Content Supplied by NHS Choices

Menopause

The menopause is the end of menstruation. It causes a woman's monthly periods to stop which means she will no longer be able to have children.

The menopause, sometimes referred to as the "change of life", is the end of menstruation. This is a woman's ovaries stop producing an egg every four weeks.

She no longer has a monthly period and is unlikely to get pregnant.

In the UK, 51 is the average age for a woman to reach the menopause, although some women experience the menopause in their 30s or 40s.

If you experience the menopause before the age of 40, it's known as a premature menopause. 

Menstruation (monthly periods) can sometimes stop suddenly when you reach the menopause. However, it's more likely that your periods will become less frequent, with longer intervals between each one, before they stop altogether.

What causes the menopause?

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, causing the ovaries to stop producing an egg each month (ovulation). Oestrogen is the female sex hormone that regulates a woman's periods.

Read more about what causes the menopause.

The reduction in oestrogen causes physical and emotional symptoms, including:

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

Read more about the symptoms of the menopause.

When to see your GP

If you have menopausal symptoms that are troubling you, see your GP.

In women under 50 years of age, the menopause is diagnosed after 24 months without a period. In women aged 50 or over, it is diagnosed after 12 months without a period.

There's no definitive test to diagnose the menopause. A blood test is sometimes carried out to measure the level of the follicle-stimulating hormone (FSH). However, the result only occasionally helps in managing the menopause.

Treating the menopause

Medication for the oestrogen deficiency symptoms that can occur around the time of the menopause isn't always needed. Many women find that making simple diet and lifestyle changes relieve their symptoms (see below).

If your menopausal symptoms are more severe and interfere with your day-to-day life, treatment may be recommended.

Hormone replacement therapy (HRT) is one of the main treatments used for the menopause. It helps relieve menopausal symptoms by replacing oestrogen. It's available in many forms including tablets, cream or gel, a skin patch or an implant.

Vaginal lubricants can be used to treat vaginal dryness, and antidepressants are sometimes prescribed for treating hot flushes.

Read more about treating the menopause.

Self-help

Making simple dietary and lifestyle changes can often improve your menopausal symptoms.

For example, eating a healthy, balanced diet and taking plenty of regular exercise can help you avoid putting on extra weight, which can often occur during the menopause.

A healthy diet that includes all the food groups will help keep your bones strong and healthy. Combining aerobic activities, such as walking, with strength and flexibility exercises will also help you maintain bone strength and muscle mass.

Read more self-help tips for managing the menopause.

Content Supplied by NHS Choices

Menopause

The menopause can cause a wide range of physical and psychological symptoms. The first symptom is usually a change in the pattern of your monthly periods.

The menopause can cause a wide range of physical and psychological symptoms.

The first symptom is usually a change in the pattern of your monthly periods.

The start of the menopause is known as the perimenopausal stage, during which you may have light or heavy periods (menorrhagia).

The frequency of your periods may also be affected. You may have one every two or three weeks, or you may not have one for months at a time.

Other menopausal symptoms include:

If you experience the menopause suddenly, rather than gradually, your symptoms may be worse.

Symptoms will usually last between two and five years before disappearing, although they can last longer. Vaginal symptoms, such as dryness, can sometimes persist and get worse with age.

Hot flushes and night sweats

A hot flush is a sudden feeling of heat in your upper body. It 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're most common in the first year after your final period.

Sleep problems

Many menopausal women have trouble sleeping because of night sweats. Sleep disturbances may also occur, as a result of anxiety.

You may find that a lack of sleep makes you irritable and that you have problems with your short-term memory and ability to concentrate.

Vaginal symptoms

During the lead 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 vaginal atrophy shortly after the menopause, with slightly more women having them later on. In some cases, vaginal atrophy can last for more than 10 years after your final period.

If you have vaginal symptoms, it's likely they will continue or get worse unless they are treated.

Urinary symptoms

During the menopause, you're more likely to have recurring lower UTIs, such as cystitis. You may also feel an urgent and frequent need to go to the toilet.

Content Supplied by NHS Choices

Menopause

The menopause is caused by a change in the balance of the body's sex hormones. Oestrogen levels decrease, causing the ovaries to stop ovulating.

The menopause is part of the natural ageing process and is caused by a change in the balance of the body's sex hormones.

Oestrogen levels decrease as you reach the menopause, which causes the ovaries to stop producing an egg each month (ovulation). Oestrogen is the female sex hormone that regulates a woman's periods.

Most women experience the menopause between the ages of 45 and 55, with 51 the average age for it to occur.

Early menopause

In rare cases, some women experience the menopause before they reach 40. This is known as premature ovarian failure (POF).

POF can occur at any age. In many cases, there's no cause.

Not all women who experience premature menopause find their periods stop completely. A small number of women still have intermittent ovarian function, which means their ovaries will occasionally release eggs, and they may still be able to conceive.

