Menopause

What do we mean by menopause?

You have reached the menopause if six months have passed since your last period. Around this time, the ovaries stop producing eggs. As the ovaries close down, they produce smaller quantities of the hormones that had been building up the lining of the womb every month to make the body ready for pregnancy. As well as regulating periods and maintaining pregnancy, the hormone oestrogen triggers all the changes in the female body that begin at puberty. So, as oestrogen production declines, the body starts to change.

When does menopause usually start?

Nowadays, the average age for a woman’s last period is 51, though changes quite often begin in the early forties. Many women have menopause symptoms and irregular periods for several years before their periods finally stop altogether. This time in a woman’s life is called the climacteric, or ‘perimenopause’, when the ovaries gradually slow their normal functioning.

The experience of menopause can vary a great deal. It might feel like a blessing to some women. For most, it just means fewer, more irregular, lighter periods, with maybe a few mild menopausal problems, which gradually stop after two to five years. But there can be downsides. Although the menopause is not a disease – in fact it’s a natural, inevitable phase of life – for some women it can be a real challenge.

There are emotional and psychological changes to adjust to, as well as physical ones. A woman’s sense of who she is, and her place in the world, may be changing as well. For as many as 4 in 10 women, menopausal changes are bothersome.  Fewer have unpleasant symptoms that last many years after their periods have stopped.

What problems are common at menopause?

Hot flushes and night sweats
Usually lasting for just a few minutes. Your face, neck and chest may go red and blotchy. You might start to sweat and feel your heartbeat get faster. When these flushes happen at night, they are known as night sweats. As a rule, hot flushes are at their worst for a year or so after the last period.

Sleep problems
Not surprisingly, night sweats can make it difficult to sleep. Some women also feel more anxious during the menopause, and this may also disturb sleep. Poor sleep can affect your mood, memory and concentration.

Vaginal dryness and soreness
Oestrogen is a sex hormone. When there is less of it in the blood, the vaginal lining gets thinner and doesn’t produce as much fluid. When there is less lubricating fluid and the vagina gets drier, it may feel itchy and sore. This inflammation – called atrophic vaginitis – may also affect the bladder and urethra, and make you more likely to get cystitis and thrush.

Sexual issues
Sex hormones have a lot to do with sex drive. Yet some women find their interest in sex is unaffected; or even that, once free of periods and the chance of pregnancy, their sex drive and enjoyment get stronger. But more often, interest in sex and the need for it reduce around the menopause. And of course if vaginal dryness and urinary problems make having sex uncomfortable, this will reduce interest all the more. Together, these changes may make the stress and discomfort some women feel around the menopause even worse.

HRT or not HRT? That was the question

For years Hormone Replacement Therapy (HRT) was the treatment of choice for the discomforts of menopause. It wasn’t a perfect answer but at first it looked like a ‘win-win’ treatment. (As women get older, they face a growing risk of having heart disease and a stroke; HRT was thought to prevent these problems.) Then the Women’s Health Initiative found the opposite – that women on HRT were more likely to have a heart attack or a stroke, and more prone to get breast cancer.

HRT today
Because of these safety fears, the number of women in the UK taking HRT fell from 2 million to fewer than 1 million between 2003 and 2007. But lately medical opinion has changed about the balance of benefit compared to risk. Doctors now seem to be moving back towards offering forms of HRT to women whose hot flushes and atrophic vaginitis are persistent and moderate to severe. Research has shown that low-dose oestrogen is effective for many women, although some require larger doses to relieve hot flushes.

But because HRT is not risk free, doctors recommend that patients should take the lowest dose that relieves their symptoms (possibly using a vaginal cream rather than a pill), and for the shortest amount of time (depending on the problem). It is also best used by women early on in their menopause. HRT is not recommended for women with a high risk of stroke, heart disease, blood clots or breast cancer. And HRT users should be re-assessed by their GP at least once a year.

To find out more about HRT treatment, visit Women’s Health Concern

Looking on the bright side
Having hot flushes may cut your risk of developing breast cancer by as much as half, according to a recent US survey of 1,437 postmenopausal women. They were asked about various menopausal symptoms, including hot flushes, night sweats, insomnia, vaginal dryness, irregular or heavy menstrual bleeding, depression and anxiety. Those women who said they had suffered from hot flushes had the lowest risk of developing breast cancer.

Further information and advice

For more information visit:

Health Talk Website

Menopause Matters

NHS Website Menopause Information

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