What is Menopause?
Menopause is a time of natural female hormonal changes, most notably, the end of menstruation. It happens gradually over a period of months or years, starting with irregular periods and often accompanied by other symptoms like hot flushes and sleeplessness.
Peri- means ‘around’, and so ‘perimenopause’ refers to the time period around menopause. It can be used to describe the time from the first suspected symptoms (or erratic periods) up until the end of menopause (i.e. 12 months after the final period).
Any time after menopause can be referred to as ‘post-menopause’. It is a time when women no longer experience periods and also heralds other changes in the body.
Being post-menopausal can be medically relevant because the different hormone profile of a woman after menopause can change her risk of developing certain diseases such as osteoporosis.
Signs & Symptoms of Menopause
The experiences of menopause can vary widely from one person to the next, but there are some symptoms that are common throughout menopause.
Hot Flushes or Hot Flashes
One of the most common symptoms of menopause is ‘hot flush’ or ‘hot flash’. This refers to a sudden feeling of warmth or extreme heat, sometimes with sweating and skin flushing. This feeling can last for several minutes or even up to an hour.
The frequency and intensity of hot flushes vary depending on the individual. Some people may experience hot flushes several times a day while for others, hot flushes are only occasional. They can be relatively mild or very uncomfortable.
A combination of hormonal changes, hot flushes and other symptoms of menopause can result in sleep problems. Depending on the individual and the underlying cause of insomnia, different people may have different ways to manage it. However, it is important to find a way to get quality sleep as sleeplessness can have a serious impact on other areas of life. If you are experiencing severe insomnia, it would be best to consult a doctor and work out a solution together.
Besides hormonal changes, there are many other aspects of menopause that can affect mood too. Menopause often coincides with a time of change in family circumstances and position; children growing up and leaving home, perhaps having children of their own. During this time of physical and emotional changes, it’s normal to have mixed feelings. This can affect mood and emotional resilience, and – although it’s normal – it is okay to need support through this time.
Irregular Periods or Spotting
Menopause is not over until 12 months after the last episode of bleeding, and menstrual bleeding can be very erratic peri-menopause. Some people go months between periods, while others may experience occasional or more frequent spotting. Any worrying symptoms like unusually heavy bleeding or bleeding after menopause is completed should be checked out by a GP as it could indicate other problems.
Problems with Sex
Intercourse can be trickier after menopause as vaginal dryness often becomes an issue. Mood swings, tiredness, and hormonal changes can also affect libido. However, many women do still have a happy and active sex life after menopause with the help of products such as simple lubricants or medicated preparations containing oestrogen.
Changes in Appearance of the Skin
The appearance of the skin changes during menopause due to a reduced amount of collagen in the skin. Collagen is the substance that keeps our skin taut and springy. With less collagen, we develop more visible wrinkles and parts of our body begin to sag.
Changes to the Hair
The way hair is distributed across our body is largely controlled by hormones, and so the hair on the head often starts to thin as hormone levels change through and after menopause. Some women also develop hair where they didn’t have any before – often on the chin and around the mouth.
How Long Do Menopause Symptoms Last?
Menopause lasts from the time the first symptoms begin – this may be when periods become erratic, or classic symptoms like hot flushes start to happen – to the date 12 months after the last period. The average total length of menopause symptoms is more than seven years, and symptoms are reported to continue after the final menstrual period for around four and a half years.
However, it is important to note that everyone’s experience is not the same, and may also be affected by treatment and management.
At What Age Does Menopause Start?
Menopause usually occurs in the late forties or early fifties. In Malaysia, the average age of menopause is 50.
If menopause begins before the age of 40, it is referred to as ‘early menopause’ or ‘premature menopause’. There is a range of genetic and environmental factors which also seem to influence the age at which women usually experience menopause, and lots of women begin menopause at around the same age their own mothers did.
Why Does Menopause Happen?
As we get older, our reproductive cycle slows down. Ovaries start to produce less oestrogen, which affects the menstrual cycle. This explains why the menstrual cycle starts to become irregular. Menopause then marks the time when women are no longer able to bear children naturally.
Interestingly, post-menopausal women with healthy uteruses (wombs) can still become pregnant through in vitro fertilization. There are numerous examples of women acting as surrogates.
Sometimes, menopause may happen earlier due to an operation to remove the ovaries (oophorectomy), a medical condition, chemotherapy, or radiotherapy which affects the ovaries’ oestrogen production.
