What is the menopause?
The menopause, also known as the 'change
of life', simply means the end of menstruation. The term is also used to refer
to the months and years in a woman's life before and after her final period a
time that is likely to bring with it some physical and emotional changes.
The menopause is usually a gradual
process. The ovaries begin to produce lower amounts of hormones, which cause
menstrual periods to become irregular and eventually to stop completely. The
fluctuating levels of hormones also contribute to other symptoms that may occur
at this time, such as hot flushes and night sweats.
When does it happen?
Most women menstruate for the last time at
about 50 years of age, although a few do so as early as 40 and a very small
percentage as late as 60. With the average life expectancy of Irish women now at
around 80 years of age, this means that one-third of an Irish womans life may
take place after their menopause. Women who smoke undergo menopause about two
years earlier than non-smokers.
Most women notice some menstrual changes
such as shortening of cycle length (periods occurring closer together), skipped
menstrual periods and occasional heavy periods up to a few years before
menstruation ceases. Menopause can often occur at a time in life when other dramatic
changes are taking place, such as the loss of parents, adjustment to children
growing up and leaving home, or retirement. These changes, in addition to the
changes in your body, may result in psychological or emotional stress.
A premature menopause (before age 40) can
sometimes occur and may be due to a number of different reasons, for example,
surgical removal of the ovaries.
What are the symptoms?
You may have both physical and psychological
symptoms during menopause. Most of the physical symptoms are due to the
reduction in levels of the hormone oestrogen. Symptoms may occur for a few
weeks, a few months, or sometimes over several years. Your symptoms may come
and go, or they may occur regularly. Some common symptoms are:
- Hot flushes the most common symptom of
menopause, these can cause flushing in the face and neck (find out more about hot flushes).
- Night sweats the night-time version of
hot flushes they may result in a disturbed sleep pattern.
- Changes in menstrual cycles more than
three-quarters of all menopausal women experience changes in their menstrual
cycle before periods cease. Cycles can be longer, shorter or irregular. They
may also be lighter or heavier than they were before. The reason for the
irregularities is changes in the bodys production of hormones, which occurs as
the ovaries run out of eggs. Slight changes in the length of your menstrual
cycle may be a sign that menopause is beginning.
- Worsening PMS symptoms unfortunately,
menopause doesnt mean the end of unpleasant PMS symptoms, such as bloating and
extreme irritability. In fact, worsening PMS may be one of the first signs that
youre entering the menopausal years. It is important to take dietary measures
and to exercise regularly to help control those symptoms.
- Mood changes, irritability, depression,
difficulty concentrating fluctuating hormone levels may contribute to mood
swings. Some studies have linked oestrogen production with the production of a
brain chemical called serotonin, which is needed to regulate moods. Lack of
serotonin can lead to depression. Other possible causes of emotional distress
around the time of the menopause are PMS or the discomfort of physical
symptoms. Many menopausal women have stressful lives that may contribute to
psychological symptoms. If a depression is severe or persistent, consult your
doctor as depression can be treated.
- Fatigue and/or insomnia many women
complain of reduced energy levels at this time and a disrupted sleeping pattern
may be a contributing factor.
- Vaginal dryness, painful sex and/or lack
of sexual interest with dropping oestrogen levels, the vagina becomes drier
and the walls thinner. Intercourse may become uncomfortable or even painful, so
it's not surprising that some women become less interested in sex during the
menopausal years. Don't be embarrassed about talking to your doctor or
pharmacist. The solution may be as simple as using an over-the-counter
lubricant to overcome vaginal dryness or it may involve hormone replacement
therapy (HRT) or other medical treatments. Regular sexual activity also improves
- Stress incontinence during menopause, decreasing
levels of oestrogen can weaken the muscles that have control over the urethra
(the tube carrying urine from the bladder to the outside of the body). This can
cause leakage of urine.
Are there any long-term health problems
associated with menopause?
The drop in oestrogen levels that occurs
in the menopause can have a number of long-term effects. Before the menopause,
oestrogen protects women against the condition atherosclerosis (hardening of
the arteries) a major cause of heart attacks and strokes. The menopause is
therefore associated with a rise in incidence of these diseases.
