Menopause

What is menopause? 

What are the stages of menopause? 

Menopause is not a single event but a gradual process that unfolds over several years, typically progressing through three distinct stages: perimenopause, menopause and postmenopause. Each stage involves characteristic hormonal changes, symptoms and implications for health.

• Perimenopause — this is the transitional phase leading up to menopause, often beginning in a woman’s forties but sometimes earlier. During this period, oestrogen and progesterone levels fluctuate unpredictably, affecting menstrual cycle regularity. Periods may become lighter, heavier, shorter or more spaced apart. Common symptoms, such as hot flushes, night sweats, mood changes and sleep disturbances, may appear during this stage. Perimenopause can last several years prior to the event termed ‘menopause’. Treatment to ameliorate these symptoms is safe and effective. 

• Menopause — this stage is reached when menstruation has permanently ceased for twelve consecutive months and no other cause for the absence of periods is identified. Ovarian hormone production has fallen to irreversibly very low levels. This is a single point of time and the period after this is discussed below.

• Postmenopause — this refers to the years following menopause. Symptoms such as hot flushes and mood swings may gradually lessen over time, although some women continue to experience them for longer. The reduction in oestrogen levels increases the risk of certain long-term health concerns, including osteoporosis and cardiovascular disease. Preventive health care, lifestyle measures, and, in some cases, medical treatments become important considerations during this stage.

What causes menopause? 

Menopause occurs because of a natural decline in ovarian function due to the loss of all viable eggs, leading to reduced production of the sex hormones, oestrogen and progesterone. These hormones regulate the menstrual cycle and support reproductive health. Prior to this, as a woman ages, the number and quality of eggs in the ovaries diminish, and in peri-menopause ovulation (the release of eggs) becomes less frequent or irregular. Eventually, ovulation stops altogether, menstrual periods cease and menopause ensues.

While menopause is a normal part of ageing, certain factors can cause it to occur earlier than usual or bring it on suddenly:

• Natural ageing — the most common cause, with hormone production declining gradually over time.

• Surgical removal of the ovaries — this causes immediate ‘surgical’ menopause, regardless of age, as the primary source of oestrogen and progesterone is removed.

• Medical treatments — chemotherapy and pelvic radiotherapy can damage the ovaries and lead to earlier menopause.

• Primary ovarian insufficiency — a condition where the ovaries stop functioning normally before the age of 40, often due to genetic factors, autoimmune disease, or unknown causes.

• Certain health conditions — some chronic illnesses, infections, or endocrine disorders can affect ovarian function and cause early menopause.

What are the signs of menopause?

The signs of menopause arise from declining oestrogen and progesterone levels and can vary widely in nature, severity and duration from one woman to another. Some women experience only mild changes, while others notice symptoms that affect their quality of life. These signs may begin during perimenopause and continue into postmenopause.

Common signs include:

• Changes in the menstrual cycle — periods may become irregular, shorter or longer in duration, lighter or heavier and may occur more or less frequently before stopping altogether.

• Hot flushes — sudden sensations of heat, often affecting the face, neck and chest, sometimes accompanied by sweating and a rapid heartbeat.

• Night sweats — episodes of excessive sweating during sleep, often leading to disturbed rest.

• Sleep difficulties — problems falling asleep, staying asleep or waking too early, sometimes linked to night sweats.

• Mood changes — increased irritability, anxiety, low mood or emotional sensitivity.

• Vaginal and urinary changes — vaginal dryness, itching, discomfort during intercourse and increased susceptibility to urinary tract infections.

• Changes in sexual desire — a decrease in libido.

• Physical changes — thinning hair, dry skin and gradual weight gain, particularly around the abdomen.

• Cognitive changes — difficulties with concentration, memory lapses or “brain fog.”

These signs can be temporary or persist for several years. Recognising them early allows women to seek appropriate support and management to maintain comfort and quality of life during the menopause transition.

What is premature menopause? 

Premature menopause refers to the onset of menopause before the age of 40. Like natural menopause, it involves the permanent end of menstrual periods due to a significant drop in ovarian hormone production, but it occurs much earlier than expected. This can happen naturally, when the ovaries stop functioning well before midlife or it can be triggered by medical interventions such as surgical removal of the ovaries, chemotherapy or radiotherapy.

When premature menopause occurs without a clear medical cause, it is often diagnosed as primary ovarian insufficiency (POI). In POI, the ovaries lose their normal function years earlier than typical, which may be linked to genetic factors, autoimmune disease, or, in many cases, no identifiable reason at all.

