What is the menopause?

The menopause is when your periods stop as a consequence of running out of eggs. Eggs are produced in the ovaries and gradually over time we lose our eggs until there are none left. The hormone oestrogen is produced in the ovaries and once a woman no longer produces eggs then oestrogen is no longer produced.

Because of the lack of oestrogen, women may experience a number of symptoms, some which they may not recognise as symptoms of menopause and other symptoms may be quite obvious such as having hot flushes and night sweats.

The are two stages of menopause, the perimenopause and the post menopause both which are explained below. Every woman is different and each will have a different experience of the peri and post menopause.

It is important to know about the menopause so you can start to recognise and understand what is happening to your body both physically and psychologically and get the help and advice that you need. Women aged 45-54 make up around 23% of all women in employment - your employer should also make reasonable adjustments to help with your symptoms.

Early menopause symptoms and the perimenopause

The perimenopause is the time leading up to when your periods stop. This is a time of hormonal changes when the ovaries produce less oestrogen, the levels of oestrogen may rise and fall unevenly and your period cycles may change. Periods may be more spaced apart but may become heavier or lighter or even last longer. You may experience many other symptoms such as hot flushes and sleep problems, your moods and emotions may change and you may find it difficult to concentrate. It is important to still continue to use contraception during this time as you can still become pregnant.

Many women experience symptoms of the perimenopause around five to ten years leading up to the menopause. For most women, perimenopause will start in their mid-40s.

Perimenopause is a normal part of the menopause journey, some women may not notice any significant symptoms whilst others may struggle and find daily life quite difficult.

Post-menopause

A woman is said to have gone through the menopause when she has not has a period for at least 12 months - she will then be ‘post-menopausal’. This does not mean that menopausal symptoms will cease, they may continue for months or even years after.

The average age of the last period in women in the UK is around 51 or 52 years of age, although many women may have periods which go on into their mid to late 50s and for others, periods may stop sooner. It is advised to continue to use contraception until you have not had a period for 2 years if your last period was age 51 or before and for a woman whose last period was age 52 or older, contraception should be continued for 1 year.

Early menopause

If a woman’s periods stop before the age of 45 then she is said to have an early menopause. This is usually diagnosed with blood tests taken in combination with a history of symptoms. HRT is usually recommended for bone and heart health and contraception is still advised.

Premature ovarian insufficiency (POI)

1% of women will experience menopause under the age of 40 and 0.1% under the age of 30. POI will need to be diagnosed by a doctor after blood tests have been taken in combination with a history of symptoms. Women with POI are at increased risk of osteoporosis, cardiovascular disease and cognitive impairment and specialist advice is usually required. POI can be extremely difficult for a lot of women as becoming pregnant is unlikely.

Surgical menopause

Surgical menopause is when both ovaries are removed (bilateral oophorectomy) before a woman has had her natural menopause. The ovaries may have been removed because of cysts or cancer. Another reason is if there is a high risk of ovarian and breast cancer. Menopausal symptoms in these women may be particularly severe due to the sudden loss of oestrogen, and pregnancy is no longer possible. Unless there are contradications to treatment, such as a personal history of hormone-dependent malignancy, all women experiencing surgical menopause should be administered HRT until age 51, according to current guidelines.

This is the first in our series on Menopause. Check out our other articles to get a full understanding of what the Menopause means for many women.