What is menopause?

Menopause is a natural event and is actually the last period a woman has at the end of her reproductive years. Because periods can be somewhat irregular for some time before menopause, it is said to have definitely occurred when a woman has not menstruated naturally for twelve consecutive months. Most women reach menopause between the ages of 45 and 55, but the average is 51 years.

Perimenopause, or the menopause transition, is the time when periods fluctuate until they stop. On average perimenopause lasts four to six years and menopause symptoms can begin gradually over this time before the final menstrual period.

What happens to your body at menopause?

Women are born with about a million eggs in each ovary but by the time we reach menopause there are no functioning eggs left. We release about 400-500 eggs in our reproductive life, from the time periods start until they end at menopause. From about 35-40 years, the remaining eggs in our ovaries rapidly diminish and we ovulate (when an egg is released from the ovary) less or irregularly until our periods stop.

The hormone oestrogen is produced from the cells around the eggs. Progesterone is also produced but only if an egg has been released following ovulation. The production of oestrogen diminishes when the number of remaining eggs is small and close to the final period. In the few years prior to menopause these hormone levels can fluctuate widely, being both high and low. As the production of oestrogen by the ovaries slows down you may notice the following changes in your menstrual cycle:

• longer, shorter or irregular periods
• lighter bleeding
• unpredictable and heavy bleeding (see your health practitioner)

Eventually hormone levels decrease so that menstruation stops altogether resulting in menopause. Where appropriate, birth control is still needed until you have had one year without a natural period if over the age of 50 and two years if under 50.

What are the symptoms of menopause?

Not all women experience menopause symptoms, in fact 20 per cent experience no symptoms. Some 60 per cent experience mild symptoms, while only 20 per cent suffer severe symptoms. As your hormone levels fluctuate, you may begin to experience some of the following physical and emotional symptoms:

• hot flushes and night sweats
• aches and pains
• crawling or itching under the skin
• headaches
• vaginal dryness
• reduced libido (sexual interest and desire)
• urinary frequency
• tiredness
• irritability
• depression
• sleeping difficulty
• low self-esteem
• forgetfulness

What is early and premature menopause?

Early menopause is when the final menstrual period occurs before the age of 45. Premature menopause is when the final menstrual period occurs before the age of 40. Early and premature menopause may occur:

• naturally when hormone levels decrease
• surgically when a woman has her ovaries removed
• chemically from chemotherapy or radiotherapy for cancer treatment

Women who experience early menopause are at greater risk of osteoporosis and heart disease because of the long-term effects of low oestrogen levels (see 'Early and Premature Menopause' fact sheet for more information). If you think you are experiencing early or premature menopause it is important to see to your health practitioner. Women who experience premature menopause need specialist medical advice in order to minimise the risk of long term health problems

What can you do to manage menopause symptoms?

It is possible to reduce some symptoms of menopause with changes to your lifestyle, as outlined below:

Healthy eating

The following suggestions may assist with managing weight, decreasing hot flushes, balancing mood, and preventing osteoporosis, high cholesterol levels, high blood pressure and heart disease:

eat plenty of fresh vegetables, fruits, cereals and wholegrains to manage weight and reduce your risk of heart disease

• drink six to eight glasses of water daily
• decrease caffeine intake (coffee, tea, cola, chocolate) as it can be a trigger for hot flushes
• limit alcohol to one to two standard glasses, or less, per day is it can also trigger hot flushes
• eat high-calcium, low-fat dairy foods to reduce your risk of osteoporosis
• include lean meats and fish in your diet to manage weight and reduce your risk of heart disease
• phytoestrogens (plant oestrogens) may reduce the risk of high cholesterol and blood pressure. Good sources include soy and linseed bread, soy beans, tofu, whole grains and legumes

See  Healthy Eating 116.18 Kb for more information

Regular physical activity

Aim for 30 minutes of moderate intensity physical activity on all or most days of the week to maintain general health, control weight and help keep bones healthy.

See  Physical Activity 98.89 Kb for more information

Alter your environment 

• Create a cooler environment
  - have fans throughout the house and always carry a little hand fan
  - air conditioning in your home to cool your environment
  - use a water facial spray when experiencing a hot flush
  - have cool drinks available when experiencing flushes

• Wear layers of clothing, so you can take off as much as you need when hot

Avoid smoking

Quitting smoking reduces many health risks. During menopause, it is important to avoid smoking because of the associated risk of osteoporosis, heart disease and lung cancer. Women who smoke may reach menopause one to four years earlier than women who don't smoke and are more likely to experience menopausal hot flushes. Need help quitting smoking? Call the Quitline on 13 7848 or www.quit.org.au

Look after your emotional health

You may experience mood changes such as mild depression, mood swings and irritability, often related to physical changes like hot flushes, night sweats and interrupted sleep. Talk to a health practitioner about controlling the physical symptoms of menopause that may help improve your general wellbeing. Seeing a psychologist or counsellor to support you through this time may help.

See Emotional Health at Midlife 163.39 Kb and  Menopause 113.91 Kb for more information.

Have regular Pap tests and breast checks

See your health practitioner for a Pap test every two years until the age of 70 and regularly check your breasts. Mammograms are free if you're over 40 years of age – phone BreastScreen on 13 20 50.

What therapies can help you manage menopause symptoms?

Hormone replacement therapy (HRT) 

Hormone replacement therapy can help relieve the symptoms of menopause but each treatment has associated side effects. The decision to use HRT should be guided by a health practitioner and be based on your individual needs with consideration of your medical history, risks and benefits. It is important that all women using HRT be reviewed once a year by their health practitioner.

See  Hormone Replacement Therapy 158.61 Kb for more information

Non-hormonal therapies

In women who have developed menopause following chemotherapy or radiotherapy for cancer or following surgery for a hormone dependent cancer, such as breast cancer, HRT is not usually recommended. There are a number of different non-hormonal medicines that are suitable. It is important to discuss these with your doctor.

Natural therapies

Women often use natural or complementary therapies to manage menopause symptoms. It is important to remember that 'natural' herb and plant medications should be treated as medicines as they can have side effects. Therefore, if considering complementary therapy, it is important to see a qualified naturopath with an interest in women's health for long-term guidance. It is also important to talk this through with your medical practitioner before starting treatment, as some natural therapies have interactions with other medications you may be taking.

Complementary therapies can often be taken in conjunction with HRT. For example, a woman might take HRT to address some symptoms and complementary therapies for others. It is essential to let both your doctor and naturopath know exactly what each has prescribed.

For women with a history of breast cancer or hormone-dependent cancers, the safety of using some herbal therapies is not known. It is advisable to seek the advice of a naturopath to discuss safe options, and you should always consult your cancer or other specialists before taking any 'natural' therapies.

Where can I get more information?

www.jeanhailes.org.au

www.managingmenopause.org.au

www.menopause.org.au – Australasian Menopause Society

www.betterhealth.vic.gov.au – Better Health Channel

www.healthinsite.gov.au

Content updated November 2011