The menopause, also known as the 'change of life' is the end of menstruation. This means a woman's ovaries stop producing an egg every four weeks. She will no longer have a monthly period or be able to have children.In the UK, the average age for a woman to reach the menopause is 52, although women can experience the menopause in their 30s or 40s.
If a woman experiences the menopause when she is under 45 years of age, it is known as a premature menopause.
Menstruation (monthly periods) can sometimes stop suddenly when you reach the menopause. However, it is more likely that your periods will become less frequent, with longer intervals in between each one before they stop altogether.
Causes of the menopause
The menopause is part of the natural ageing process and is caused by a change in the balance of the body's sex hormones.
Upon reaching the menopause, oestrogen levels decrease, which causes the ovaries to stop producing an egg each month (ovulation). Oestrogen is the female sex hormone that regulates a woman's periods.
Most women experience the menopause when they are 45-55 years of age. The average age for the menopause to occur is 52.
Early menopause
It is possible, though rare, for some women to experience the menopause before they reach 45 years of age. This is known as premature ovarian failure.
Premature ovarian failure can occur at any age and in many cases there is no cause.
However, not all women who experience premature menopause find their periods stop completely. A small number of women still have intermittent ovarian function, which means that their ovaries will occasionally release eggs and they may still be able to conceive.
Possible causes of premature ovarian failure include:
Surgery to remove ovaries or womb (hysterectomy)
Certain types of radiotherapy or chemotherapy
In rare cases, some infections, such as tuberculosis, mumps, malaria, varicella (the virus that causes chickenpox and shingles) and shigella (a type of bacteria that causes dysentery)
Certain medical conditions, such as enzyme deficiencies, Down's syndrome, Turner syndrome, Addison's disease and hypothyroidism (an underactive thyroid gland)
Symptoms of the menopause
The menopause can cause a wide range of physical and psychological symptoms. The first symptom is usually a change in the pattern of your monthly periods.
The start of the menopause is known as the perimenopausal stage. During this time, you may have light or heavy periods.
The frequency of your periods may also be affected. You may have a period every two-three weeks, or you may not have one for months at a time.
Other menopausal symptoms include:
Hot flushes and night sweats
A hot flush is a sudden feeling of heat in your upper body, which can start in your face, neck or chest, before spreading upwards and downwards.
The skin on your face, neck and chest may become red and patchy and you may start to sweat. You may also feel a change in your heart rate. It may become very rapid, or it may be irregular and stronger than usual (palpitations).
Hot flushes that occur at night are called night sweats. Most hot flushes only last a few minutes and they are most common in the first year after your final period.
Sleep problems
Many menopausal women have trouble sleeping due to night sweats, but sleep disturbances may also occur as a result of anxiety.
You may find that a lack of sleep makes you irritable and that you have problems with your short-term memory and ability to concentrate.
Vaginal symptoms
During the time leading up to the menopause, you may experience vaginal dryness, itching or discomfort. This can make sex difficult or painful (dyspareunia). These symptoms combined are known as vaginal atrophy.
About a third of women experience the symptoms of vaginal atrophy shortly after the menopause, with slightly more women having them later on. In some cases, vaginal atrophy can persist for more than 10 years after your final period.
If you have vaginal symptoms, it is likely that they will continue or get worse over time unless they are treated.
Urinary symptoms
During the menopause, you are more likely to experience recurrent lower urinary tract infections, such as cystitis. You may also feel an urgent and frequent need to pass urine.
If you experience the menopause suddenly rather than gradually, your symptoms may be worse.
Your symptoms will usually last for two-five years before disappearing, although in some cases they can last longer. Vaginal symptoms, such as dryness, can sometimes persist and get worse as you get older.
Self-help advice for managing menopausal symptoms
Medication may not be necessary if you have reached the menopause and you do not have severe symptoms.
Many women are able to ease their menopausal symptoms by making simple changes to their lifestyle and diet.
Below is some self-help advice that may help ease hot flushes and night sweats and reduce sleep problems and mood changes.
To improve hot flushes and night sweats:
Take regular exercise
Wear light clothing
Keep your bedroom cool at night
Try to reduce your stress levels
Avoid potential triggers, such as spicy food, caffeine, smoking and alcohol
To improve sleep problems:
Avoid exercising late in the day
Go to bed at the same time every night
Read more about insomnia.
To improve mood changes:
Make sure that you get plenty of rest
Take regular exercise
Try relaxation therapies, such as yoga .
Many women do not need treatment for the menopause, with about one in 10 women seeking medical advice.
If your symptoms are mild, you may be able to manage them yourself, without medication. Read more about self-help for managing your menopausal symptoms.
However, if your symptoms are more severe and are interfering with your day-to-day life, medication may be recommended.
Treatment options include:
Hormone replacement therapy (HRT)
Tibolone (similar to HRT)
Clonidine
Vaginal lubricants
Antidepressants
Early menopause
A premature menopause is where a woman under 45 years of age experiences the menopause.
If you are under 40 years of age and you experience the menopause, your GP will refer you to a gynaecologist for treatment and to discuss your fertility (ability to conceive).
You will need treatment to ease your symptoms and prevent osteoporosis (brittle bones) which is more likely to occur as the level of oestrogen in your body decreases.
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