Understanding Menopause

Menopause is a natural stage of life, not an illness. It marks the end of menstrual periods and of the reproductive years. The transition can last several years and affects women very differently: some notice little, others have symptoms that disrupt sleep, work and wellbeing. Understanding what is happening makes it easier to manage.

The stages

Perimenopause

The transition leading up to menopause. Hormone levels rise and fall unevenly, periods become irregular and symptoms may begin. The Office on Women’s Health notes that it usually starts in a woman’s mid- to late 40s and lasts about four years on average. Pregnancy is still possible during this time.

Menopause

The point at which periods have stopped for a full year. The NHS notes that menopause usually happens between the ages of 45 and 55. It can occur earlier, naturally or as a result of surgery to remove the ovaries or treatments such as chemotherapy.

Postmenopause

The years after menopause. Some symptoms ease, while others, such as vaginal dryness, may continue.

Common symptoms

• Changes in periods: shorter, longer, lighter, heavier or less regular.
• Hot flashes: a sudden feeling of heat in the upper body, sometimes with flushing and sweating.
• Night sweats and disturbed sleep.
• Vaginal dryness and discomfort during sex.
• Mood changes: irritability, anxiety or low mood.
• Difficulty concentrating or memory lapses, often called brain fog.
• Urinary symptoms: urgency or more frequent infections.
• Joint aches, changes in skin and hair, and reduced sex drive.

Health after menopause

Lower estrogen levels affect long-term health.

• Bones: bone loss speeds up, raising the risk of osteoporosis and fractures.
• Heart: the risk of heart disease rises after menopause. Heart disease is the leading cause of death for women in the United States.
• Weight: many women gain weight around the abdomen.

This makes checkups, blood pressure and cholesterol tests, and bone health especially important.

Managing symptoms

Lifestyle measures

• Dress in layers and keep the bedroom cool.
• Identify hot flash triggers, such as spicy food, alcohol, caffeine or stress.
• Exercise regularly, including weight-bearing activity for bones.
• Eat a balanced diet with enough calcium and vitamin D.
• Keep a regular sleep routine.
• Stop smoking.
• Try relaxation techniques; cognitive behavioral therapy can help with mood and sleep.

Medical treatments

• Menopausal hormone therapy (also called hormone replacement therapy): replaces estrogen and is the most effective treatment for hot flashes. It has benefits and risks that depend on your age, health and history, so the decision is made with your doctor.
• Non-hormonal prescription medicines can reduce hot flashes for women who cannot or prefer not to take hormones.
• Vaginal estrogen, moisturizers and lubricants relieve dryness.

Supplements and herbal products

Many products are marketed for menopause. Evidence for most is limited, quality varies, and some interact with medicines. Discuss them with your doctor or pharmacist.

Nutrition and bones

Women over 50 need 1,200 mg of calcium a day, along with adequate vitamin D. Dairy foods, fortified alternatives, canned fish with bones and leafy greens help, and a supplement such as Calcium + Vitamin D3 can make up a shortfall. Ask your doctor about bone density testing.

Contraception

You can still become pregnant during perimenopause. Ask your doctor how long to continue contraception.

When to see a doctor

• Symptoms that affect your daily life, sleep or mood
• Menopausal symptoms before age 45
• Very heavy bleeding, bleeding between periods or bleeding after sex
• Any bleeding after menopause, even spotting
• Persistent low mood or anxiety

Emotional wellbeing

Hormonal changes, poor sleep and midlife pressures can combine to affect mood. Talking to friends, a support group or a professional helps. Depression is treatable at any stage.

Looking after yourself

Keep up with screening, including mammograms, cervical screening and blood pressure checks. A home monitor such as our Automatic Upper Arm Blood Pressure Monitor can be useful if your doctor recommends home readings.

The bottom line

Menopause is a normal transition with real effects. Lifestyle steps help, effective treatments are available, and you do not have to manage difficult symptoms alone. Explore wellbeing essentials in our women’s health department.

Sources

1. Office on Women's Health. Menopause basics.
2. NHS. Menopause and perimenopause.
3. Office on Women's Health. Osteoporosis.
4. Centers for Disease Control and Prevention. About Women and Heart Disease.