What is the Menopause?

Menopause is the time in a woman’s life when her periods stop as a result of the reduction and loss of ‘ovarian reproductive function’. Ovaries include the hormones oestrogen, progesterone and testosterone. When a woman approaches the menopause, less oestrogen is produced causing her body to behave differently. This process is usually a gradual one that progresses over several years. Oestrogen also plays an important role in maintaining bone and heart health as well as brain function during the reproductive years.

The menopause usually occurs between 45 and 55 years of age. The average age in the UK is 51. It is defined as when a woman has had no periods for one year or more. Before then a woman will experience ‘early peri-menopause’ and ‘late peri-menopause’.

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Early peri-menopause

Women initially experience a change in menstrual cycle pattern when periods become infrequent and the cycles become slightly longer, e.g., 6-7 weeks apart. This phase is called the ‘early peri-menopause’. The average age it occurs is 47 and it is when women may start experiencing menopausal symptoms.

Late peri-menopause

Subsequently, many women experience worsening of their menopausal symptoms. Menstrual cycles become less frequent, with periods a few months apart. This is called the ‘late peri-menopause’ and the average age it occurs is 49.

What do women experience when they go through the menopause?

All women experience the menopause at some stage in their life. It is estimated that more than 80% of women will be menopausal by the age of 54. Whilst not all women will experience menopausal symptoms when they go through the menopause, up to 80-90% will have some symptoms, with 25% describing them as severe and debilitating. Clearly this has significant implications for women at work.

Symptoms

The most common symptoms are hot flushes and night sweats (vasomotor symptoms), experienced by 70-80% of women. Other symptoms include disturbed sleep and insomnia, low energy levels, low mood, anxiety, low libido and low sexual drive, impaired memory and concentration, a sensation of ‘brain fog’, joint aches, headaches, palpitations and vaginal dryness and urinary symptoms. Menopausal symptoms last on average for more than 7 years and it is estimated that more than a third of women experience long-term menopausal symptoms which may continue for a number of years beyond that.

Long-term health

When the ovaries have stopped producing oestrogen, this fall in hormone levels may have an effect on long-term health. Most commonly these changes affect the strength and density of bones, increasing the risk of the bone-thinning disease osteoporosis. The bones of the female skeleton depend on oestrogen to maintain their strength and resistance to fracture. However, whilst a hot flush or vaginal dryness are obvious, there are no obvious symptoms of osteoporosis – the first sign may be a fracture of a bone. In addition, oestrogen deficiency after the menopause has also been shown to result in an increase in the risk of heart disease in women.

How do you diagnose the menopause?

The diagnosis of the menopause should be made by assessing the clinical picture and based on a combination of menopausal symptoms and change in menstrual cycle pattern in women beyond the age of 45. Hormonal testing (Follicle Stimulating Hormone – FSH) is not helpful in diagnosing the menopause as the level of the hormone can fluctuate from one month to another and may not give an accurate assessment.

What interventions are available to women going through the menopause?

The menopause transition can have a considerable impact on many women. The majority of women will experience menopausal symptoms, and for a significant proportion troublesome symptoms may continue long-term. All women should be able to access advice on how they can optimise their menopause transition. There should be a holistic and individualised approach in advising women, with particular reference to lifestyle advice and diet modification. This should be an opportunity to discuss the advantages and disadvantages of their management options including Hormone Replacement Therapy (HRT) and alternative therapies.

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