Oestrogen deficiency is also associated
with osteoporosis a condition in which there is a gradual thinning of the
bone, leading to increased risk of fractures. Lack of oestrogen accelerates the
loss of bone that occurs in this condition.
Women may also find that they suffer from
more infections of the bladder (cystitis) after the menopause. This is due to a
reduction in acidity in the vagina, which can make it easier to contract
How is it diagnosed?
Menopause is most commonly diagnosed on
the basis of your symptoms and medical history. Your doctor may conduct tests to
eliminate other causes of your symptoms if necessary, for instance, with blood or
How is it treated?
Menopause is a natural part of a woman's
life cycle. It is not a disease and does not necessarily require any treatment.
However, many women choose to take medications, such as Hormone Replacement Therapy (HRT) in order
to relieve their symptoms.
HRT may contain either oestrogen only or a
combination of oestrogen and progesterone. It may be prescribed in the form of
tablets to be swallowed, patches to be applied to the skin, or a cream to be
inserted into the vagina.
There has been concern in recent years
about a possible connection between the use of HRT and an increased risk of heart disease and breast cancer. Because of this, HRT is now only recommended for short-term treatment
of menopausal symptoms, when the benefits are considered to outweigh any risks. It is not considered to be suitable for long-term use, e.g. for the prevention
of osteoporosis. You should discuss the pros and cons of HRT with your GP.
There are other medications that may help
to relieve the individual symptoms of the menopause e.g., the hot flushes,
vaginal dryness and stress incontinence.
There are also other ways to help prevent
osteoporosis for example, you can take calcium supplements and exercise
regularly, and there are a number of different medications that can be used in
its treatment. See our article on osteoporosis for more.
Exercise and eating healthy foods may also
help with some of the unpleasant side-effects of menopause. Eating foods high
in plant oestrogens, such as soya beans and lima beans, may alleviate symptoms.
Other sources include nuts and seeds, fennel, celery, parsley and flax-seed
What can I do?
Improve your diet
- Eat more foods that are high in calcium,
such as dark green vegetables and non-fat (skimmed) milk and dairy products.
- Eat fruits, vegetables, and whole grain
cereal products, especially those high in vitamin C and carotene these
include oranges, grapefruit, carrots, tomatoes, broccoli, cauliflower and green
- Reduce saturated fats in your diet these
are found mainly in meat and dairy products. Also remember to check labels for
product contents before you buy them.
- Avoid sugar as much as you can it may
cause hot flushes and other menopausal symptoms.
- You may find that eliminating or limiting
caffeine and alcohol intake also helps with symptoms.
- For people who cannot eat an adequate
diet, supplements may be necessary. Speak to your doctor about your individual
nutritional needs using supplements without supervision can be risky because
large doses of some vitamins may have serious side-effects.
- Regular physical exercise will help you
fight depression and maintain good circulation, mobility, bone density and a
sense of wellbeing.
- Resistance exercises (lifting weights) and
other weight-bearing exercise (dancing, walking and climbing stairs) are
important for preventing osteoporosis. Regular aerobic exercise (swimming,
walking, cycling) helps you control your weight and blood pressure and lowers
heart disease risk.
- Consult your doctor before starting a
rigorous exercise programme and discuss which types of exercises are best for
you. An exercise programme should start slowly and build up to more strenuous
activities. Women who already have osteoporosis of the spine should be careful
about exercise that jolts or puts weight on the back, as it could cause a
- Women who smoke begin their menopause on
average two years earlier than non-smokers.
- Smoking decreases the amount of oestrogen
in the body, and can trigger and worsen hot flushes.
- Smoking is a risk factor for osteoporosis
because it can decrease bone mass. It also increases the risk of heart disease,
lung cancer and other cancers.
- Ask your doctor for advice on quitting,
read some self-help books and consider joining a support group.
Use birth control during sexual
intercourse until your doctor says that you may stop. It is not possible to
know exactly when you will stop being able to get pregnant and pregnancies for
women in their later 40s carry higher risks of medical complications for mother
and baby and also a higher risk of birth defects in the baby.
Look for support
Talk to a friend or family member who
understands what you are experiencing. Discuss the problems with your doctor or