Definition

The menopause is strictly speaking the stopping of the periods but more often it is used to describe ‘the change of life’ which happens around the time of the last period.

Incidence / age

The age of the average menopause is 51 years old. It occurs earlier in some women and some women are still having periods into their late fifties. If you have had a hysterectomy and removal of the ovaries the menopause occurs immediately but if the ovaries have been left, the menopause occurs in general a few years earlier than it would have occurred had a hysterectomy not been done.

Causes/prevention

The menopause happens when a woman’s ovaries stop producing the hormone oestrogen. This will eventually happen to all women. It cannot be prevented.

Signs and Symptoms

At the time of the menopause most women will have symptoms but a few will experience no changes. The type of symptoms you may develop include:

• Period changes – usually the periods become less frequent at the ‘time of the change’ and the loss should get less. Twelve months after the last period one is certain the menopause has been reached. Any blood loss after this time should be investigated.
• Hot flushes & Sweats - 75% of women will suffer these symptoms which although not harmful are very troublesome.
• Emotional changes – irritability and depression are common
• Forgetfulness
• Tiredness and loss of energy
• Vaginal dryness – the lack of oestrogen causes dryness and this can cause problems with painful intercourse
• Bladder problems – symptoms of ‘cystitis’ are not infrequent
• Weight gain

These are the short-term effects of the menopause. Long term effects of the menopause are now well established particularly bone loss (Osteoporosis) and heart disease. Neurological effects like Alzheimer’s pre-senile dementia and bowel cancers have been more recently associated with the menopause.

Complications of disorder

Osteoporosis causes bones to be more brittle and as a result fractures are more likely.

Heart disease is the commonest cause of death in women as well as men. Heart disease is more likely after the menopause and it appears that the hormone oestrogen reduces the risk of heart disease developing and has been shown to improve the blood lipids (fats).

Strokes occur when there is narrowing of the blood vessels supplying blood to the brain. The risk of strokes increases after the menopause.

Tests

Usually no tests are needed to diagnose the menopause but a blood sample for hormones called FSH & LH can be taken to confirm menopause if needed. The levels of these hormones are raised after the menopause.

Treatment

Some women will decide not to take any medication at the time of the menopause but many will decide on treatment. Hormone Replacement Treatment (HRT) is available to alleviate women’s symptoms around the time of the menopause and is very successful at doing this by replacing the bodys oestrogen levels.

HRT can be continued after the symptoms have settled to prevent the long-term complications of the menopause such as osteoporosis and heart disease. It is necessary to take HRT for at least 5 years and preferably longer to achieve these long-term benefits. As women are living longer, it means a greater part of their life is now spent after the menopause and overall it is probably a good thing to consider taking HRT.