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Menopause

Published by Bupa's health information team, September 2009.

This factsheet is for women who are going through the menopause, or anyone who would like information about it.

Menopause is when your periods permanently stop. It's a natural part of ageing, signalling the end of your reproductive years. The average age of natural menopause in the UK is 50, although this varies from woman to woman and can happen earlier or later. It can also be brought on by surgery, medicines, radiotherapy or an infection.

• About the menopause
• Symptoms of menopause
• Keeping healthy during menopause
• Treatment of menopause
• Questions and answers
• Related topics
• Further information
• Sources

About the menopause

The menopause happens when your ovaries stop producing eggs. The eggs you produce stimulate your ovaries to produce oestrogen, so when you stop producing them, there is a drop in the levels of oestrogen in your blood. This fall in hormone levels disrupts your menstrual cycle and produces the other symptoms that are associated with menopause.

When does the menopause happen?

The menopause usually happens gradually. For a few years before menopause, your periods may become irregular, happening more or less often than they used to. There may be a change in the amount of bleeding - slightly heavier periods are more common.

If you have started noticing these changes or other menopause symptoms (see Symptoms of menopause), you are said to be perimenopausal. The perimenopause can last several years and in most women starts between 45 and 47. You are considered to be through the menopause, or postmenopausal, when it's been a year since your last period.

Surgery that removes the ovaries causes immediate menopause. Surgery to remove the womb (hysterectomy), some types of radiotherapy and some types of chemotherapy can also result in early menopause. Some infections, such as mumps, can very rarely cause menopause, but this is usually temporary. Other infections, such as malaria, can cause permanent menopause.

When menopause happens before the age of 45, it's considered premature (early) menopause. You should see your GP for advice if you are under 45 and you begin to get menopause symptoms. Women who smoke go through the menopause an average of two years early.

You can still become pregnant while going through the menopause. You should keep using contraception for one year after your last period if you're over 50, and for two years after your last period if you're under 50.

Symptoms of menopause

Although some women have no symptoms other than the ending of their periods, eight in 10 experience menopause symptoms. Symptoms may be worse if your menopause happens suddenly, for example after surgery, rather than gradually. They can include:

• hot flushes and night sweats, sometimes associated with feeling faint or feeling your heart thumping fast (palpitations) - eight in 10 women experience flushes, most commonly in the first year after the last period
• vaginal changes, such as dryness and loss of tone
• difficulty sleeping (insomnia), due to night sweats or mood changes
• loss of interest in sex (libido), related to vaginal changes, sleep problems or mood changes
• mood changes such as irritability, depression or anxiety, although it's possible that these are due to life changes rather than the menopause itself
• headaches
• urinary changes - you may find you have reduced control of urination (incontinence) around the time of the menopause, but this is more likely to be caused by being overweight or by having had children in the past, especially if you have had more than one baby

The reduced levels of hormones can increase the risk of various health problems in the long term. These include:

• osteoporosis (loss of bone density) - bones become brittle and break more easily
• heart disease, increasing the risk of having a heart attack
• stroke
• weakness of the pelvic floor and vaginal muscles

Keeping healthy during menopause

Physical activity

Regular exercise can help improve some symptoms of the menopause, including hot flushes and night sweats, difficulty sleeping and mood changes.

Physical activity that stresses the bones, such as running and walking, can help your bones to become stronger, slowing down the loss of bone density. Physical activity can also help protect against heart disease and stroke. The recommended amount of physical activity is at least half an hour of moderate intensity physical activity on at least five days each week.

Diet

A healthy diet can help protect your body against some of the long-term effects of the menopause. Your diet should include at least 700mg of calcium per day, which helps keep bones strong and reduces the risk of osteoporosis. You can get this from milk, other dairy products, tinned fish with bones such as sardines, and leafy green vegetables.

Our skin produces most of the vitamin D we need when it's exposed to sunlight. If you are indoors a lot of the time, or have little exposure to the sun, make sure your diet includes plenty of vitamin D. Vitamin D is found in oily fish, eggs and some fortified breakfast cereals.

Eating too much food containing vitamin A may increase your risk of osteoporosis. High levels of vitamin A are found in liver and liver products such as pate, so you should only have these once a week, or eat small portions. You are more likely to gain weight around your waist as you get older. Gaining weight puts you at a higher risk of heart disease so it's important that you try to keep at a healthy weight for your height.

