Menopause


Also known as:
Last Review Date: December 30, 2018


What is it?

Menopause is the time in a woman's life when her normal menstrual periods cease and a woman's ovaries, the organs that produce eggs, stop making female hormones. Menopause occurs at an average age of about 50, but the usual range is anytime in the late 40s to the early 50s. It can occur much earlier (40 or even 35) or be delayed (55 or even later).

Two important hormones, oestradiol and progesterone, are made by the ovaries (the organs that produce eggs) in a cyclical fashion and help to maintain a normal menstrual cycle. When a woman reaches menopause, cyclical hormone production from the ovaries stops, leading to a cessation in monthly menstrual periods and of egg production.

The menopausal change is slow and usually takes two to five years to complete. During the so-called peri-menopausal period, hormone levels can fluctuate from high to low and from one month to the next. Some months a woman may have a period but then go for several months without a period. It is important to note that during this time, a woman may still be able to get pregnant. Menopause is said to have taken place when a woman has not had a period for 12 months.

Menopause happens naturally as a woman ages. However, menopause can also occur for other reasons, including the removal of the ovaries for cancer or other medical reasons like endometriosis.


Symptoms


A woman’s body goes through several changes during menopause. Some of the more common symptoms of menopause occur when oestrogen levels start to drop. Women may experience:
  • hot flushes;
  • rapid mood swings ranging from depression to euphoria
  • decreased libido and sex drive
  • increased frequency or sudden urge to urinate
  • vaginal dryness with pain during intercourse.

In addition, bone loss, which occurs naturally with age, is accelerated after menopause due to the lack of oestrogens. Excessive bone loss can lead to osteoporosis and a higher incidence of fractures of the hip and spinal column. A higher risk for heart disease is also seen after menopause because the levels of LDL cholesterol ( 'bad' cholestrol) in the blood may rise.

Postmenopausal bleeding , that is bleeding more than an year after the final menstrual bleed, should be reported to your doctor as a small percentage of these bleeds may be due to cancer of the uterus.
 


Tests


The diagnosis of menopause is usually made on clinical grounds, i.e. symptoms and history. The following biochemical investigations may be performed on blood when menopause is suspected but the diagnosis is not clear:
  • Follicle-stimulating hormone (FSH) - to learn whether the woman is approaching or has gone through menopause: FSH concentrations generally increase during the transition. However raised FSH during the peri-menopause does not guarantee that another period will not occur or that the woman cannot become pregnant.
  • Oestradiol - to measure ovarian production of oestrogen and to further assist in determining menopausal state
  • Additional tests that may be requested include:
  • Thyroid function testing (free T4 and TSH tests) - to assess the function of the thyroid gland
  • Lipid profile
  • Vitamin D-low concentrations increase the risk of osteoporosis.

Treatment


Some menopausal symptoms can be managed without drug treatments, such as with diet and exercise or by quitting smoking and cutting back on alcohol consumption. Some women, particularly those with severe symptoms, and those with menopause due to surgery or other non-age-related cause, may choose to start taking hormone replacement therapy to help prevent or reduce hot flushes, mood swings and bone loss.

Hormone replacement therapy (HRT) is the most common therapy prescribed to relieve the various symptoms of menopause. It has been and continues to be controversial, however. For more information about HRT, see Better Health Channel: Menopause - hormone replacement therapy. You should also discuss HRT with your doctor to make sure it is right for you.

Calcium and vitamin D supplementation is often recommended for bone health.
 


Related pages

On this site
Tests: FSH, Oestradiol, free T4, TSH, Lipid profile, Vitamin D

Elsewhere on the web
Jean Hailes Foundation for Women's Health
Better Health Channel: Menopause
Healthdirect Australia: Menopause