The menopause happens when your ovaries stop producing eggs and is said to have occurred if you have not had a period for 12 months. It can vary in how it occurs with some people experiencing gradually changing periods, or missed periods, and others finding a sudden end to their periods. Once you have had one year without a period it can be confirmed that you have gone through the menopause. Natural menopause is due to increasing age, where over time your ovaries producing less of the hormone oestrogen which in turn means your ovaries don’t release an egg (so you can no longer conceive naturally) and your periods subsequently stop. It happens to all women, however, when exactly menopause occurs, and the symptoms people experience during this time vastly differ.
In the UK, the average age of menopause is 51 and is said to be early if it occurs before the age of 45. Around 1% of will go through premature ovarian insufficiency, which is defined as the menopause occurring before the age of 40. You may also experience menopause due to having had surgery to remove your ovaries, having radiotherapy around the area of your ovaries, some chemotherapy treatment, or certain medical conditions.
About 80% of women experience symptoms of the menopause, and up to a quarter have severe symptoms. They can occur months or years prior to your last period and can last a similar amount of time afterwards. The main symptoms of menopause include hot flushes (in about 75% of women), changes in your mood or irritability levels, a reduced sex drive, vaginal dryness and difficulty sleeping or increased tiredness. One or a combination of the symptoms may be experienced and there can be a huge range of severity.
Just as a side note, if you have had a hysterectomy (your womb removed) but not your ovaries, you can still experience the symptoms of menopause just without the classic sign of your periods stopping as your will already not be experiencing periods.
If you are experiencing severe symptoms there are various treatment options to help with these. The treatments may focus on one particularly bothersome symptom or a variety of symptoms. They can include medications, talking therapy, lifestyle focussed changes, or a general hormonal treatment. Hot flushes, mood disturbance, and vaginal dryness are examples of some of the specific symptoms that can be addressed.
One of the treatment options is HRT (hormone replacement therapy) which replaces the oestrogen that has decreased naturally and is causing your symptoms. Depending on the symptoms, HRT can be taken orally in the form of tablets, as skin patches, gels or if your symptoms are specifically vaginal dryness then treatment can be via vaginal pessary, cream, or a vaginal ring. HRT, as with any medication, comes with its own risks and your doctor will discuss these with you prior to you commencing on it.
Postmenopausal women are at a higher risk of heart problems and also weakening of their bones known as osteoporosis as oestrogen helps keep bones strong and helps protect the heart. Because of this, especially around menopause and after, it is important to eat healthily, exercise regularly and avoid smoking or excessive alcohol to help prevent bone or heart issues. Having enough calcium in your diet and also getting enough vitamin D can also help protect your bones.
There is a small chance of getting pregnant as you go through the menopause so if you are not trying to get pregnant you should still use contraception if you are sexually active until 2 years after your last period if you are 50 years old or under, or a year after if you are over 50.
It is best to get the menopause diagnosed by your doctor through a routine doctor's appointment. They can diagnose it by listening to your symptoms and sometimes may do a blood test for more information.
There are other medical conditions that can stop your periods from occurring. It is important to see your doctor if your periods stop before you are 45, if you are having symptoms that are not the typical menopausal symptoms, or if you have had significant changes to your usual menstrual bleeding. If you are experiencing severe menopausal symptoms you should also see your doctor in order for them to discuss treatment options with you.
If you have started bleeding again after you are post-menopausal (one year of having no periods) you should book to see your doctor. This is because bleeding after the menopause usually needs investigating to ensure the lining of the womb (endometrium) is not abnormal.
Your doctor will ask you about your medical history and your current symptoms. If you are comfortable, they will also ask you about your periods and if they have stopped, when your last one was. They will take baseline health measurements such as blood pressure and they may also do a blood test. They will then discuss any treatment options with you if you require it.
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