Often called ‘the change’ or ‘change of life’, the menopause marks the end of ovulation and is preceded by a gradual slowing of menstrual periods. Menopause symptoms occur as a result of falling oestrogen levels, the hormone that regulates ovulation and menstruation.

Most women go through the menopause between the ages of 45 and 55. By strict definition, a woman is said to have reached the menopause when she has not had a menstrual period for one year. The period of symptoms leading up to the menopause is more accurately described as the perimenopause.

The duration of the process varies widely, but ‘going through the change’ takes between two and five years from the appearance of the first perimenopausal symptoms.

Menopause can also occur for reasons other than natural reasons. These include, but are not limited to, the following:

  • Premature menopause. Premature menopause may occur when there is ovarian failure before the age of 40, and may be associated with smoking, radiation exposure, chemotherapy drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.
  • Surgical menopause. Surgical menopause may follow an oophorectomy (removal of an ovary or both ovaries), or radiation of the pelvis, including the ovaries, in premenopausal women, possibly as a result of treatment for cancer. These results in an abrupt menopause, with women often experiencing more severe menopausal symptoms than if they were to experience menopause naturally.

What are the symptoms of menopause?

The symptoms of menopause vary considerably between women. Around 20 % of women experience no symptoms at all other than lighter and less frequent periods, while 45 % of women experience difficulties with their perimenopausal symptoms.
Women who have had problems with their periods such as PMS (pre-menstrual syndrome) are more likely to experience difficulty with the more troublesome symptoms of the menopause.

These symptoms include:

  • Hot flushes and night sweats: these are most common in the first year of perimenopausal symptoms and the rapid, short-lived changes in body temperature can last anything from a few seconds to a few minutes. They can produce reddening of the skin, sweating, heart palpitations and a feeling of itchiness or crawling on the skin. Hot flushes at night are called night sweats and can disrupt sleep if they cause severe sweating.
  • Irregular, unusual or missing periods: as the balance of hormones changes, periods become more infrequent until they cease altogether. Periods may be lighter or heavier during this time.
  • Sleeping problems: the combination of night sweats, anxiety and low oestrogen levels can severely disrupt sleep in perimenopausal women. This in turn can lead to irritability, lethargy, lack of concentration and poor short-term memory.
  • Bladder problems: these include symptoms such as increased urgency and frequency of urination and repeated infections such as cystitis.
  • Vaginal dryness: around a third of women approaching the menopause will experience vaginal dryness and loss of elasticity, called vaginal atrophy. Both conditions can make sex uncomfortable. This, combined with lower hormone levels and lack of sleep, can lead to a reduced sex drive and depression.

Many women believe that there is a link between the menopause and weight gain, however this has not been proven. It may simply be that the menopause comes at a time of life where activity reduces and weight is gained.

There is also conflicting evidence regarding the emotional effects of the menopause. Although many women report symptoms such as mood swings, anxiety and depression, it is hard to isolate the effects of the menopause from other psychological issues common among women of this age, such as the stress of ageing or dying parents, concerns about children leaving home and worries about the effects of ageing.