The Menopause: What to Expect

The menopause is a natural stage of life that every woman goes through, usually between the ages of 45 and 55. It is defined as the point when you have not had a period for 12 months, and it marks the end of the reproductive years. For some women it passes with barely a blip; for others the symptoms are intense and disruptive. Knowing what is normal, what is temporary and what can be treated makes a real difference, so this guide covers the essentials.

What the menopause is

As the ovaries run low on eggs, they produce less oestrogen and progesterone, and eventually stop releasing eggs altogether. That fall in hormones causes the symptoms that make up the menopause. The transition before your final period is called perimenopause, and the time after is postmenopause. Many of the symptoms people associate with the menopause actually begin during perimenopause, often years before periods stop.

Common symptoms

Hot flushes and night sweats are the best known, but the list is far longer and different for everyone.

• Hot flushes, flushing or a sudden feeling of heat in the face, neck and chest
• Night sweats that can soak bedding and disturb sleep
• Mood changes, irritability, anxiety or low mood
• Problems with sleep, memory and concentration, sometimes called brain fog
• Vaginal dryness, itching or discomfort, and lower libido
• Joint aches, headaches and drier skin and hair

How many of these you get, and how severe they are, varies enormously and is influenced by genetics, weight, smoking and stress. Nobody's experience is the correct one.

How long the symptoms last

On average, symptoms last around four years, but for some women they continue for much longer, and a significant minority still have flushes more than seven years after their final period. The timing and duration are unpredictable, which is one reason the menopause can feel like such a rollercoaster. The good news is that for most women symptoms do ease over time.

Treatment options

Treatment is entirely optional and depends on how much symptoms bother you. Lifestyle changes such as wearing layered clothing, cooling the bedroom and cutting back on caffeine and alcohol help some women. For moderate to severe symptoms, hormone replacement therapy is the most effective option and is available after a consultation. HRT replaces the oestrogen the body has stopped making and is safe for most women when the risks are properly assessed. For vaginal dryness, moisturisers and lubricants work well, and low-dose vaginal oestrogen is another option.

Effects on longer-term health

The fall in oestrogen also affects bones and the heart, which is why the menopause is a good moment to think ahead. Bone density drops more quickly in the years around the menopause, raising the risk of osteoporosis, and the risk of heart disease rises too. Weight-bearing exercise, plenty of calcium and vitamin D, and not smoking all help protect you, as does staying physically active. A check of your blood pressure and cholesterol around this time is sensible.

Talking to your GP

There is no reason to struggle in silence. Your GP can confirm whether you are perimenopausal or menopausal, discuss treatments such as HRT, and check for anything else that could be causing your symptoms, such as an underactive thyroid. The NICE guideline on the menopause is a useful read if you want to prepare for the conversation. If your periods have stopped and you have not been for a while, you may also be due a cervical screening appointment, which you can read about on this site.

The menopause is not something to simply endure. Between symptom tracking, lifestyle changes and treatment that works, most women can find a combination that genuinely helps. If you are in the earlier stages, the guide to perimenopause signs explains what to look out for first, and for night-time problems, the article on menopause and sleep is a good next stop.