A hysterectomy (removal of the womb) for a condition like uterine or cervical cancer may or may not also involve the removal of ovaries. If the ovaries are removed, menopause begins immediately. If the ovaries are left intact and in situ, they continue to produce oestrogen and so menopause does not begin. On average, however, women who have had a hysterectomy without oophorectomy still tend to begin menopause slightly earlier than women who have not had a hysterectomy.
How Is Menopause Diagnosed?
Usually, the symptoms alone are enough to make a diagnosis of menopause.
To confirm the diagnosis, blood or urine tests may be completed to show the fluctuating levels of hormones that happen around the time of menopause.
Menopause is only considered completed 12 months after the last menstrual period, so the end of menopause is only diagnosed retrospectively.
Although we talk about ‘diagnosis’ and ‘symptoms’ in medical terms, menopause is a natural and normal occurrence, rather than a medical condition. Many women do not have any trouble at all. On the other hand, some people experience severe symptoms which can affect their everyday life. Remember that everyone’s experience is different and it is okay to seek professional advice and treatment for troublesome symptoms.
If the symptoms of menopause are affecting your quality of life, there are several medical treatments that can be prescribed by a GP, as well as a range of alternative therapies and naturopathic remedies that may help.
Hormone Replacement Therapy (HRT)
HRT can ease the symptoms of menopause. Some people find this treatment essential to get them through periods of severe symptoms. HRT is available in many forms, including tablets, patches that stick on the skin, and vaginal creams and pessaries.
However, there are risks associated with some forms of HRT and it may not be recommended for those with a history of breast cancer.
Antidepressants are often used to reduce the effect of mood changes and sleeplessness during menopause. Some antidepressants also have a beneficial effect on other menopause symptoms, including hot flushes.
Besides managing the symptoms of menopause, women should also take note of the increased risks of certain conditions post-menopause. For example, reduced oestrogen production increases the risk of osteoporosis, and so it is important to take the necessary steps to manage this risk, such as using medication or supplements.
There are lots of different supplements for menopausal and post-menopausal women. These range from herbal or homeopathic remedies to specially blended multivitamins. The evidence behind the supplements available is variable, so it is important to do some research before taking supplements. If in doubt, always turn to a medical professional for advice.
Some of the most common herbal and alternative medicines marketed for managing menopause include:
One of the most common herbal remedies used in menopause, red clover has been the subject of several studies to determine its effectiveness in reducing menopausal symptoms. The results have been variable, but show some promise.
Research into ginseng in menopause has found that, while it does not seem to have a significant impact on troublesome hot flushes, it can help with depression and mood changes.
Evening Primrose Oil
Evening primrose oil has been used for many years to reduce the intensity of hot flushes in menopause.
Like evening primrose oil, black cohosh is used to reduce the intensity of hot flushes, and also seems to reduce its frequency as well.
The phytoestrogens in some plants are thought to reduce the effects of fluctuating oestrogen in women’s bodies during menopause. Soy can be incorporated into the diet in the form of soy milk, edamame beans, tofu, various meat or dairy alternatives, or concentrated supplements.
Taking a multivitamin designed for menopause is often recommended by healthcare professionals. While a healthy diet alone can provide a person with all the vitamins and minerals they need for good health, there may be some specific requirements during and after menopause.
Bone density decreases markedly after menopause so Calcium and vitamin D supplements are commonly recommended – alongside a good diet and exercise – to help prevent osteoporosis. The B vitamins, along with vitamins C and D are also particularly essential for menopause.
Lifestyle Tips for Menopause Management
Many of the symptoms of menopause can be well managed using simple measures. For example, wearing cool clothing, having cold drinks on hand, and using fans or other cooling measures can help with hot flushes.
Post-menopause, being aware of the altered profile of disease risk is important. Staying active and following a healthy diet helps reduce the risk of cardiovascular disease, weight gain, and the conditions associated with a high body mass index (BMI) like type 2 diabetes and high blood pressure. A diet high in calcium and vitamin D can help maintain healthy bones into later life.
Continuing to attend regular health check-ups, breast screening, and taking prescribed medication as directed are all essential for staying healthy after menopause.
As we get older and face a higher risk of conditions associated with ageing, it is essential to maintain a healthy lifestyle to mitigate that risk. A healthy diet, regular exercise, and cutting back on caffeine and alcohol are a good start. If you smoke, quitting is also one of the most important things you can do to keep diseases at bay and ensure a healthy life.
