Menopause

The word ‘menopause’ means a pause or the cessation of your menses (periods). I.e. your last period. While this is the obvious physical event that signals the end of your reproductive life, many changes take place in the body for many months or years before the ‘menopause’. Changes in the estrogen levels can affect the way you feel while you are still having periods. Women are therefore concerned about the perimenopausal (around the time of the menopause) years, as much as they are concerned with the end of their periods. Before the menopause the levels of the two female sex hormones, oestrogen and progesterone, alter as egg production slows down and then stops. After the menopause, women continue to produce sex hormones but at very low levels.

How will it affect me?

Every woman is different and the way that hormones affect them, both emotionally and physically, vary. Some women notice very few side effects from changes in their hormones, either when having a period, a baby or the menopause.

Other women suffer great changes during these times. Women’s bodies vary in the way they need to adjust to these changes. You need to allow about 18 months to elapse after your last period before you can be sure you have stopped ovulating and are no longer fertile. This is important to remember for women who need contraception. The age range for the menopause varies widely. It can happen at any time from the late 30s to early 60s. Nearly 25% of women reach the menopause by time they are 45, about 40% of women between 45 and 49, and over 20% of women between 50 and 54 years old.

How will it affect my body

The ovaries do not stop functioning suddenly, they wax and wane in their production for months or years before finally virtually stopping to work. It is often the fluctuation in their activity that can cause the greatest physical distress. The most common sign is irregular periods. This may start several years or only a few months before you stop menstruating totally. You may miss the odd period, or several, or they may become lighter, or a combination of all these at different times. If you start bleeding more heavily at any time, you should always have a medical check-up just to rule out other causes such as polyps, fibroids, cysts etc.

Just as some women have a terrible time around the menopause, others simply notice that their periods become light or stop altogether. Mood changes (anxiety, depression, irritability) at the menopause also vary from one woman to another. These mood changes can persist after the menopause. It is important to be aware that depression is very common in women aged 45-55 years. It can be difficult working out how much mood change is due to changes in hormone levels. You might begin to have hot flushes or hot or cold sweats, vaginal soreness or dryness, together or separately, although these are more common after periods have stopped.

Women who have had their womb removed but kept their ovaries will still go through the menopause even though they have no periods. They may experience any of the changes described above.

Headaches and depression can occur in the pre-menopausal phase and are related altering hormones. In this case, they usually vanish when periods finally stop and hormone levels settle down again. You may not have realised at the time but you may look back and recognise it.

How does it affect my bones

We need calcium to keep our bones strong. Our bones are in a constant state of being built up and broken down.

As we reach middle age, we start to lose more bone that we make. If the bones lose a lot of calcium, they become brittle and can break easily. Although the fractures that usually happen to people in their 60s and 70s, the bone loss typically starts in their 40s. In about one third of women, the menopause accelerates bone loss and puts them at increased risk of developing osteoporosis. There are lots of factors that influence whether you are at risk of osteoporosis e.g. family history, diet and exercise levels.