What is menopause?

It is also known as the 'change of life' and it is the end of menstruation. This means a woman's ovaries stop producing an egg every four weeks. She will no longer have a monthly period or be able to have children.

In the UK, the average age for a woman to reach the menopause is 52, although women can experience the menopause in their 30s or 40s.

If a woman experiences the menopause when she is under 45 years of age, it is known as a premature menopause. Monthly periods can sometimes stop suddenly when you reach the menopause. However, it is more likely that your periods will become less frequent, with longer intervals in between each one before they stop altogether.

Causes

The menopause is caused by a change in the balance of the body's sex hormones.

In the lead up to the menopause (perimenopause) oestrogen levels decrease, which causes the ovaries to stop producing an egg each month (ovulation). Oestrogen is the female sex hormone that regulates a woman's periods.

The fall in oestrogen also causes both physical and emotional symptoms including:

• hot flushes
• night sweats
• mood swings
• vaginal dryness

If you experience the menopause suddenly rather than gradually, your symptoms may be worse. The symptoms will usually last for two-five years before disappearing, although in some cases they can last longer. Vaginal symptoms, such as dryness, can sometimes persist and get worse as you get older.

Hot flushes and night sweats

A hot flush is a sudden feeling of heat in your upper body, which can start in your face, neck or chest, before spreading upwards and downwards. The skin on your face, neck and chest may become red and patchy and you may start to sweat. You may also feel a change in your heart rate. It may become very rapid, or it may be irregular and stronger than usual (palpitations).

Hot flushes that occur at night are called night sweats. Most hot flushes only last a few minutes and they are most common in the first year after your final period. Many menopausal women have trouble sleeping due to night sweats, but sleep disturbances may also occur as a result of anxiety.

Vaginal symptoms

During the time leading up to the menopause, you may experience vaginal dryness, itching or discomfort. This can make sex difficult or painful (dyspareunia). These symptoms combined are known as vaginal atrophy. About a third of women experience the symptoms of vaginal atrophy shortly after the menopause, with slightly more women having them later on. In some cases, this can persist for more than 10 years after your final period.If you have vaginal symptoms, it is likely that they will continue or get worse over time unless they are treated.

Urinary symptoms

During the menopause, you are more likely to experience recurrent lower urinary tract infections, such as cystitis. You may also feel an urgent and frequent need to pass urine.

You should speak to your GP if you have menopausal symptoms that are troubling you.

Although there is no definitive test to diagnose the menopause, a blood test to measure the level of follicle-stimulating hormone (FSH) may sometimes be recommended.

Most women do not need treatment for the menopause. However, treatments are available if symptoms are severe and interfere with day-to-day life.

Hormone replacement therapy is one of the main treatments for the menopause. It helps to relieve menopausal symptoms by replacing oestrogen. However on the IBIS II study HRT is not allowed and there is increasing evidence to show that it can be a risk for developing breast cancer

Other treatments

Clonidine

Clonidine is a medicine that was originally designed to treat high blood pressure, but it has been found to reduce hot flushes and night sweats in some menopausal women.

Clonidine can cause unpleasant side effects including dry mouth, drowsiness, depression, constipation and fluid retention. You will need to take it for a trial period of two-four weeks to see whether it will be effective. If your symptoms do not improve during this time, or if you experience side effects, the treatment should be stopped and you should return to your GP.

Vaginal lubricants

If you experience vaginal dryness, your GP can prescribe a vaginal lubricant or moisturiser that can be used for as long as you like.

Antidepressants

Although they are not licensed for treating hot flushes, there are several antidepressant medications that may be effective, including, venflaxine, fluoxetine, citalopram and paroxetine.

Potential side effects of these antidepressants can include nausea, dizziness, dry mouth, anxiety and sleeping problems.

Self-help

Medication may not be necessary if you have reached the menopause and you do not have severe symptoms.

Many women find that making changes to their lifestyle and diet e.g. avoid potential triggers, such as spicy food, caffeine, smoking and alcohol, helps improve menopausal symptoms.

Taking regular exercise and avoiding certain foods can help reduce hot flushes, night sweats and mood swings. To improve sleep problems, avoid exercising late in the day and go to bed at the same time every night

Phyto-oestrogens

Some people believe that phyto or plant oestrogens found in certain foods can help. These are oestrogenic compounds that bind with oestrogen receptor sites in the body cells, increasing the total oestrogenic effect. By acting in a similar way to oestrogen, they may help in keeping hormones a little more in balance. A high intake of phytoestrogens is thought to explain why hot flushes and other menopausal symptoms rarely occur in populations consuming a predominantly plant-based diet. To increase your intake of phyto-oestrogens eat more: soya milk and soya flour, linseeds, tofu, tempeh and miso, pumpkins seeds, sesame seeds, sunflower seeds, celery, rhubarb and green beans.

Visit The British Menopause Society website for more information.

This information was taken with permission from the NHS Choices website.