The early loss of oestrogen has health implications beyond fertility. Women who go through premature menopause face an increased risk of osteoporosis, cardiovascular disease, and certain mood disorders, and they may also experience more intense menopausal symptoms. Because of these risks, timely diagnosis and tailored management, often including hormone replacement therapy (HRT) unless contraindicated, are important to protect long-term health and quality of life.

How long do menopause symptoms last?

The duration of menopause symptoms varies widely between individuals. For many women, symptoms such as hot flushes, night sweats and mood changes begin during perimenopause and continue for several years after the final menstrual period. On average, these symptoms last about four to five years, but in some cases they can persist for a decade or more.

Hot flushes and night sweats tend to be most frequent and intense in the early postmenopausal years, gradually reducing over time. Other symptoms, such as vaginal dryness and discomfort during intercourse, may become more noticeable later and can continue indefinitely without treatment, due to persistently low oestrogen levels.

Certain factors can influence how long symptoms last and how severe they feel, such as:

• Age at menopause
• Overall health
• Cigarette smoking
• Stress levels 

Managing symptoms early, whether through lifestyle measures, hormone therapy or other treatments, can help improve comfort and quality of life throughout the menopause transition.

How is menopause diagnosed?

Diagnosis is based mainly on symptoms and menstrual history, rather than a single definitive test, though hormone testing gives further evidence to what is occuring. The most reliable sign is having no menstrual periods for twelve consecutive months without another underlying medical cause.

Ways menopause may be diagnosed include:

• Clinical assessment — in women over 45, diagnosis is often made from symptom patterns, such as irregular periods, hot flushes and night sweats, without the need for tests.

• Hormone testing — blood tests to measure follicle-stimulating hormone (FSH) and oestradiol may be used in women under 45 or when the diagnosis is unclear. Elevated FSH and low oestradiol levels indicate reduced ovarian function.

• Investigations for early menopause — in suspected premature menopause or primary ovarian insufficiency, further tests such as genetic analysis or autoimmune screening may help identify an underlying cause.

• Excluding other conditions — assessment may include checking for thyroid disorders, pregnancy or other health issues that can mimic menopause symptoms.

This structured approach ensures that menopause is accurately identified and managed appropriately, especially when symptoms occur earlier than expected or overlap with other conditions.

What health risks are associated with menopause?

The drop in oestrogen levels after menopause affects more than just reproductive function. It also influences bone density, heart health and other body systems, increasing the risk of certain long-term conditions. Understanding these risks allows women to take preventive steps early.

Key health risks include:

• Osteoporosis — lower oestrogen accelerates bone loss, which increases the likelihood of fractures, especially in the spine, hips and wrists.

• Cardiovascular disease — menopause is linked to higher risks of heart disease and stroke due to changes in cholesterol levels, blood vessel health and fat distribution.

• Weight gain and metabolic changes — a slower metabolism and altered fat distribution, often around the abdomen, can increase the risk of type 2 diabetes and metabolic syndrome.

• Urogenital problems — persistent vaginal dryness, thinning of vaginal tissues  and changes in bladder function can cause discomfort and increase urinary tract infections.

• Cognitive changes — some women notice memory lapses or difficulty concentrating and research continues into possible links between menopause and dementia risk.

• Mood disorders — hormonal shifts can contribute to anxiety, depression or mood swings, particularly in women with a prior history of mental health issues.

These risks highlight the importance of regular health checks, healthy lifestyle habits and timely medical advice to protect long-term well-being after menopause.

When should I see a doctor about menopause symptoms?

While menopause is a natural stage of life, medical advice is important if symptoms are severe, disruptive or occur earlier than expected. Seeking professional help ensures that other health conditions are not overlooked and that you receive the right management for your needs.

It is advisable to see a doctor if you experience:

• Symptoms before age 45 — this may indicate premature menopause or primary ovarian insufficiency, which require further assessment.

• Heavy or unusual bleeding — very heavy periods, bleeding between periods or bleeding after menopause should be checked promptly.

• Severe or persistent symptoms — hot flushes, night sweats, mood changes or sleep problems that affect daily life.

• Pain during intercourse or urinary issues — especially if linked to vaginal dryness, recurrent urinary tract infections or bladder changes.

• Signs of osteoporosis — such as unexplained back pain, height loss or fractures from minor falls.

• New or worsening mood changes — including irritability, anxiety, depression or difficulty coping.

Early medical input can help tailor treatment options, monitor health risks and improve quality of life during and after menopause.

What are the treatment options for menopause symptoms?

Managing menopause includes relieving symptoms, improving quality of life and reducing long-term health risks associated with low oestrogen levels. The right approach depends on the type and severity of symptoms, personal health history and individual preferences.

Common options include:

• Hormone replacement therapy (HRT) — replaces declining oestrogen (and sometimes progesterone) levels to relieve symptoms such as hot flushes, night sweats and vaginal dryness, while also protecting bone health.

