What is the menopause? When does it start? And, what are the symptoms? If you’ve asked yourself these questions you’ve come to the right place. Learn all about this transition period of life including the difference between perimenopause and the menopause, and what you may be able to try to help with the symptoms.
Table of Contents
- What is the definition of the menopause?
- What happens during the menopause?
- Why does the menopause happen?
- Stages of the menopause
- Symptoms of the menopause
- Can there be any complications with the menopause?
- Can the menopause be diagnosed?
- Are there any ways to treat the menopause?
- When to see a doctor
- The bottom line
What is the definition of the menopause?
When you think of the menopause, chances are you think of a long transition period with uncomfortable symptoms—perhaps even lasting years—before a woman’s period stops. Although, what most consider the menopause is the “menopausal” symptoms a woman goes through in the time leading up to the day her periods stop altogether, by definition the menopause refers to the single day when a woman hasn’t had a period in 12 consecutive months and can no longer get pregnant.
After this 12-month period, a woman is considered post-menopausal.
The average age the menopause happens is 51, but typically it takes place somewhere between ages 45 and 55. It’s also possible for menopause to begin earlier in rare cases. Going through menopause aged 40 to 45 is referred to as “early menopause”. Menopause under the age of 40 is called premature ovarian insufficiency.
What happens during the menopause?
A woman experiencing so-called “menopausal” symptoms is often in the period known as perimenopause (peri means near or around). Perimenopause can last years, and one of the main signs of a woman being perimenopausal is her periods becoming more irregular.
When a woman approaches the end of her fertile time, estrogen levels begin to decline. This hormonal change begins to affect her menstrual cycles and she may start having either unusually light or heavy periods, or the frequency of her periods may change.
Women’s experiences around this time can be very different. Some may see their cycles get shorter at first, perhaps having a period every two to three weeks before skipping periods for several months. Other women can go from having regular cycles to having no periods at all quite suddenly. Irregular cycles or skipped periods could be one of the first signs of approaching menopause.
Although the perimenopause experience of each woman is unique, after a few months or years of disrupted menstrual cycles, periods do eventually stop altogether.
Why does the menopause happen?
Menopause happens when your ovaries stop producing eggs.
For around 5% of women1, it’s possible for early menopause (under the age of 45) to happen. It’s also possible to go through premature menopause (under the age of 40), which is incredibly rare, as it only affects only 1% of women2. Experts aren’t quite sure why some women go through early or premature menopause, although chances are it’s genetic. If your mother had an early menopause, you’re more likely, but not guaranteed, to go through it early too.
Sometimes early menopause can be triggered by:
- An oophorectomy, which is when the ovaries are removed (surgical menopause)
- Some breast cancer treatments, like chemotherapy or radiotherapy
- An underlying condition like Down’s syndrome or Addison’s disease.
Stages of the menopause
The menopause happens in three stages and doesn’t just happen overnight. Each of these stages helps your body adjust to the hormonal and physiological changes:
- Early perimenopause often begins around four years before the menopause, and is defined as when a woman has irregular or 'variable length' cycles with at least 7-day difference in cycle length between consecutive cycles or a cycle length <25 days or >35 days.
- Late perimenopause starts once the cycles are >60 days in length
- The menopause. This stage happens once the ovaries stop releasing eggs and periods stop altogether.
- Post-menopause. After not having had a period for 12 consecutive months, you are considered post-menopausal. Some women find that many of the symptoms they experienced during perimenopause start to decrease, although it can take four years or more for the symptoms of menopause to stop entirely once in post-menopause.
Symptoms of the menopause
Menopause affects every woman differently. You may very mild or even no symptoms at all, or they could be severe.
The most common symptoms of menopause—can include a variety of symptoms, like those listed below:
- Vasomotor symptoms.
- Hot flushes. Sudden and short bursts of heat that usually occur in the face, neck, and chest, which can also make your skin red and sweaty.
- Night sweats. When you sweat so much that your night clothes and bedding are soaking wet.
- Palpitations. You may notice your heartbeat becomes more noticeable.
- Sexual symptoms.
- Vaginal dryness. This may also be accompanied by pain, itching, or discomfort during sex.
- Reduced sex drive.
- Physical symptoms.
- Joint stiffness, aches, and pains.
- Sleeping difficulties. You may be kept awake by hot flushes, night sweats, or just have trouble sleeping, either way this may leave you feeling tired and irritable during the day.
- Psychological symptoms.
- Mood changes.
- Memory and concentration problems.
Around 8 in 10 women will have some of the above symptoms of the menopause before and after their periods stop. Symptoms can appear months or years before your periods actually stop altogether and can last around four or more after your last period.
Can there be any complications with the menopause?
It’s possible for complications associated with the menopause to happen, like
- vulvovaginal atrophy (when the walls of the vagina thin)
- painful intercourse (sharp or intense pain in the genital or pelvic area during, before, or after sex)
- slower metabolism (burning fewer calories at rest than before)
- osteoporosis (weakened bones with reduced strength and mass)
- cataracts (a dense, cloudy area that forms in the lens of the eye)
- periodontal disease (an infection of the gums)
- urinary incontinence (the sudden and involuntary urge to urinate)
- heart or blood vessel disease.
Talk to your doctor about how lifestyle changes or hormone replacement therapy (HRT) could help reduce your risks of any of these potential complications.
Can the menopause be diagnosed?
