Menopause: A Comprehensive Guide to the End of Menstruation

Menopause is the point in time when a woman ceases to menstruate (have periods).

A woman is generally considered postmenopausal when she has not had periods for 12 consecutive months.

Most women experience menopause naturally during the ages of 45 and 55, though some women may experience menopause prematurely due to surgical interventions, medical treatments, or health conditions.

Menopause is known to cause several uncomfortable symptoms, including hot flushes, night sweats, and mood changes. Many of these symptoms can be reduced through lifestyle changes - however, if they begin interfering with your daily function, you may need to seek medical support.

Today, we are going to cover all things menopause, including where you can find support to navigate the “change of life”.

What is menopause?

Menopause is the point in time when a woman ceases to menstruate (have periods). It signals the end of the reproductive stage of a woman’s life.

Natural menopause generally takes place when a woman is between 45 and 55 years of age. It occurs when the number of eggs in each ovary begins to decline. At the same time, the body stops producing female hormones regularly, including oestrogen and progesterone. Oestrogen is responsible for developing and maintaining the female reproductive system, while progesterone helps regulate menstruation and support pregnancy.

This combination of changes subsequently causes the body to stop ovulating, which leads to a further drop in female hormones and the winding down of periods altogether.

1. Oophorectomy, an operation in which one or both ovaries are removed. Oophorectomies are commonly performed to remove an ovarian cyst, a twisted ovary, or if there is a risk of ovarian cancer. When a woman stops menstruating due to surgical interventions, this is known as surgical menopause.
2. Cancer treatments, including chemotherapy and radiotherapy. Chemotherapy uses powerful drugs to kill fast-growing cells in the body. The cells of the ovaries (oocytes) tend to divide quickly, and so are often impacted by chemotherapy. This can lead to infertility and early menopause, as oocytes produce hormones that help release eggs each month and prepare the uterus for possible pregnancy. When a woman stops menstruating due to medical treatments, this is known as induced menopause.
3. Health conditions, such as primary ovarian insufficiency (POI), when the ovaries cease functioning before the age of 40. There are many possible causes of POI, including chromosomal abnormalities, autoimmune diseases, and metabolic disorders. More often than not, however, the exact cause remains unclear.

Stages of menopause

There are three stages of menopause, including:

Perimenopause

Perimenopause is largely considered the ‘lead-up’ to natural menopause. It occurs when the ovaries begin running out of eggs, which causes the body’s levels of female hormones to fluctuate dramatically. As such, you may stop ovulating regularly, which can impact the frequency, intensity, and duration of your periods.

Perimenopause is often signalled by changes to the menstrual cycle, though it also causes a host of other physical and emotional symptoms. In fact, the symptoms often associated with menopause are generally felt more intensely during perimenopause, including:

• Hot flushes and night sweats.
• Difficulty falling and staying asleep.
• Dry skin that feels itchy or crawly.
• Exhaustion and difficulty concentration.
• Vaginal dryness and loss of libido.
• Mood changes, such as anxiety and irritability.
• Unexplained weight gain, due to the metabolism slowing.

Perimenopause generally affects women in their 40s, and on average it lasts for 4 to 6 years. Most women only experience mild to moderate symptoms during perimenopause. However, if your symptoms are so severe that they are impacting your daily life, you should consult a healthcare professional.

Menopause

Menopause is the final period, and a woman is considered to have reached menopause when they have not had a period for 12 months. It occurs when the ovaries run out of eggs, and the body can no longer ovulate or have periods. As we mentioned earlier, the symptoms often associated with menopause, such as hot flushes, mood changes, and unexplained weight gain, are generally felt before a woman reaches menopause.

Postmenopause

Postmenopause starts when a woman has not had periods for 12 months.

Complications of menopause

After menopause, a woman’s risk of certain medical conditions increases, including:

1. Cardiovascular disease (CVD): CVD refers to any condition affecting the heart and blood vessels. It is often caused by atherosclerosis, a condition in which fats, cholesterol, and other substances build up in the inner lining of arteries to form plaque. This build-up of plaque can reduce the heart’s blood flow temporarily, as in angina (chest discomfort), or it can block the heart’s blood flow completely, as in a heart attack. Heart attacks can be fatal, as the longer the heart goes without oxygen, the greater the chance it will sustain permanent damage and begin to fail. Menopause can drive certain risk factors for CVD. According to the Australasian Menopause Society, a drop in oestrogen levels can increase the level of fat in a woman’s blood. This can subsequently result in high cholesterol and blood pressure, both of which can weaken blood vessels and make them more prone to clotting.
2. Osteoporosis: Osteoporosis means ‘porous bones’. It is a condition in which bones become thin, weak, and prone to fractures. Bone is a living tissue that comprises various cells, proteins, and minerals. Bones are in a constant state of renewal, with old bones being broken down to make way for new ones. Osteoporosis occurs when old bone tissue is lost faster than the body can replace it. There are numerous risk factors for osteoporosis, including low body weight, calcium intake, and vitamin D levels. Menopause can also trigger certain risk factors for osteoporosis, as oestrogen regulates the activity of osteoblasts, cells that make new bone. As such, low oestrogen levels can decrease a woman’s bone mineral density and make them more susceptible to osteoporosis.
3. Urinary Incontinence: Urinary incontinence is when urine leaks from the urethra involuntarily. It can occur when the bladder muscles suddenly tighten, such as when a person coughs, sneezes, or laughs, but the sphincter muscles are not strong enough to pinch the urethra shut. There are various types of urinary incontinence, all of which can result from a host of different lifestyle habits, medical conditions, or physical problems, such as pregnancy, alcohol consumption, and urinary tract infections. Menopause can also increase a woman’s risk of urinary incontinence. This is because oestrogen plays a key role in maintaining the elasticity of vaginal tissue, the thickness of the urethra, and the strength of the pelvic floor (the muscles that support the urethra and bladder). As such, low oestrogen levels can increase the frequency and urgency of a woman’s need to urinate.