Possible causes of POF include:

Content Supplied by NHS Choices

Menopause

In many cases, treatment for the menopause isn't needed. However, possible treatments include hormone replacement therapy (HRT), tibolone and clonidine.

Many women don't need treatment for the menopause, with only about 1 in 10 seeking medical advice.

If your symptoms are mild, you may be able to manage them yourself, without medication. Read more about self-help for managing menopausal symptoms.

However, medication may be recommended if your symptoms are more severe and they're interfering with your day-to-day life.

Treatment options include:

The type of treatment that's suitable for you will depend on your symptoms, medical history and your own preferences.

HRT and tibolone don't provide contraceptive protection, and although your fertility will decrease during the menopause, it may still be possible for you to conceive. You should therefore continue to use contraception:

  • for one year after your last period if you're over 50 years of age
  • for two years after your last period if you're under 50 years of age

The various treatments for the menopause are outlined below.

Hormone replacement therapy (HRT)

HRT is effective in treating many of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and urinary tract infections (UTIs), such as cystitis.

Long-term, HRT can also reduce the risk of osteoporosis (weak and brittle bones), and combined HRT (see below) can reduce your risk of developing bowel cancer.

HRT works by replacing the female sex hormone, oestrogen, which naturally begins to decrease as the menopause approaches. There are three main types of HRT:

  • oestrogen-only HRT  recommended for women who have had their womb and ovaries removed; if oestrogen is taken on its own, it can thicken the womb lining, increasing your risk of cancer
  • combined HRT  for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
  • continuous HRT  for post-menopausal women

HRT is available as a cream or gel, a tablet, a skin patch or an implant.

A number of side effects are associated with HRT, including weight gain, tender breasts, nausea, headaches and mood changes. You may be able to be reduce any side effects by changing the type or dose of HRT that you're using.

Your GP can give you more information about the risks and benefits of HRT.

Read more about HRT, including how it's taken, possible side effects and risks.

Tibolone

Tibolone is a synthetic (man-made) hormone that acts in the same way as HRT. It may be recommended as an alternative to combined HRT for post-menopausal women who want to end their periods.

Like HRT, tibolone is effective in treating menopausal symptoms, such as hot flushes and night sweats, and it can also help prevent spinal fractures. It may also improve sexual problems, such as a decreased sex drive.

Tibolone carries some small risks, including a slight increased risk of breast cancerwomb cancer and stroke. It's not suitable for women over 60 years of age.

Clonidine

Clonidine is a medicine that was originally designed to treat high blood pressure (hypertension), 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 to four weeks, to test its effectiveness. If your symptoms don't improve during this time, or if you experience any 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 antidepressant medications aren't licensed for treating hot flushes, there are several that may be effective, including:

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

Follow-up

If you're taking HRT, you'll need to return to your GP for a follow-up review three months after starting the treatment and once a year after that. At your three-month review your GP will:

  • make sure your symptoms are under control
  • ask about any side effects and bleeding patterns
  • check your weight and blood pressure

At your annual review your GP will:

  • review the type of HRT you're taking and make any necessary changes
  • examine your breasts and show you how to do it yourself
  • remind you about the benefits and risks of HRT

If you're using non-HRT treatments, you'll need to return to your GP for a review at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest that treatment is stopped altogether.

Your symptoms may return for a short period of time. However, as long as this doesn't continue over the long term, you may be able to stop taking it permanently.

Early menopause

A premature menopause is where a woman under 40 years of age experiences the menopause.

If this happens to you, your GP will refer you to a gynaecologist for treatment. Gynaecologists specialise in treating conditions that affect the female reproductive system, and they will be able to discuss your fertility (ability to conceive) with you.

You will need treatment to ease your symptoms and prevent osteoporosis (brittle bones), which is more likely to occur as the level of oestrogen in your body decreases.

HRT and the combined contraceptive pill are recommended treatments, as they both contain oestrogen and progestogen.

Read about Johanna's experience of having an early menopause.

Content Supplied by NHS Choices

Menopause

Medication may not be necessary if you don't have severe menopausal symptoms. Making simple changes to your diet and lifestyle may help ease your symptoms.

Medication may not be necessary if you've reached the menopause and don't have severe symptoms.

Many women are able to ease their menopausal symptoms by making simple changes to their lifestyle and diet.

It can be easy to put on weight during the menopause because your muscle mass will decrease, which means your body may need less calories.

Therefore, eating a healthy, balanced diet and exercising regularly will help you avoid putting on extra weight.

Diet

During the menopause, the amount of calcium in your bones will decrease due to a fall in oestrogen. Women who aren't using hormone replacement therapy (HRT), which contains oestrogen, are particularly at risk.

