Menopause is the stage in a woman’s life when she stops having periods. Menopause is a natural life event. It follows the perimenopause, or menopause transition, which is the time from the onset of menopausal symptoms, through to 12 months after the last menstrual period. This transition can last up to 5 or 6 years.
For many women, these changes will have little impact on their lives; however, some women may experience symptoms severe enough to affect their health and well-being, and disrupt their lives. Some women might feel anxious about reaching the menopause and mourn the loss of their fertility and youth. For others the menopause can mean a new lease of life, free from concerns about periods, premenstrual syndrome or pregnancy.
When do women reach menopause?
Women reach menopause at different ages, but most women stop menstruating between the ages of 45 and 55. Early menopause is when a woman stops having periods before the age of 45 and premature menopause is when a woman has her last period before the age of 40. Premature menopause may happen naturally or it may be brought about by medical treatments affecting the ovaries such as surgery, radiotherapy or chemotherapy.
What happens when you approach menopause?
Before the menopause the ovaries release ova (eggs) and produce the hormones oestrogen and progesterone, as well as small quantities of testosterone. As a woman approaches menopause, the production of these hormones fluctuates and slows down. The fluctuating levels of oestrogen are thought to cause most perimenopausal symptoms. The ovaries stop releasing ova and eventually periods stop. After the woman’s last period the amount of oestrogen produced in her body is much lower.
What might women experience at menopause?
During perimenopause periods commonly change. Periods may end suddenly, but more often become irregular, or heavier and longer before eventually stopping. Other physical effects may include:
- Hot flushes or sweats. Hot flushes may be associated with sweating, palpitations, and a sudden ‘wave of heat’, especially around the neck and face, or a ‘crawling’ feeling under the skin. Sweating may be more noticeable at night, disturbing sleep.
- Vaginal discomfort and dryness - the lining of the vagina becomes thinner and less elastic, and there may be less vaginal lubrication. This may cause intercourse to be uncomfortable or less enjoyable.
- Urinary problems - reduced elasticity in the muscles may affect bladder tone and cause urine to be passed frequently or when coughing or sneezing.
- Dry skin, increased facial hair, joint pain, loss of breast tissue
Emotional or psychological changes may include:
- Symptoms of depression, anxiety, mood swings, tiredness, lower sex drive, and poor concentration or memory. These emotional symptoms might also be due to life stresses such as children leaving home, ageing or death of parents, changes in employment, health or relationships which commonly occur around the same time as menopause.
What are the long-term effects of menopause?
CARDIOVASCULAR DISEASE: Before menopause women are less likely than men to suffer from heart disease or strokes. The rates of these conditions increase after menopause, and by the age of 65, the rates in men and women are equal. Almost 50% of women die from cardiovascular disease.
OSTEOPOROSIS: Osteoporosis is characterised by thinning of the bones, leading to a greater chance of a fracture occurring, particularly in the hip, spine and wrist. Loss of oestrogen after the menopause is the major cause of osteoporosis. Factors that may increase a woman’s risk of osteoporosis include:
- Early menopause, a thin build, anorexia, excessive exercise
- Family history of osteoporosis
- Long term use of some medications such as cortisone, anticonvulsants, some antacids, and some diuretics
- Lifestyle factors such as smoking, high intake of alcohol and caffeine, low calcium diet, and lack of exercise
What can women do to manage menopause?
Information and support: Women may benefit from understanding what is happening to their bodies. Discussing menopause with other women can also be helpful. Partners and other family members will find it easier to be supportive if they understand what happens during menopause.
Women can also go online to the Australasian Menopause Society to access good evidence based information on many aspects of menopause, explore some self-assessment tools, look over book reviews and find menopause doctors in their area.
Diet and Exercise: Regular exercise and a healthy diet are helpful in maintaining or improving overall health and feelings of well-being. A diet that is low in fat, salt and sugar, but high in calcium and fibre may help prevent osteoporosis and heart disease and maintain a healthy weight.
Stress management: Relaxation helps maintain physical and mental health so it may be useful for women to learn relaxation techniques and try to make time for themselves.
Hot flushes: Within reason, try to avoid situations that may trigger hot flushes. These include emotional situations, smoking, changes in temperature, eating hot spicy foods, and drinking caffeine or alcohol. Layer clothing so top ones can easily be removed when necessary.
Professional help: Professional help may include assessment, information, counselling, medical treatments and/or alternative therapies. Medical treatments include horone replacement therapy (HRT). HRT is the most effective treatment for the symptoms of menopause, and is also believed to be beneficial for bone health and may decrease mortality from Cardiovascular disease.
The Canberra Menopause Centre, based at Sexual Health & Family Planning, is a dedicated service for those seeking information, support, and medical management of menopause, It is staffed by experienced female doctors who have a special interest in this area. The doctors at the Canberra Menopause Centre can provide a full assessment and discuss your individual needs to assist you managing the symptoms of menopause or in deciding which therapy is best for you.
What about sexuality after menopause?
Interest in and feelings about sex sometimes change in midlife. Generally, if sex has been important and enjoyable in a woman’s younger years it will continue to be in her middle and later years. The quality of a woman’s relationship with her partner will also affect her feelings about sex. Sexuality involves more than just intercourse, it is enhanced when partners feel good about themselves and feel loved, and loving.
If physical changes such as vaginal dryness and thinning of vaginal walls lead to discomfort during sex, then vaginal lubricants, the use of topical oestrogen in the form of cream or pessaries, or HRT can be very helpful.
Is contraception still necessary after menopause?
To prevent pregnancy it is important to continue using a reliable method of contraception for at least 1 year after the last period, if this occurred after the age of 50; and for 2 years after for women whose last period occurred before the age of 50. This is a guideline only, and it is recommended that advice be sought from a SHFPACT doctor or your GP. If a woman has been taking the Pill or HRT before her periods have stopped it may not be clear if she has reached menopause, and professional advice should be sought.
What about other health checks?
All women should have a regular general health check-up. Cervical Screening Test is recommended every 5 years (you should have your first Cevical Screening Test two years after your last test, if it was a Pap smear). Breast screening is recommended every 2 years. National breast screening programs accept women for mammography screening for breast cancer from the age of 50.