An Overview of Menopause

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Published: 31 May 2021

What is Menopause?

Menopause marks the permanent end to a person’s menstrual cycle (AMS 2016.)

While menopause is mostly experienced between the ages of 45 and 55 (with an average age of 51), some people reach menopause early or late (Better Health Channel 2019).

  • Premature menopause is when menopause occurs before the age of 40
  • Early menopause is when menopause occurs before the age of 45
  • Late-onset menopause is when menopause occurs after the age of 55.

(Better Health Channel 2019; Obermair 2020)

Despite this, there is no set age for when menopause should begin - it depends on the individual (Obermair 2020).

A person is considered to be postmenopausal after 12 consecutive months without experiencing a period (AMS 2016).

Why Does Menopause Occur?

Females are born with one million eggs in each ovary. This decreases to 300 000 by the time they undergo puberty. After the onset of puberty, they will go on to experience approximately 400 to 500 menstrual periods, and after about the age of 35, their number of eggs will decrease more rapidly and ovulation will occur less often (Jean Hailes 2018).

It is thought that menopause is triggered by the ovaries running out of eggs completely, but the cause is not yet completely understood (The Women’s 2019).

Stages of Menopause

There are three stages of menopause:

  1. Perimenopause: The duration of time between the last few years leading up to the final period and the first year following. As menopause approaches, the ovaries reduce the production of oestrogen and progesterone (the female hormones) and hormone levels fluctuate. As a result, there may be changes in the menstrual cycle such as longer, shorter or irregular cycles, or lighter or heavier bleeding. Fertility is low in these final years, but pregnancy is still possible.
  2. Natural Menopause: The spontaneous, natural ending of menstrual periods (not caused by treatment or surgery), defined by 12 consecutive months without menstrual bleeding.
  3. Postmenopause: Life following the first year after the final period.

(The Women’s 2019; Better Health Channel 2019)

Menopause Symptoms

menopause irregular periods
Irregular periods is usually one of the first symptoms that occurs.

Most people will experience a variety of symptoms during the perimenopause and postmenopause phases.

The first symptoms are usually irregular periods, hot flushes and night sweats.

However, it is important to remember that no two people experience menopause in the same way - the specific symptoms experienced and their severity will depend on factors such as culture, health, lifestyle and whether menopause occurred naturally or was induced by surgery or chemotherapy (Jean Hailes 2018).

  • 20% experience no symptoms
  • 60% experience mild or moderate symptoms
  • 20% experience severe symptoms that impair daily functioning.

(Jean Hailes 2021b)

Possible symptoms include:

  • Vasomotor symptoms (i.e. hot flushes and night sweats), which affect about 80% of people
  • Sleeping problems due to vasomotor symptoms
  • Impaired memory and concentration due to disturbed sleep
  • Mood changes including low mood, depression, tearfulness and irritability, which affect about 10% of people
  • Vaginal dryness
  • Reduced interest in sex, libido or sexual responsiveness
  • Aches and pains
  • Headaches or migraines
  • Bloating
  • Itchy or ‘crawling’ skin
  • Fatigue
  • Breast pain or tenderness
  • Urinary frequency
  • Wakefulness.

(The Women’s 2019; Jean Hailes 2021b)

The decrease of female hormones also leads to long-term health risks, including:

  • Osteoporosis and consequently, an increased risk of fractures
  • Increased risk of heart attack, heart disease, high blood pressure and stroke.

(Better Health Channel 2019)

Vasomotor Symptoms (Hot Flushes and Night Sweats)

Vasomotor symptoms are commonly experienced during menopause. They are usually the most severe in the year around the final menstrual period (The Women’s 2019).

Hot flushes are characterised by a sensation of overheating that usually begins in the chest before spreading up to the head and neck. They can last from a few seconds to a few minutes and may be accompanied by sweating, skin reddening and a racing heartbeat (The Women’s 2019; Jean Hailes 2021b).

Some people may experience one hot flush per day, while others may experience more than 20 (Jean Hailes 2021b). Hot flushes may even continue for many years postmenopause (The Women’s 2019.

While the exact cause of vasomotor symptoms is not completely understood, it’s thought that reduced oestrogen levels interfere with the parts of the brain responsible for temperature regulation (Jean Hailes 2021b).

menopause vasomotor symptoms hot flush

Treatment of Menopause Symptoms

Hormone therapy (menopausal hormone therapy (MHT) or hormone replacement therapy (HRT)) is effective in relieving menopause symptoms such as vasomotor symptoms, mood swings, irritability, insomnia, joint aches and vaginal dryness (Healthdirect 2020).

MHT/HRT/HT is able to reduce vasomotor symptoms in about 80% of people, as well as reduce osteoporosis (The Women’s 2019).

It can generally be safely taken for up to five years but may increase the risk of breast cancer if used beyond that time period (The Women’s 2019).

It is not an appropriate treatment for those who have:

  • A history of oestrogen-dependent cancer (e.g. breast or uterine cancer)
  • Undiagnosed vaginal bleeding
  • Untreated uterine lining thickening
  • Unmanaged hypertension
  • Blood clots or an increased risk of blood clots
  • Coronary heart disease, stroke or dementia.