A balanced diet, including all the food groups, will help keep your bones healthy. Eating plenty of fruit and vegetables and a small amount of dairy, such as low-fat milk and yoghurt, will provide a good supply of calcium.

Other healthy eating tips to ensure good bone and heart health before, during and after the menopause include:

The British Dietetic Association (BDA)  has produced a food fact sheet (PDF, 531kb) that provides more information and advice about eating healthily during the menopause.

Exercise

As well as eating a healthy diet, regular exercise also plays a crucial part in ensuring you remain healthy both during and after the menopause.

Maintaining muscle mass and bone strength are two key areas for menopausal women. This means your exercise programme should include aerobic activities, such as walking, running, cycling and swimming, as well as strength and flexibility exercises.

Aim to do at least 150 minutes of moderate exercise each week. Read more about the physical activity guidelines for adults.

If you have osteoporosis (brittle bones), it may be recommended that you avoid high impact activities. This is because of the increased risk of falling and fracturing your bones. Your GP can give you more advice about the type of exercise that's suitable for you.

Read more about exercise and bone health.

Easing hot flushes and night sweats

Below is some advice that may help ease hot flushes and night sweats, as well as reducing sleep problems and mood changes.

To improve hot flushes and night sweats you should:

  • take regular exercise (see above)
  • wear light clothing
  • keep your bedroom cool at night
  • try to reduce your stress levels
  • avoid potential triggers, such as spicy food, caffeine, smoking and alcohol

To reduce sleep problems, avoid exercising late in the day and go to bed at the same time every night. Read more about insomnia.

To improve mood swings, make sure you get plenty of rest, as well as getting regular exercise. Activities such as yoga and tai chi can help you relax.

Content Supplied by NHS Choices

Menopause

Pat found a few simple lifestyle changes made her menopause symptoms easier to manage.

Pat found a few simple lifestyle changes made her menopause symptoms easier to manage.

Pat was 44 when she realised she had started missing a few periods. “It didn’t bother me at first as I lead quite a stressful life,” she says. “But after a while, I also started getting really bad PMT when I did have a period. It was awful.”

Pat decided to keep a diary charting her periods and how she felt generally. She kept it for six months. Looking back on it, she suspected that she was starting to go through the menopause. She went to her GP and discussed the best course of action.

“My GP is a woman, so I felt comfortable discussing things with her,” she says. “At that point, I didn’t feel that I needed any medication. I just wanted information about what was happening to me and how I could manage it.”

Soon afterwards, Pat began to experience hot flushes. “They're awful,” she shudders. “Lots of women think they’re having a panic attack when they have their first one and I can see why. I certainly did. I get a feeling of intense pressure in my upper chest, then my face starts to feel like it’s on fire. Then my face and upper chest turn red. Some women also get palpitations, though luckily I don’t.

“The attacks come on at any time. I work in a shop so it’s very embarrassing when one comes on as I’m talking to a customer. Luckily, there are lots of women where I work, many of a certain age, and we all support each other.”

Pat’s currently considering whether to try hormone replacement therapy (HRT). “If my symptoms get worse, I’ll certainly give it a go,” she says. “I want to read up on it and make sure I know all my options. At the moment, however, I’ve made some small changes which make a big difference. For example, I never used to eat breakfast as I have three kids under 10 and a husband to sort out! But now I make sure I have a cereal bar at least. I have a proper lunch with brown bread to keep my blood sugar levels steady as well.”

Menopause is a fact of life, says Pat, and she’s determined to manage her condition. “I have bad days,” she admits. “It’s difficult for my husband sometimes, as well. He says he never knows whether I’m going to wake up nice or nasty. But there’s no need for women to suffer menopausal symptoms in silence, like our mothers and grandmothers did. Educate yourself and you’ll find there’s a lot of help out there.”

Content Supplied by NHS Choices

Menopause

Barbara Hunt, 59, a retired civil servant from Canterbury, Kent, has had many ups and downs with the menopause and HRT.

Barbara Hunt, 59, a retired civil servant from Canterbury, Kent, has had many ups and downs with the menopause and HRT.

“I was 51 when I had my first hot flush. My periods had been erratic for six months so I realised I was approaching the menopause. Then the flushes started with a vengeance.

“My GP immediately suggested HRT. This was when it was being hailed as a wonder drug. I started with patches. I still had periods, but at least the flushes went away.

“After four years, I heard about its possible side effects and stopped taking it. The flushes returned and I got night sweats too. Heat would engulf me, then disappear as quickly as it had arrived. The night sweats really got to me. I was waking every half an hour and became so short of sleep that going back on HRT seemed my only option.

“I started taking it again and, to my relief, the flushes and sweats are a thing of the past. I’m now trying to wean myself off the patches by cutting a third off them each time. Having gone on HRT, it seems to be such a job to get off it and I sometimes wonder whether, if I’d never taken it, the flushes might be over by now.”

Share this page