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Menopause

Menopause is a natural stage of life that occurs when periods stop permanently due to a decline in hormone production by the ovaries. It is diagnosed after 12 consecutive months without a menstrual period and most commonly occurs between the ages of 45 and 55.


Menopause occurs in three stages:

  • Perimenopause – the years leading up to menopause when hormone levels fluctuate and symptoms may begin

  • Menopause – defined as 12 months after the final menstrual period

  • Postmenopause – the years after menopause when hormone levels stabilise, although some symptoms may continue


Some women experience early menopause (before age 45) or premature menopause (before age 40), which may require specialist assessment.

Commonality

Causes

Menopausal symptoms are primarily caused by declining oestrogen levels as ovarian function gradually decreases.


Oestrogen affects many areas of the body, including:

  • Temperature regulation

  • Sleep

  • Mood and brain function

  • Bone strength

  • Cardiovascular health

  • Vaginal and urinary tissues


As hormone levels fluctuate and fall, a range of physical and emotional symptoms can develop.

Symptoms

Symptoms vary widely between individuals and can range from mild to severe.


Common symptoms include:

  • Hot flushes

  • Night sweats

  • Sleep disturbances

  • Mood changes or anxiety

  • Brain fog and difficulty concentrating

  • Vaginal dryness

  • Pain during intercourse

  • Reduced libido

  • Joint pain and muscle stiffness

  • Fatigue and low energy

  • Weight and body composition changes

  • Hair thinning

  • Dry skin

Effects on Fertility

Diagnosis

For women over the age of 45, menopause is usually diagnosed based on symptoms and medical history.


Additional investigations may include:

  • Blood tests to measure FSH and oestradiol levels

  • Thyroid function tests

  • Bone density scans (DEXA)

  • Assessment of unexpected or abnormal vaginal bleeding


A comprehensive assessment may also consider overall health and long-term risk factors.

Treatments

Treatment depends on symptoms, medical history and individual preferences.


Hormone replacement therapy (HRT)

  • Oestrogen-only HRT – for women who have had a hysterectomy

  • Combined HRT (oestrogen and progesterone) – for women who still have a uterus

  • Body-identical HRT – for hormones chemically identical to those produced naturally by the body

  • Testosterone therapy – for women experiencing low libido or reduced energy


HRT can be delivered as:

  • Tablets

  • Skin patches

  • Gels or sprays

  • Vaginal creams, rings or pessaries


Potential benefits of HRT include:

  • Relief from hot flushes and night sweats

  • Improved sleep

  • Better mood and reduced anxiety

  • Protection against bone loss and osteoporosis

  • Improved vaginal health and sexual comfort


Potential risks of HRT may include:

  • A slight increase in breast cancer risk with long-term use of combined HRT

  • A small risk of blood clots or stroke, particularly with oral formulations

  • Side effects such as breast tenderness or headaches


For most healthy women under the age of 60 or within 10 years of menopause, the benefits of HRT generally outweigh the risks.


Non-hormonal and lifestyle approaches

  • Regular exercise and strength training

  • Maintaining a healthy weight

  • Balanced nutrition with adequate calcium and vitamin D

  • Stress management

  • Good sleep habits

  • Cognitive behavioural therapy (CBT)

Ongoing Care

Living with the Condition

Menopause can affect many aspects of daily life, including sleep, mood, energy levels, relationships and overall wellbeing. Symptoms may have a significant impact on work, confidence and quality of life.


The hormonal changes associated with menopause can also affect long-term health, including:

  • Bone health – reduced oestrogen increases the risk of osteoporosis and fractures

  • Heart health – menopause is associated with an increased risk of cardiovascular disease

  • Mental health – hormonal changes can affect mood, memory and concentration


With appropriate support, treatment and lifestyle adjustments, many women experience substantial improvement in symptoms and long-term health.

When to See a Specialist

You may benefit from specialist assessment if you experience:

  • Hot flushes or night sweats

  • Sleep disturbance

  • Mood changes or anxiety

  • Vaginal dryness or discomfort

  • Reduced libido

  • Early menopause (before age 45)

  • Premature menopause (before age 40)

  • Symptoms that are affecting your quality of life


Specialist advice can help you understand your treatment options and develop a personalised management plan.

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