofessionals/PositionStatements/nutritionandphysicalactivity/Soyphytooestrogensandcancer.htm (accessed Oct 2009).