Menopause

Menopause usually happens between 45 and 55 years of age but can also happen earlier or later. Menopause can happen naturally, or because of cancer therapies or surgery.

 

Perimenopause is the time before periods stop completely and can last for several years. Perimenopause is when the ovaries are running out of eggs, causing hormone levels to go up and down (fluctuate). It is often during this time that people begin to experience some of the physical and emotional symptoms associated with menopause.

Diagnosis of menopause is based on your health history and symptoms. If you are aged 45-55, testing hormone levels is generally not helpful because the hormone levels vary a lot from day to day. However, in certain situations a blood test may be useful (for example, in cases of early or premature menopause).

If you are over the age of 50 and have not had a period for 12 months, then you have gone through menopause and are postmenopausal.

Once you have had 12 months of no periods, any vaginal bleeding that happens after this is abnormal and should be discussed with your doctor.

 

Symptoms of menopause

Menopausal symptoms are different for everyone.

Some people will only experience mild symptoms, while others have symptoms which are more unpleasant, uncomfortable or troublesome.

Most symptoms happen because of a drop in the level of the hormone oestrogen. Most people have symptoms for 5 to 10 years around the time of the final period.

As a general guide, for every 10 people going through menopause:

• 2 will not have any symptoms
• 6 will have some symptoms
• 2 will have very bad symptoms which can interfere with their life.

 

Possible symptoms include:

Physical changes 

• Hot flushes (a sudden feeling of heat in the upper part of the body, including the neck and face)
• Night sweats (some people even need to change the sheets during the night because of heavy sweating)
• Vaginal dryness, burning or irritation (this can cause pain or discomfort during sex)
• Difficulty sleeping (trouble falling asleep or staying asleep)
• Aches and pains
• Headaches or migraines
• Itchy skin
• Sore or tender breasts
• Tiredness
• Needing to urinate (pee) more often
• Weight gain.

 

Emotional changes

• Mood changes including feeling depressed, anxious, overwhelmed, irritable or tearful
• Loss of interest in sex
• Memory changes, forgetfulness or ‘brain fog’
• Reduced concentration.

There are other medical conditions which can cause similar symptoms to those of menopause (e.g. depression, anaemia and thyroid disorders). It is important to see your doctor for a check-up if you have any concerns.

 

Premature and early menopause

Premature menopause is when periods stop completely and permanently before the age of 40. Early menopause is when the final period happens between the ages of 40-45.

This can happen spontaneously (sometimes called premature ovarian insufficiency), or may occur after:

• surgery to remove both ovaries
• treatment for cancer (e.g. chemotherapy or radiation therapy) to the pelvis.

Although fertility (ability to get pregnant) is reduced in premature or early menopause, pregnancy can sometimes still occur, so if you want to avoid a pregnancy you should still use contraception.

Younger people who go through premature or early menopause are generally recommended to take menopausal hormone therapy (MHT) until around 50 years of age, unless there is a medical reason preventing this. This helps treat menopausal symptoms but also protects against bone loss (osteoporosis) and fractures.

 

Menopause management options

Menopause is managed in a variety of ways. If symptoms are bothering you, your doctor can do a detailed assessment of your situation and can help you to understand your symptoms and your treatment options.

Management of menopausal symptoms depends on your unique circumstances including your stage of life, relationships, general health and the severity of symptoms. Treatments may include healthy lifestyle changes, menopausal hormone therapy, other prescription medications, psychological therapies or complementary therapies.

Many people have mild symptoms and don’t need any medication. Some people can manage symptoms with lifestyle changes alone, including regular exercise and eating a balanced diet.

If your symptoms are more severe and prolonged or interfere with your day-to-day life, you may choose to use medicines or hormones – these treatments need a doctor’s prescription.

Early and premature menopause have important health considerations, especially bone loss (osteoporosis), so hormone therapy is generally recommended until age 50 for prevention.

Talking with your partner/s about how you are feeling and any treatment you are having is important.

 

Managing your symptoms

Below is a list of possible options to help manage symptoms of menopause.