• Vaginal oestrogen — creams, tablets or rings that act locally to relieve vaginal dryness, discomfort during intercourse and urinary symptoms, with minimal absorption into the bloodstream.

• Non-hormonal medicines — Fezolinetant and selective estrogen receptor modulators like Tibolone may help reduce hot flushes and night sweats in women who cannot or choose not to use HRT.

• Lifestyle measures — maintaining a healthy diet, regular exercise, stress management, and good sleep habits can help reduce symptom severity and improve overall well-being.

• Complementary therapies — some women find benefit from approaches such as acupuncture, mindfulness or herbal supplements, though scientific evidence for their effectiveness is variable.

• Bone health support — adequate calcium and vitamin D intake, weight-bearing exercise, and, if needed, medication to protect against osteoporosis.

Treatment should always be individualised, with regular reviews to ensure it remains safe and effective over time.

What lifestyle changes can help manage menopause symptoms? 

Adopting healthy daily habits can ease the severity of menopausal symptoms, improve mood and energy levels and support long-term health after menopause. While lifestyle changes may not eliminate symptoms entirely, they often complement medical treatments and provide additional benefits.

Helpful lifestyle adjustments include:

• Balanced diet — focus on nutrient-rich foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Adequate calcium and vitamin D are essential for bone health.

• Regular physical activity — aim for a mix of aerobic exercise, strength training, and flexibility work to improve mood, maintain a healthy weight and protect against bone loss.

• Sleep routine — establish a consistent bedtime, limit caffeine and alcohol, and create a cool, quiet sleep environment to counter night sweats and insomnia.

• Stress management — techniques such as yoga, meditation, deep breathing, or mindfulness can help reduce anxiety and emotional fluctuations.

• Limiting triggers — identifying and avoiding personal triggers, such as hot drinks, spicy foods or alcohol, may help reduce hot flushes.

• Maintaining a healthy weight — helps reduce the risk of heart disease, type 2 diabetes and joint problems, while improving overall comfort.

• Stopping smoking — protects heart health, bone strength and overall well-being.

These lifestyle measures can be tailored to individual needs and, when maintained consistently, help women feel more in control during the menopause transition.

Is hormone replacement therapy (HRT) safe for everyone during menopause? 

HRT, which involves replacing declining levels of oestrogen and sometimes progesterone, can be an effective way to relieve menopause symptoms and protect bone health. However, it is not suitable for everyone. 

Women with a history of breast cancer, certain types of gynaecological cancer, unexplained vaginal bleeding, blood clots, liver disease or uncontrolled high blood pressure may be advised to avoid HRT. Suitability depends on individual health history, current medical conditions, and personal risk factors, which is why a thorough medical assessment is essential before starting treatment.

What are the side effects of hormone replacement therapy (HRT) for menopause?

The side effects of HRT can vary depending on the type, dose and method of delivery, as well as how an individual’s body responds. Some effects are temporary and improve as the body adjusts, while others may require a change in treatment or closer monitoring.

Possible side effects include:

• Breast tenderness or swelling — often settles after the first few months of use.

• Bloating — a feeling of abdominal fullness or mild discomfort.

• Headaches — may occur when starting treatment or with dose changes.

• Nausea — usually mild and may improve with food or a different HRT form.

• Mood changes — slight shifts in mood, irritability or emotional sensitivity.

• Irregular bleeding — common in the first months of treatment, particularly with certain HRT regimens.

• Longer-term risks — depending on type and personal health, may include a small increase in the risk of blood clots, stroke or certain cancers.

Regular reviews with a healthcare professional help ensure that benefits outweigh risks and that any side effects are addressed promptly.

Summary 

Menopause is a natural stage in a woman’s life marked by the permanent end of menstrual periods, usually occurring between the ages of 45 and 55. It progresses through perimenopause, menopause, and postmenopause, with symptoms ranging from hot flushes, night sweats and mood changes to vaginal dryness and changes in bone and heart health.

While it is most often caused by the natural decline in ovarian function, factors such as surgery, certain medical treatments or primary ovarian insufficiency can lead to earlier onset. Diagnosis is based on symptoms and menstrual history, and management options include hormone replacement therapy (HRT), non-hormonal medicines, lifestyle adjustments, and bone health support. Understanding the potential health risks, including osteoporosis, cardiovascular disease, and mood disorders, and seeking timely medical advice ensures better long-term well-being. 

If you are experiencing symptoms of menopause or want guidance on managing this transition, schedule a consultation with us for a detailed diagnosis and personalised treatment plan.

Frequently Asked Questions (FAQs)