The menopause, also known as the 'change of life' is the end of menstruation.  This means a woman's ovaries stop producing an egg every four weeks. She will no longer have monthly periods 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 thirties or forties.

If a woman experiences the menopause when she is under 45 years of age, it is known as a premature menopause. 

Menstruation (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.

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

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

Read more about the symptoms of the menopause.

Should I see my GP?

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.

Treating the menopause

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 (HRT) is one of the main treatments for the menopause. It works by replacing oestrogen which helps to relieve menopausal symptoms.

HRT is available in many forms including tablet, creams or gel, a skin patch or an implant.

Read more about treatments for the menopause.

Self-help

Many women find that making changes to their lifestyle and diet helps improve menopausal symptoms. Taking regular exercise, reducing your stress levels and avoiding certain foods can help reduce hot flushes, night sweats and mood swings.

Read more self-help tips for managing the menopause.

It is estimated that 8 out of 10 women in the UK experience symptoms leading up to the menopause. Of these, 45% find their symptoms difficult to deal with.

In most cases, the first symptom is a change in the usual pattern of your periods. Your period may start every two to three weeks, or you may not have one for months at a time. The amount of menstrual blood lost may also change, and most women find it increases slightly.

Other common symptoms of the menopause (and the months just before and after this) are detailed below.

Without treatment, most menopausal symptoms gradually stop naturally. This usually happens two to five years after the symptoms start, although some women experience symptoms for many more years.

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 experience a change in your heart rate. It may become very rapid, or it may be irregular and stronger than usual (known as palpitations).

Hot flushes that occur at night are called night sweats. Most hot flushes only last a few minutes and are most common in the first year after your final period.

Sleep disturbance

Many menopausal women have trouble sleeping due to night sweats, but sleep disturbance 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 time leading up to the menopause, you may experience vaginal dryness, itching or discomfort. This can make sex difficult or painful (known as dyspareunia). These symptoms combined are known as vaginal atrophy.

Approximately one-third of women experience the symptoms of vaginal atrophy shortly after the menopause, and slightly more women have them later on. It is possible to experience vaginal atrophy more than 10 years after your final period.

If you experience vaginal symptoms, it is likely that they will persist or worsen over time unless they are treated.

Urinary symptoms

During the menopause, you may become prone to recurrent lower urinary tract infections, such as cystitis. You may also experience an urgent need to pass urine and need to pass it more often than normal.

The menopause results from a fall in the level of the female hormone oestrogen in your blood. Oestrogen regulates your menstrual cycle, and a fall in this stops you producing an egg every month (ovulation).

Causes of premature menopause

In rare cases, a woman may begin to approach menopause before the age of 45 because her ovaries are failing earlier than they normally would. This is known as premature ovarian failure. Although it is rare, premature ovarian failure can occur at any age, and in many cases no cause will be found.

However, not all women who go through premature ovarian failure find that their periods stop. A small number of these women still have intermittent ovarian function, which means that their ovaries release eggs once in a while and they may still be able to conceive.

The possible causes of premature ovarian failure are outlined below.

• Medical conditions: enzyme deficiencies, Down's syndrome, Turner's syndrome, Addison's disease and hypothyroidism can all make premature ovarian failure more likely.
• Medical treatments and procedures: surgery to remove the ovaries, radiotherapy to your pelvic area, chemotherapy and hysterectomy surgery (removal of the womb) can all cause premature ovarian failure, although this is rare.
• Infections: in very rare cases, certain infections such as tuberculosis or mumps may bring on premature ovarian failure. However, in the case of mumps, the damage to your ovaries is usually only temporary and normal function usually returns. Malaria, varicella (the infection that causes chickenpox and shingles) and shigella can also cause premature ovarian failure, although this is very rare.

Only 1 in 10 women seek medical advice when they go through the menopause and many do not need any treatment. However, if your menopausal symptoms are severe enough to interfere with your daily life, there are treatments that can help.

The treatment options are:

• hormone replacement therapy (HRT)
• tibolone (similar to HRT)
• clonidine
• vaginal lubricants
• antidepressants

The kind of treatment you can take depends on your symptoms, medical history and your own preferences.

HRT and tibolone do not provide contraceptive protection, and although your fertility decreases during the menopause, it may still be possible for you to conceive. Therefore, continue to use contraception:

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

The treatments for menopause are detailed below.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and cystitis.

As the name suggests, HRT works by replacing oestrogen, which naturally begins to fall in the approach to menopause, causing menopausal symptoms. There are three main types:

• oestrogen-only HRT, for women who have had their womb and ovaries removed
• cyclical HRT, for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
• continuous HRT, for women who are post-menopausal

HRT can be taken as a cream or gel, a tablet, a skin patch or an implant.

For more information on HRT, including how it is taken, who can use it, how it works, side effects and risks, go to Health A-Z: HRT.

Tibolone

Tibolone is a synthetic hormone that acts in the same way as HRT. It may be used as an alternative to combined HRT (which contains both oestrogen and progestogen) 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 help prevent fractures of the spine. It may also improve sexual problems, such as a decreased sex drive.

Tibolone carries some small risks, including a small increased risk of breast cancer, cancer of the womb and stroke. It is also not suitable for women over the age of 60.

Clonidine

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

However, it can sometimes cause unpleasant side effects including dry mouth, drowsiness, depression, constipation and fluid retention. If your GP prescribes clonidine, you will need to take it for a trial period of two to four weeks to see if 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, such as ReplensMD, which 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 for this, including:

• venlafaxine
• fluoxetine
• citalopram
• paroxetine

Side effects of these antidepressants may include nausea, dizziness, dry mouth, anxiety and problems sleeping.

Follow-up

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

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

At your annual review, your GP will:

• review the type of HRT you are taking and make any necessary changes
• perform a breast examination and show you how to do it yourself
• remind you of the risks and benefits of HRT

If you are on a non-HRT treatment, you will need to return to your GP for a review of your treatment at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest a trial withdrawal of treatment.

Your symptoms may recur for a short while after you stop your treatment, but as long as this does not continue in the long term, you may be able to stop taking it permanently.

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

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

Below is some self-help advice that may help ease hot flushes and night sweats and reduce sleep problems and mood changes.

To improve hot flushes and night sweats:

• take regular exercise
• 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 improve sleep problems:

• avoid exercising late in the day
• go to bed at the same time every night

Read more about insomnia.

To improve mood changes:

• make sure that you get plenty of rest
• take regular exercise
• try relaxation therapies, such as yoga or tai chi

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 ten 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 menopause symptoms in silence, like our mothers and grandmothers did. Educate yourself and you’ll find there’s a lot of help out there.”

Barbara Hunt, 59, a retired civil servant from Canterbury in 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.”