Menopause

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What is menopause ?

Menopause usually occurs between the ages of 45 and 55 with the average age being 51. This is the time when the ovaries stop producing eggs and the menstrual cycle ends.

Symptoms can occur years before the menstrual cycle stops and may include hot flushes, night sweats and vaginal dryness.

How can menopause be diagnosed ?

The ‘perimenopause’ begins when your periods become more or less frequent, more or less heavy or periods are skipped. When it has been 12 months since your last period, this is considered menopause.

A blood test can be done to confirm this diagnosis but this is often not necessary. It may be useful if a woman has already had a hysterectomy because they will not have menstrual periods after this surgery.

Once you are menopausal, you cannot fall pregnant.

What symptoms can occur with menopause ?

  • Menstrual periods may come more or less often
  • Menstrual bleeding can become lighter
  • Skipping of periods
  • Hot flushes
  • Night sweats
  • Sleep disturbance
  • Depression
  • Vaginal dryness

What is considered abnormal bleeding ?

It can be difficult to know exactly what is abnormal bleeding close to menopause. You should consult with your doctor if you have :

  • Menstrual periods more often than every 3 weeks
  • Excessive, heavy menstrual periods
  • Bleeding between periods or with sexual intercourse
  • Bleeding after menopause

Should menopause be treated ?

As the ovaries stop working, the amount of oestrogen a woman produces falls. The fall in oestrogen production leads to the symptoms of menopause. It can also contribute to cardiovascular disease and weakening of the bones called osteoporosis.

Some women will have few, if any, symptoms of menopause which require no treatment at all.

Others will have very bothersome symptoms that interfere with their day to day life. These symptoms can begin well before they stop having periods and may require consultation with a doctor.

How can menopause be treated ?

Every woman’s treatment has to be individualized to suit their symptoms, expectations and their previous medical history.

A variety of lifestyle changes may help with some of the symptoms of menopause such as quitting smoking, losing weight, regular exercise, using lubricants prior to sexual intercourse and moderating caffeine and alcohol intake.

There are a number of natural remedies available which may also help such as phytoestrogens, evening primrose oil and other herbal remedies. The effectiveness of these remedies is controversial but they often are a popular starting point.

Hormone replacement therapy (HRT) with oestrogen can be given to women with bothersome symptoms. Another drug, progesterone, also needs to be added if the woman has not had a hysterectomy, to avoid overstimulation of the uterine lining and possible endometrial cancer.

HRT can be taken as a tablet, skin patch, vaginal ring, vaginal cream or an implant. Most women with bothersome symptoms will benefit from this. The type of hormone replacement, the way it is given and the length of treatment, needs to be individualized with a doctor. Some women cannot take oestrogen (e.g history of breast cancer) but there are alternatives available. The pros and cons of hormone replacement therapy, as well as the duration of treatment, need to be discussed between a woman and her doctor.