A diagnosis for menopause is made when you’ve gone 12 consecutive months without a period. Your doctor may diagnose you’re entering perimenopause if you have the symptoms of menopause. If you are experiencing irregular periods or hot flushes and are concerned about it—especially if you are younger than 45—ask your GP for an evaluation.
Most of the time a test is not required for your GP to make a diagnosis, but in certain circumstances (for example, if early menopause is suspected), you may be offered a blood test. This test checks
- the levels of follicle-stimulating hormone (FSH), which goes up, and estrogen, which decreases, during menopause
- the levels of thyroid-stimulating hormone (TSH) because an underactive thyroid can cause similar symptoms to that of the menopause.
Are there any ways to treat the menopause?
Once you’ve passed through menopause, you can’t reverse menopause itself and regain your fertility, but there are things you can do that make living with the symptoms easier. There are a few way to manage your GP may recommend, lifestyle changes you can make, and home remedies you may wish to try that can help reduce any uncomfortable symptoms that may accompany menopause (or rather perimenopause). Read on to discover more about these.
Management of menopause-related symptoms
If the symptoms you get before, during, or after the menopause interfere with your daily life, your GP may recommend certain things like:
- Hormone replacement therapy (HRT). This type of therapy comes in the form of tablets, skin patches, gels, or implants. HRT helps with the symptoms of the menopause as it replaces the estrogen that’s no longer produced by the body. There are numerous benefits to HRT—for example, it can help prevent osteoporosis—so talk to your doctor about the risks and benefits of HRT, and how it could help you.
- Vaginal estrogen creams, lubricants, or moisturisers to help with vaginal dryness.
- Cognitive behavioural therapy (CBT). This can help deal with any mood changes or increased anxiety associated with the menopause.
- Supplements like Vitamin D and Calcium. Taking supplements like Vitamin D and Calcium can help keep your bones healthy.
In some cases, your GP may refer you to a specialist if you cannot take HRT or your symptoms do not improve.
There are a few lifestyle changes you can make that may help some of the symptoms improve:
- Exercise regularly. Weight-bearing and resistance training can help against osteoporosis and exercise can also help with mood changes.
- Follow a healthy diet. A diet with plenty of fruit and veg, and dairy products like low-fat milk and yoghurt can help with weak bones and promote your overall health.
- Get some sunlight. Sunlight triggers the production of Vitamin D, which can also help keep bones strong. Your doctor may also recommend you take a Vitamin D supplement to ensure you get enough.
- Stop smoking and cut down on alcohol. Smoking, alcohol, and caffeine can all trigger hot flushes. Reducing your intake is also great for your general health as these substances can increase your risk of stroke and heart disease, among other conditions.
- Do yoga or tai chi. Relaxing, gentle exercise can help reduce anxiety.
- Do pelvic floor exercises. This can help with any urinary incontinence you may be experiencing.
Natural remedies for menopause
Some women say certain home remedies have helped them, and you may also see some complementary and alternative medicines touted as being able to help but be careful. There is little evidence to say how safe and effective these treatments actually are. They may also interact with other medications you’re taking, or have side effects of their own. Talk to your GP before trying any of these.
Some alternative treatments can include:
- Phytoestrogens (plant estrogens). These are estrogens occurring naturally in foods like legumes, beans, and seeds. Whether these can relieve the symptoms of menopause remains to be seen, but studies looking into it found them to be ineffective. Of course, you can go ahead and eat chickpeas but do it for culinary reasons rather than medical ones.
- Bioidentical hormones. These hormones come from plant sources, but many of these haven’t been proven to be effective and they are not regulated like those hormones used in HRT.
- Acupuncture. Some women find it gives temporary relief from symptoms like hot flushes, but there is little research showing its true efficacy.
- Hypnosis. Some say hypnosis may decrease hot flushes and may help improve sleep.
When to see a doctor
You may want to book an appointment with your GP if
- you have any symptoms that are hard to live with
- you are showing signs of menopause and are under the age of 45
- you notice you are bleeding after menopause.
The menopause itself is classified as the day you haven’t had a period in 12 months. The stage leading up to it, known as perimenopause, can last for years. Afterwards you are post-menopausal.
It often refers to perimenopause, which is when a woman is going through changes due to decreasing estrogen levels as she approaches the menopause. The menopause itself is when periods have stopped for good and a woman can no longer get pregnant.
The menopause typically happens when women are aged 45-55, but perimenopause can begin as early as the late 30s.
No. Once a woman has passed menopause, she is no longer fertile and cannot get pregnant. However, it is still possible for a woman to get pregnant during perimenopause if she is still ovulating. Keep in mind, fertility declines from the age of 35.
Once you’re post-menopausal, many of the symptoms of the menopause slowly go away. You will no longer be able to get pregnant and you won’t have periods.
The bottom line
A lot happens to your body during this stage of life. Hormonal changes can lead to uncomfortable symptoms like hot flushes, mood swings, dry skin, and tiredness, among others. A healthy lifestyle can help with some of the symptoms, but if you find you are experiencing intense symptoms, your GP may prescribe a treatment like HRT. You can’t stop the menopause from happening, but rest assured that there are things you can do to make the transition easier, and eventually the symptoms will subside.
Can I get pregnant if I'm over 35?
If you’re over 35 you may need a little more patience and greater understanding about your fertility window to help you have a baby naturally.