What is menopause?
Menopause is a time when a menstrual period has naturally stopped for 12 consecutive months. This occurs when the ovaries stop making estrogen. Estrogen is a hormone that helps control the menstrual cycle of releasing an egg every month. Menopause marks the end of reproductive years and for Australian women the average age at menopause is approximately 51 years, with a normal range of 45 to 55 years.
Perimenopause is the transition to menopause which is the time from the first onset of symptoms to 12 months after the last menstrual period. This time period can vary in length depending on the individual, but symptoms from fluctuating hormone levels can occur 1-3 years before the last period.
Things to know:
- Many healthy women who have recently entered perimenopause can safely use menopausal hormonal therapy to treat hot flashes and night sweats.
It is normal to:
- Irregular periods
- Weight gain & shape change
- Reduced capacity to cope with daily activities
- Decreased libido (may cause relationship issues)
- Mood changes
- Skin and hair changes
- Hot flushes and night sweats
- Joint aches and muscle pains
- Vaginal dryness
- Sore breasts
- Memory and concentration issues – “memory fog”
- Headaches and migraines
- Sensation of skin crawling with ants
Requiring evaluation by your healthcare provider:
- Very frequent periods (fewer than 21 days between periods)
- Periods that are much heavier than usual
- Periods lasting longer than 10 days
- Spotting or bleeding between periods
- Bleeding after sex
- Any bleeding after menopause
Possible health changes:
- High blood pressure
- Changes in cholesterol and other facts
- Irritability and mood changes
- Risk of recurrence of depression
- Increased risk of diabetes
- Life and social changes
If ovaries stop functioning before the ages of 40, it is called premature ovarian insufficiency and has health implications. Younger women should be advised about how to compensate for the loss of ovarian hormones.
Women who have their final period between the ages of 40 and 45 years have early menopause.
Surgical menopause is when surgery, rather that the natural ageing process, causes a woman to go through menopause. It occurs after an oophorectomy, a surgery that removes the ovaries and may be done at the time of hysterectomy for benign (non-cancerous) disease or gynaecological cancers, or as part of risk reduction treatment in women with an inherited increased chance of developing ovarian cancer.
Some premenopausal women will elect to have their ovaries removed for other indications, such as endometriosis or chronic pelvic pain. Depending on the circumstances, removal of the ovaries may improve pain, but it is not always effective.
Australasian Menopause Society – Surgical menopause
Menopausal hormone therapy (MHT)
Menopausal hormone therapy is available in different forms such as a tablet, skin path, gel and vaginal pessary or cream.
Things to know:
- MHT is used to treat some symptoms of perimenopause and menopause, e.g. hot flashes and nights sweats, and usually involves some sort of synthetic estrogen and progestin.
- Initially, the Women’s Health Initiative study found substantial increased risk of developing cardiovascular disease and breast cancer from oral MHT – but later analyses found the relationship inconclusive.
- The Lancet Paper showed that for women with a family history of breast cancer, MHT use does not further increase breast cancer risk. It also showed that longer use of MHT is associated with a slower decline in risk after stopping using it.
- In 2016, the world’s leading menopause specialists said the benefits of MHT are more likely to outweigh the risks if women with menopausal symptoms start taking it before they turn 60 or within 10 years after menopause.
- Different forms of MHT have different advantages and disadvantages.
Benefits of MHT:
- MHT tablets, gels and patches can act on the whole body.
- Vaginal creams and pessaries only for the local area only.
- MHT forms that only act locally have no increased risk of breast cancer of thromboembolism.
- MHT is an effective treatment for hot flushes, night sweats and vaginal dryness.
- MHT helps prevent osteoporosis, and possibly help with colon cancer, type 2 diabetes and coronary heart diseases.
Different uses of MHT
Read The Conversation: Thinking of menopausal hormone therapy? Here’s what you can expect from your GP
Measuring hormone levels
Things to know:
- Measuring hormone levels is not useful for diagnosing menopause, manage perimenopause, manage treatment, or tell you when your periods will end
- Measuring hormone levels can diagnose premature menopause.
Australian Menopause Society – Consumer information (find an AMS doctor, videos, fact sheets, infographics)
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists – Menopause
Continence Foundation of Australia – Menopause
Very Well Health – Defining premenopause, perimenopause, and menopause
The Royal Women’s Hospital – Menopause
Women’s Health Concern – The menopause
Menopause – multilingual
Menopause – English
Supporting women through menopause
Understanding premature & early menopause
Menopausal hormone therapy: Is there a cause for concern?
Sexual Health and Family Planning ACT Menopause Centre