Treatment of menopause

Self-help

Take practical steps to deal with hot flushes, by keeping cool and avoiding possible triggers such as spicy food, caffeine, smoking or stress.

Hormone replacement therapy

Hormone replacement therapy (HRT) replaces some of the hormones that are reduced during and after the menopause. It usually includes a combination of oestrogen and progesterone, rather than just oestrogen. This is because taking oestrogen on its own increases the risk of cancer in the lining of the womb. You can have oestrogen-only HRT if you have had an operation to remove your womb (a hysterectomy).

Combined HRT (oestrogen and progesterone) comes in tablets, patches, skin gels and implants. Vaginal creams, pessaries or a vaginal ring may be helpful for vaginal problems such as dryness. You normally take HRT for two to three years. Symptoms can come back in some women for a short time after stopping HRT.

HRT can have side-effects, including tender breasts, heavier periods, water retention, weight gain, depression, feeling sick and headaches. Changing the type and dose of HRT may reduce the side-effects. You can ask your GP for more information and advice on different forms of HRT.

The long-term benefits of HRT are a reduced risk of osteoporosis, and, for combined HRT, a reduced risk of colorectal cancer. Other benefits include:

• relief from hot flushes and night sweats
• it may improve sleep by reducing night sweats
• relief of vaginal dryness and urine infections
• maintenance of vaginal muscle tone, which may help to reduce urinary incontinence

Taking HRT for a long time may slightly increase the risk of developing certain conditions, including:

• breast cancer
• endometrial cancer (cancer of the lining of the womb) or ovarian cancer when you take oestrogen-only HRT
• a blood clot in your leg vein (deep vein thrombosis)
• gallstones
• stroke and possibly heart disease

Talk to your GP to help you weigh up the benefits and risks of taking HRT. For most women, the benefits outweigh the risks.

Other medicines

Other treatment options include the following.

For hot flushes and night sweats:

• tibolone (which acts like oestrogen, progesterone and testosterone) is suitable for women under 50
• non-hormonal medicines such as selective serotonin re-uptake inhibitors (SSRIs) eg paroxetine -two in three women find that these reduce hot flushes

For loss of libido and vaginal dryness:

• vaginal lubricants
• medicines containing the hormone testosterone

For mood disturbances, your GP may recommend counselling or antidepressant medicines. HRT is not recommended if depression, anxiety or other mood disturbances are your only menopause symptoms.

Complementary therapies

There isn't enough evidence for doctors to recommend taking phytoestrogens (naturally occurring oestrogen-like compounds found in plants), but some studies have found that one type, called isoflavone, may reduce hot flushes. However, there may be an increased risk of endometrial cancer. Dietary sources of phytoestrogen include roasted soy beans, soy milk, tofu and miso.

There is little evidence to show that herbal remedies such as black cohosh, angelica and evening primrose oil, work. Herbal remedies are medicines and, like all medicines, they can have side-effects and interact with other medicines. For example, black cohosh can damage the liver. There is no regulation of herbal medicines, so you can't be sure how much of the active ingredient it contains. You should ask your GP or pharmacist for advice if you decide to try any herbal treatments.

Other complementary therapies that promote relaxation, exercise, and wellbeing (such as aromatherapy, acupuncture, yoga and reflexology) may help reduce symptoms in some women.

Related topics

• Healthy eating
• Healthy weight for adults
• HRT implants

Further information

• Women's Health Concern
  www.womens-health-concern.org

Sources

• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:732.
• Menopausal symptoms. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 22 June 2009
• Menopause. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 22 June 2009
• Health care guideline: menopause and hormone therapy (HT): collaborative decision-making and management. Institute for Clinical Systems Improvement. 8th ed. 2008. www.icsi.org
• At least five a week: evidence on the impact of physical activity and its relationship to health. Chief Medical Officer. Department of Health, 2004. www.dh.gov.uk
• Ages and stages - women. Eat well, be well. www.eatwell.gov.uk, accessed 24 June 2009
• Joint Formulary Committee. British National Formulary. 57th ed. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 2009
• BMS consensus statements: summary & practice points: hormone replacement therapy. British Menopause Society, February 2008. www.thebms.org.uk
• Complementary approaches to menopausal symptoms - RCN guidance for nurses, midwives and health visitors www.rcn.org.uk, accessed September 2006

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009