(Healthdirect 2020)

Other treatment options that may help to relieve the symptoms of menopause include:

  • Counselling and psychological therapy
  • Acupuncture
  • Certain non-hormonal medicines to reduce vasomotor symptoms e.g. antidepressants, gabapentin or clonidine
  • Lubricants, oils or vaginal moisturisers to reduce vaginal dryness.

(The Women’s 2019; Healthdirect 2020)

Lifestyle changes that may relieve symptoms include:

  • Maintaining a healthy diet and exercising regularly
  • Maintaining mental health
  • Avoiding caffeine, alcohol and spicy foods, which may trigger hot flushes
  • Wearing layers of clothing that are easy to remove
  • Using fans or air conditioners
  • Using stress-management techniques
  • Getting good-quality sleep
  • Using light-weight sleepwear and bedding
  • Smoking cessation.

(Healthdirect 2020; Better Health Channel 2019)

Early and Premature Menopause

Early menopause is thought to affect up to 8% of people (Obermair 2020).

Causes of Early Menopause

Potential causes of early menopause include:

  • Bilateral oophorectomy (surgical removal of both ovaries) or hysterectomy (surgical removal of the uterus) to treat conditions such as endometriosis or ovarian cancer
  • Cytotoxic treatments including chemotherapy and radiotherapy, which are toxic to the ovaries
  • Primary ovarian insufficiency (POI), which occurs when the ovaries spontaneously stop functioning before the age of 40. This may be caused by:
    • Autoimmune conditions e.g. hypothyroidism, Crohn’s disease, systemic lupus erythematosus or rheumatoid arthritis
    • Genetic conditions such as Turner syndrome and being a carrier of Fragile X syndrome
    • Certain metabolic conditions e.g. galactosaemia
  • Viral infections such as mumps or cytomegalovirus, though there is no conclusive evidence that these are linked to early menopause.

(Obermair 2020; Jean Hailes 2021a; AMS 2020; Better Health Channel 2018)

About 60% of instances of early menopause have no known cause and are therefore referred to as idiopathic premature menopause (Better Health Channel 2018).

Other factors that may increase the risk of early menopause include starting periods before the age of 12 and epilepsy (Obermair 2020).

Risk Factors for Early Primary Ovarian Insufficiency

  • Family history of early menopause
  • Nulliparity
  • Hysterectomy
  • Living with human immunodeficiency virus (HIV) infection
  • Smoking
  • Low body weight.

(AMS 2020)

Consequences of Early Menopause

Early menopause can be emotionally distressing for a number of reasons. People may experience feelings such as:

  • Grief over no longer being able to have children
  • Anxiety about ‘getting old’ too quickly
  • Concern that they won’t be seen as sexually attractive by their partner anymore
  • Reduced self-esteem
  • Confusion
  • Mixed emotions about other people’s pregnancies.

(Better Health Channel 2018; AMS 2020)

Early menopause also increases the risk of early-onset osteoporosis and heart disease (Better Health Channel 2018).

Treatment of Early Menopause

early menopause treatment hormone replacement therapy
People experiencing early menopause may be recommended to undergo hormone replacement therapy (HRT).

While there is no treatment available to make the ovaries function, there is a chance that they will start to work again on their own. In fact, about 10% of people with POI who continue to try for a pregnancy, succeed, despite their diagnosis (Better Health Channel 2018).

In order to reduce the risk of early-onset osteoporosis and heart disease, people experiencing early menopause may be recommended to undergo hormone replacement therapy (HRT) until they reach the average age of menopause (51) (Better Health Channel 2018; AMS 2020).

HRT comes in several forms, including:

  • Oestrogen tablets, patches, gels and topical vaginal treatments (used for those who have undergone a hysterectomy)
  • Oestrogen plus progesterone (used for those who have not undergone a hysterectomy)
  • Combined oestrogen and progestogen oral contraceptive pill.

(Better Health Channel 2018; AMS 2020)

People experiencing early menopause should receive plenty of support from their partner, family and friends, as this can be a distressing time (AMS 2020).

Late-Onset Menopause

People who experience late-onset menopause have increased exposure to female hormones and are therefore more at risk of oestrogen-dependent cancers. Furthermore, increased ovulation heightens the risk of ovarian cancer (Obermair 2020).

Despite this, late-onset menopause is also associated with longer life expectancy, decreased risk of heart disease and stroke, and delayed osteoporosis (meaning their bones are stronger and less prone to fracturing) (Obermair 2020).

The LGBTQ+ Menopause Experience

Menopause is often talked about as something that only affects women, however, it should be noted that menopause also happens to people of differing genders, including trans men (assigned the female gender at birth) and non-binary people, who identify as neither male nor female (Sutton 2021).

Menopause may trigger feelings of severe unease, known as dysphoria, in people who don’t identify as female, as it may remind them that their reproductive system and physiological experiences don’t align with the gender they identify as. Furthermore, using gendered language when discussing menopause can cause members of the LGBTQ+ community to feel alienated, and possibly avoid seeking medical help altogether (Sutton 2021).

For this reason, it is important to be inclusive in your language and practice (e.g. using people’s correct pronouns such as he/him or they/them and using the word ‘people’ instead of ‘women’) in order to ensure that healthcare for menopause and other areas of reproductive health is accessible for all patients (Sutton 2021).

Additional Resources


References

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