- Greendale, G. A., Lee, N. P., & Arriola, E. R. (1999). The menopause. The Lancet, 353(9152), 571-580. https://doi.org/10.1016/S0140-6736(98)05352-5
- Gold E. B. (2011). The timing of the age at which natural menopause occurs. Obstetrics and gynecology clinics of North America, 38(3), 425–440. https://doi.org/10.1016/j.ogc.2011.05.002
- Steiner, A. Z., Baird, D. D., & Kesner, J. S. (2008). Mother’s menopausal age is associated with her daughter’s early follicular phase urinary follicle-stimulating hormone level. Menopause (New York, N.Y.), 15(5), 940–944. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856641/
- S.Indramalar (2020). Being ahead of the changes that come before menopause is crucial | The Star. [online] Available at https://www.thestar.com.my/lifestyle/family/2020/07/03/being-ahead-of-the-changes-that-come-before-menopause-is-crucial
- Blume-Peytavi, U., Atkin, S., Gieler, U., & Grimalt, R. (2012). Skin academy: hair, skin, hormones and menopause–current status/knowledge on the management of hair disorders in menopausal women. European Journal of Dermatology, 22(3), 310-318. https://grimalt.net/wp-content/uploads/2018/06/Blume-Peytavi-hair-hormones-skin-academy.pdf
- Dog, T. L. (2005). Menopause: a review of botanical dietary supplements. The American Journal of Medicine, 118(12), 98-108. https://doi.org/10.1016/j.amjmed.2005.09.044
- Hall G and Phillips TJ. (2005) Estrogen and skin: The effects of estrogen, menopause, and hormone replacement therapy on the skin. J Am Acad Dermatol 53:555-68. https://doi.org/10.1016/j.jaad.2004.08.039
- Cassidy, A., Albertazzi, P., Nielsen, I., Hall, W., Williamson, G., Tetens, I., . . . Branca, F. (2006). Critical review of health effects of soyabean phyto-oestrogens in post-menopausal women. Proceedings of the Nutrition Society, 65(1), 76-92. https://www.doi.org/10.1079/PNS2005476
- Melissa K. Melby, Margaret Lock, Patricia Kaufert, Culture and symptom reporting at menopause, Human Reproduction Update, Volume 11, Issue 5, September/October 2005, Pages 495–512, https://doi.org/10.1093/humupd/dmi018
- Kim, M. S., Lim, H. J., Yang, H. J., Lee, M. S., Shin, B. C., & Ernst, E. (2013). Ginseng for managing menopause symptoms: a systematic review of randomized clinical trials. Journal of Ginseng Research, 37(1), 30–36. https://doi.org/10.5142/jgr.2013.37.30
- North American Menopause Society (2004). Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause (New York, N.Y.), 11(1), 11–33. https://pubmed.ncbi.nlm.nih.gov/14716179/
- Avis NE, Crawford SL, Greendale G, et al. (2013) Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996
- Bruce, D., & Rymer, J. (2009). Symptoms of the menopause. Best Practice & Research Clinical Obstetrics & Gynaecology, 23(1), 25-32. https://doi.org/10.1016/j.bpobgyn.2008.10.002
- Hidalgo, L. A., Chedraui, P. A., Morocho, N., Ross, S., & San Miguel, G. (2005). The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 21(5), 257–264. https://doi.org/10.1080/09513590500361192
- Johnstone, R. A., & Cant, M. A. (2010). The evolution of menopause in cetaceans and humans: the role of demography. Proceedings of the Royal Society B: Biological Sciences, 277(1701), 3765-3771. https://doi.org/10.1098/rspb.2010.0988
- Farzaneh, F., Fatehi, S., Sohrabi, MR. et al. (2013) The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Arch Gynecol Obstet https://doi.org/10.1007/s00404-013-2852-6
- Mehrpooya, M., Rabiee, S., Larki-Harchegani, A., Fallahian, A. M., Moradi, A., Ataei, S., & Javad, M. T. (2018). A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. Journal of education and health promotion, 7, 36. https://pubmed.ncbi.nlm.nih.gov/29619387/
- Milart, P., Woźniakowska, E., & Wrona, W. (2018). Selected vitamins and quality of life in menopausal women. Przeglad menopauzalny = Menopause review, 17(4), 175–179. https://doi.org/10.5114/pm.2018.81742