What is menopause?

When you reach your 40s or 50s you will stop menstruating. Menopause is officially signalled when it has been 12 months since your last period, and you will not have any more. This is the natural end of your reproductive life.

What are the symptoms of menopause?

Almost all women going through menopause experience symptoms. As you begin to approach menopause your ovaries begin to slow down the production of oestrogen and progesterone. During this time your hormone levels tend to fluctuate and you may notice menstrual cycle irregularities, including:

  • Shorter, longer or totally irregular periods
  • Lighter bleeding
  • Unpredictable and heavy periods.

Some symptoms that you may have have during menopause include:

  • Hot flushes
  • Night sweats (including waking up hot and sweaty)
  • Tiredness
  • Aches and pains
  • Headaches
  • Reduced sex drive
  • Tiredness
  • Forgetfulness
  • Irritability
  • Lowered self-esteem
  • Crawling sensations under the skin or itching
  • Difficulty sleeping including wakefulness
  • Increased urinary frequency
  • Vaginal dryness and discomfort during vaginal intercourse
Menopause Symptom Management

Most women find these symptoms are manageable and do not have treatment. When symptoms are particularly severe or prolonged, there are a range of ways to manage them. Through:

  • Healthy diet including limiting caffeine and alcohol and increasing calcium
  • Exercise, particularly weight-bearing and strength training activities to prevent bone density loss and keeping your bones healthy. Exercise also improves balance to reduce the risk of falls and injury.
  • Looking after your mental health
  • Reducing stress
  • Getting enough good quality sleep
  • Avoiding things that that trigger your hot flushes and sleeping with light-weight pajamas and bedding
  • Quitting smoking as it increases the risk of osteoporosis, heart disease and lung cancer.
  • If your symptoms are particularly bad you may require hormone replacement therapy (HRT).

If you are not a candidate for HRT because of past breast cancer, heart disease or clots you may be prescribed medications that control symptoms instead, such as:

  • Antidepressants for mood
  • Medication for migraines and blood pressure.

Hormone replacement therapy reduces many of the side effects of menopause. If you have moderate to severe symptoms it may be appropriate for you. If you have undergone early menopause HRT will be recommended until you turn 50, unless there is a health reason to avoid doing so.

Your doctor will be able to help you determine what form of HRT is right for you. The benefits typically outweigh the risks of HRT for most women. You may have HRT in the form of tablets, a patch or gel applied to your skin, a vaginal pessary (tablet) or vaginal creams if your vaginal or urinary symptoms are severe.

Some women have severe symptoms of menopause for more than 10-years you need long term HRT. You should have annual check ups to assess the risks and benefits of HRT therapy for you.

Postmenopausal bleeding

If you have reached menopause and are having bleeding you should see your doctor. It is not normal to have bleeding or spotting 12 months after your last period. This does not always mean a serious disease, but you should still get checked out. When detected early, most conditions that cause bleeding after menopause can be treated, including cancer.

What causes postmenopausal bleeding?

Postmenopausal bleeding can be caused by:

  • Thinning or inflammation of the vaginal lining (called atrophic vaginitis)
  • Thinning of the uterus lining
  • Polyps on the cervix or uterus. These are not usually cancerous
  • Thickened endometrium because of HRT
  • Abnormalities of the cervix or uterus.
  • Cancer of the cervix or uterus (rare)

Bleeding can be investigated through a physical examination, blood test, ultrasound, cervical screening test, biopsy, hysteroscopy or D&C (dilation and curettage) to scrape away and test part of your endometrium. The latter is done under general anaesthetic.

Treating postmenopausal bleeding

The treatment you will need depends on the underlying cause of the bleeding:

  • HRT or other medications
  • Surgery to remove polyps.
  • Cancer treatment if necessary.

Frequently asked questions about menopause

When will I reach menopause?

Most women reach menopause between 45 and 55. If you go into menopause before 41 it is considered ‘early menopause’.

Once your hormone levels fall below a certain point your ovaries will stop releasing eggs. At this point your periods will stop and menopause will have been reached. You will know you have reached menopause if it has been 2 years without a natural period if you are under 50 and 1 year if you are over 50.

Do I still need to use contraception after menopause?

While fertility is low after 45, you still need to use contraception if you do not wish to become pregnant. You should continue to use protection until it has been one year without a period if you are over 50 and 2 years without a natural period if you are under 50. You should also use condoms if you are worried about STIs.

Do I still need CSTs after menopause?

After you reach menopause you should continue to have cervical screening tests every five years. You should also have mammograms every two years after 40.

What are the risks associated with menopause?

As you will have a decrease in female hormones after menopause you have increased risks of:

  • Osteoporosis (thinning of the bones) and therefore fractures
  • Heart attack and heart disease
  • High blood pressure and stroke.