What is the menopause? Factsheet

The word menopause literally means when your periods stop. Meno­ refers to your menstrual cycle and pause refers to the cycle stopping. The medical definition of being menopausal is when you have not had a period for one year. The menopause occurs when your ovaries no longer produce eggs and, as a result, the levels of hormones called estrogen, progesterone and testosterone fall.

Estrogen protects a number of different systems in your body: your brain, skin, bones, heart, urinary functions and the genital area – low levels of estrogen can affect all these parts of your body.

What is perimenopause?
The term perimenopause is often used to describe the time before the menopause when you experience menopausal symptoms but are still having periods. These periods typically change during the perimenopause and may occur further apart or closer together; they can be more irregular and heavier or lighter in flow.

The hormones estrogen and progesterone work together to regulate your menstrual cycle and also the production of eggs. During your perimenopause, the levels of these hormones fluctuate greatly, and it is often the imbalance of these hormones which leads to symptoms of the menopause occurring. For some women, symptoms only occur for a few months and then their periods stop completely. However, other women experience symptoms for many months or even years before their periods stop. Often when you read about menopausal symptoms, it also includes perimenopausal symptoms as they are the same, and both are due to your hormones changing.

When does it happen?
The average age of the menopause in the UK is 51 years – therefore the last period occurs, on average, at 50 years old – however, this can be earlier for some women. Symptoms of the perimenopause often start at around 45 years of age. If the menopause occurs before the age of 45, it is called an early menopause. If it happens under 40 years old, it is classed as Premature Ovarian Insufficiency (POI). Early menopause or POI can sometimes run in the family.

Surgical Menopause
Although the menopause is a normal event in a woman’s life, certain conditions can bring about an early menopause. Such as:
– If you have had your ovaries removed
– If you have radiotherapy to your pelvic area as a treatment for cancer
– If you have received certain types of chemotherapy drugs that treat cancer
– If you have medical or surgical treatment for endometriosis or premenstrual syndrome
– Some genetic and autoimmune factors can contribute to early menopause

If you have had your womb (uterus) removed by an operation called a hysterectomy, before your menopause, you may experience an early menopause even if your ovaries are not removed. Your ovaries will still make some estrogen after the hysterectomy, but it is common that your level of estrogen will fall at an earlier age than average due to reduced blood flow. As women do not have periods after a hysterectomy, it may not be clear when you are in ‘the menopause’, however, you may develop some typical symptoms when your level of estrogen falls.

Making the diagnosis of menopause
If you are over 45 years of age, have irregular periods and other symptoms of the menopause, you do not normally need any tests to diagnose the menopause. Your account of what symptoms you are experiencing is the basis for a diagnosis of the perimenopause or menopause. It is useful to track your symptoms using an app such as ‘balance’ menopause support, or you could fill in the Greene Climacteric Scale questionnaire available on the menopause doctor website.

If you are younger than 45 years of age, your healthcare professional may want you to have some tests before making a diagnosis. The most common test is a blood test measuring a level of a hormone called follicle stimulating hormone (FSH). If this is raised, then it is very likely that you are menopausal. This blood test is often repeated 4 to ­6 weeks later. If you are under 40 years, then you may be advised to have further investigations to rule out other conditions that can stop periods or affect your hormones.

Treatments for the menopause
The most effective treatment for symptoms of the menopause is to replace the hormones your body no longer produces. Hormone replacement therapy (HRT) contains estrogen, a progestogen (or progesterone) if it’s needed, and in some cases, testosterone.

HRT also protects your future health from the bone­weakening disease known as osteoporosis, and heart disease, type 2 diabetes, bowel cancer and dementia.

For most women the benefits of taking HRT outweigh any risks.

Other ways to minimise a negative impact of the menopause on your health and wellbeing is to make some healthy changes to your lifestyle by cutting out smoking and reducing alcohol, taking regular exercise that keeps your heart healthy and your bones strong, and eating a well balanced diet that promotes gut health. Finding time to do things that help you relax and having strong social and emotional connections with others can also help your journey.