There are benefits and risks with all medication/treatment options. Your doctor will assess your health history and can discuss which is the best and safest option for your specific situation, so you can make an informed decision.

Lifestyle:

• Drink plenty of water
• Eat plenty of vegetables, fruit and whole grains
• Aim to be physically active every day
• Get enough sleep
• Stop smoking
• Limit sugary drinks, sweet and fried food
• Reduce stress/stress management
• Maintain bone health by including calcium in your diet, strength/weight-bearing exercise and getting enough vitamin D.

 

Non-pharmacological (drug-free) treatments:

• Counselling and psychological therapies
• Cognitive behavioural therapy (CBT)
  • Mindfulness
  • Yoga
• To improve cooling:
  • Adjust clothing (e.g. dressing in layers, avoiding jumpers and scarves)
  • Using a hand fan or electric fan as required
  • Keep cooler at night by lowering the room temperature.

 

Non-hormonal drug treatments:

• Some types of antidepressants
  • Usually low dose
  • Help with more severe hot flushes and sweats.
• A drug called gabapentin
  • Usually used to treat epilepsy
  • Helps with hot flushes and night sweats.
• A drug called clonidine
  • Usually used to treat blood pressure
  • Can sometimes help with mild menopausal symptoms.
• A drug called fezolinetant
  • Specifically designed to help with hot flushes and night sweats.

 

Menopausal Hormone Therapy (MHT), previously known as Hormone Replacement Therapy (HRT): 

MHT is the most effective way to improve menopausal symptoms. It can also improve bone health and reduce the risk of fractures. MHT is safe to use for most people aged in their 50s, or for the first 10 years after menopause.

• Available as tablets, patches, gels or vaginal treatments
• Different types of MHT are associated with different risks
• The increased risk for blood clots, stroke and breast cancer while taking MHT is small
• The type of MHT needed and the risks depend on:
  • Your age
  • Whether you have a uterus
  • Whether you have other health conditions.
• If you have a ‘hormone-dependent’ cancer you should not take hormone therapies. Speak to a doctor about other non-hormonal treatment options.

A Mirena intra-uterine device (IUD) can also be used as part of menopause treatment and is particularly helpful if you are experiencing heavy menstrual bleeding in the perimenopause stage. It’s a good idea to speak to your doctor about using the Mirena for heavy menstrual bleeding management.

 

Menopause and complementary/herbal therapies

Complementary and herbal medicines (most of which you can get without a prescription) are often promoted as being ‘natural’ and ‘safe’ without any strong proof that they help. In fact, none of these options have been shown to work as well as MHT.

Complementary therapies include acupuncture, magnetic therapy, homeopathy and hypnosis. Herbal/vitamin supplements include St John’s Wort, wild yam, black cohosh, evening primrose oil and red clover, amongst others.

There have been studies into complementary and herbal medicines with mixed results, which makes it difficult to know for sure whether they are safe and effective. There are also lots of products available which have not been studied enough to work out if they help or if they harm.

Herbal products may contain heavy metals, illegal ingredients and toxic chemicals. Herbal or complementary products can also interact with other prescription medications and cause harm.

Compounded ‘bioidentical’ hormonal preparations are not recommended due to serious concerns about the safety and efficacy of these products.

It’s important to speak with a doctor if you are considering taking any complementary or herbal products.

 

Contraception and menopause

It is actually still possible to get pregnant in your late 40s or early 50s if you’re still having periods. If you are over 50 and want to avoid a pregnancy, you should use contraception for at least 1 year after your final period. If you are under 50 and want to avoid a pregnancy, you should use contraception for at least 2 years after your final period. It is important to know that MHT treats the symptoms of menopause and is not a form of contraception.

Some contraception changes the bleeding cycle and can make it difficult to know when menopause has happened.

If you are considering stopping contraception, it’s a good idea to speak with your doctor if you have any questions about your specific situation.

 

Further information

You can find more information on menopause at:

• Australian Menopause Society www.menopause.org.au
• Jean Hailes www.jeanhailes.org.au

 

Updated August 2024