Treating Menopause Symptoms

There are several treatment options available to help women manage menopause symptoms and reduce their risk of menopause complications.

Sleep Well

According to Jean Hailes for Women’s Health, it is not uncommon for women to experience sleep difficulties before, during, and after menopause. Most menopausal women attribute their sleep difficulties to hot flushes and night sweats, as these can disturb your sleep pattern and trigger insomnia. Insomnia is a common sleep disorder in which a person struggles to fall and stay asleep.

Menopausal women are also prone to developing sleep apnoea due to the loss of oestrogen and progesterone, which both help maintain the airway’s muscle tone. Sleep apnoea is a common sleep disorder in which a person’s breathing repeatedly stops and starts during sleep. Like insomnia, sleep apnoea can lead to sleep deprivation and cause daytime fatigue, headaches, and depression.

You can improve your sleep quality by establishing a regular sleep schedule, creating a comfortable sleeping environment, having a pre-bedtime routine to wind down, and fostering good sleeping habits during the day, such as exercising and getting a good dose of daylight. More tips for getting a good night's sleep can be found in our Article Library.

Maintain a Healthy Weight

As we mentioned earlier, menopause can be accompanied by unexpected weight gain, as well as increase a woman’s risk of cardiovascular disease and osteoporosis. One way to stave off these side effects is by maintaining a healthy weight through regular physical activity and a varied, nutritious diet.

For instance, regular physical activity has been shown to facilitate weight loss, reduce the levels of ‘bad’ cholesterol in the body, and train the heart to pump blood more efficiently. This subsequently reduces the level of wear and tear on blood vessels, and makes them less prone to collecting plaque. Likewise, regular physical activity has been shown to improve muscle strength, which can increase a person’s balance, flexibility, and bone density, and thereby diminish their risk of falls, breakages, and chronic pain.

The food we eat also goes a long way in improving our heart and bone health. For instance, leafy vegetables have high levels of nitrates, which have been shown to reduce blood pressure, decrease arterial stiffness, and promote healthy blood vessels. Soy protein has also been shown to reduce the risk of CVD due to its high levels of isoflavones, which have anti-inflammatory properties. Protein, likewise, plays an important part in bone health, as it is essential for preserving bone mass and reducing the effects of ageing on bone health.

If you need help with integrating physical activity into your daily life, head to our Resource Library.

Smoking

If you are going through menopause, it might also be worthwhile to give up smoking, as tobacco and e-cigarettes have been shown to increase the risk of CVD.

For instance, nicotine increases the levels of ‘bad’ cholesterol in the blood and makes it more prone to sticking to artery walls. The chemicals in smoke can also cause platelets to stick together and form clots, while simultaneously narrowing blood vessels, making the heart beat faster, and forcing blood pressure upwards.

Likewise, smoking has been linked to an increased risk of osteoporosis, as smoking generates free radicals – molecules that attack the body’s natural defences and damage the cells, organs, and hormones required to keep bones healthy.

Other

There are several other lifestyle changes that you can make to reduce the symptoms and complications of menopause.

For instance, to offset the effects of hot flushes, you could reduce your intake of alcohol, caffeine, and spicy foods. These foods act as vasodilators and increase blood flow to the skin.

To lessen the severity of mood swings, and the anxiety and depression that can accompany them, you could partake in supportive therapies and develop relaxation techniques. Supportive therapies can include hypnotherapy, mindfulness, and cognitive behavioural therapy (CBT).

Hormone Replacement Therapy

If your menopause symptoms are so severe that they can’t be effectively managed with lifestyle changes, you may need to consult a healthcare professional about starting menopausal hormone therapy (MHT).

MHT refers to the medical replacement of oestrogen, progesterone, and (sometimes) testosterone. It can provide relief from several menopausal symptoms, including hot flushes, night sweats, mood swings, insomnia, and vaginal dryness. MHT can also reduce the risk of osteoporosis and postmenopausal bone fractures.

As with any medical treatment, MHT is not without its risks, including blood clots, breast cancer, and stroke. However, these risks are considered small and inconsequential compared with the overall benefits of MHT. Head to the Jean Hailes website for more information on the different types of MHT available.

Final thoughts

Menopause is the point in time when a woman ceases to have periods. It occurs naturally when the ovaries run out of eggs and the body can no longer ovulate.

Menopause comes in three stages: perimenopause, menopause, and postmenopause. It is during perimenopause, when a woman’s ovaries begin running out of eggs, that women typically experience the symptoms closely associated with menopause.

These symptoms can include hot flushes, night sweats, and mood changes. Menopause can also trigger a woman’s susceptibility to certain health conditions, including cardiovascular disease, osteoporosis, and urinary incontinence.

There are several lifestyle changes and treatment options available to help you manage these symptoms and complications, such as sleeping well, maintaining a healthy weight, and using menopausal hormone therapy.

Menopause is a natural part of life, and no woman should feel ashamed for going through the ‘change of life’. There are plenty of resources and information available to help you navigate any uncertainty – head to the Jean Hailes website for more details.