Menopause marks the permanent end to a person’s menstrual cycle (AMS 2016.)
While menopause is mostly experienced between the ages of 45 and 55 (with an average age of 51), some people reach menopause early or late (Better Health Channel 2019).
(Better Health Channel 2019; Obermair 2020)
Despite this, there is no set age for when menopause should begin - it depends on the individual (Obermair 2020).
A person is considered to be postmenopausal after 12 consecutive months without experiencing a period (AMS 2016).
Females are born with one million eggs in each ovary. This decreases to 300 000 by the time they undergo puberty. After the onset of puberty, they will go on to experience approximately 400 to 500 menstrual periods, and after about the age of 35, their number of eggs will decrease more rapidly and ovulation will occur less often (Jean Hailes 2018).
It is thought that menopause is triggered by the ovaries running out of eggs completely, but the cause is not yet completely understood (The Women’s 2019).
There are three stages of menopause:
(The Women’s 2019; Better Health Channel 2019)
Most people will experience a variety of symptoms during the perimenopause and postmenopause phases.
The first symptoms are usually irregular periods, hot flushes and night sweats.
However, it is important to remember that no two people experience menopause in the same way - the specific symptoms experienced and their severity will depend on factors such as culture, health, lifestyle and whether menopause occurred naturally or was induced by surgery or chemotherapy (Jean Hailes 2018).
(Jean Hailes 2021b)
Possible symptoms include:
(The Women’s 2019; Jean Hailes 2021b)
The decrease of female hormones also leads to long-term health risks, including:
(Better Health Channel 2019)
Vasomotor symptoms are commonly experienced during menopause. They are usually the most severe in the year around the final menstrual period (The Women’s 2019).
Hot flushes are characterised by a sensation of overheating that usually begins in the chest before spreading up to the head and neck. They can last from a few seconds to a few minutes and may be accompanied by sweating, skin reddening and a racing heartbeat (The Women’s 2019; Jean Hailes 2021b).
Some people may experience one hot flush per day, while others may experience more than 20 (Jean Hailes 2021b). Hot flushes may even continue for many years postmenopause (The Women’s 2019.
While the exact cause of vasomotor symptoms is not completely understood, it’s thought that reduced oestrogen levels interfere with the parts of the brain responsible for temperature regulation (Jean Hailes 2021b).
Hormone therapy (menopausal hormone therapy (MHT) or hormone replacement therapy (HRT)) is effective in relieving menopause symptoms such as vasomotor symptoms, mood swings, irritability, insomnia, joint aches and vaginal dryness (Healthdirect 2020).
MHT/HRT/HT is able to reduce vasomotor symptoms in about 80% of people, as well as reduce osteoporosis (The Women’s 2019).
It can generally be safely taken for up to five years but may increase the risk of breast cancer if used beyond that time period (The Women’s 2019).
It is not an appropriate treatment for those who have:
(Healthdirect 2020)
Other treatment options that may help to relieve the symptoms of menopause include:
(The Women’s 2019; Healthdirect 2020)
Lifestyle changes that may relieve symptoms include:
(Healthdirect 2020; Better Health Channel 2019)
Early menopause is thought to affect up to 8% of people (Obermair 2020).
Potential causes of early menopause include:
(Obermair 2020; Jean Hailes 2021a; AMS 2020; Better Health Channel 2018)
About 60% of instances of early menopause have no known cause and are therefore referred to as idiopathic premature menopause (Better Health Channel 2018).
Other factors that may increase the risk of early menopause include starting periods before the age of 12 and epilepsy (Obermair 2020).
(AMS 2020)
Early menopause can be emotionally distressing for a number of reasons. People may experience feelings such as:
(Better Health Channel 2018; AMS 2020)
Early menopause also increases the risk of early-onset osteoporosis and heart disease (Better Health Channel 2018).
While there is no treatment available to make the ovaries function, there is a chance that they will start to work again on their own. In fact, about 10% of people with POI who continue to try for a pregnancy, succeed, despite their diagnosis (Better Health Channel 2018).
In order to reduce the risk of early-onset osteoporosis and heart disease, people experiencing early menopause may be recommended to undergo hormone replacement therapy (HRT) until they reach the average age of menopause (51) (Better Health Channel 2018; AMS 2020).
HRT comes in several forms, including:
(Better Health Channel 2018; AMS 2020)
People experiencing early menopause should receive plenty of support from their partner, family and friends, as this can be a distressing time (AMS 2020).
People who experience late-onset menopause have increased exposure to female hormones and are therefore more at risk of oestrogen-dependent cancers. Furthermore, increased ovulation heightens the risk of ovarian cancer (Obermair 2020).
Despite this, late-onset menopause is also associated with longer life expectancy, decreased risk of heart disease and stroke, and delayed osteoporosis (meaning their bones are stronger and less prone to fracturing) (Obermair 2020).
Menopause is often talked about as something that only affects women, however, it should be noted that menopause also happens to people of differing genders, including trans men (assigned the female gender at birth) and non-binary people, who identify as neither male nor female (Sutton 2021).
Menopause may trigger feelings of severe unease, known as dysphoria, in people who don’t identify as female, as it may remind them that their reproductive system and physiological experiences don’t align with the gender they identify as. Furthermore, using gendered language when discussing menopause can cause members of the LGBTQ+ community to feel alienated, and possibly avoid seeking medical help altogether (Sutton 2021).
For this reason, it is important to be inclusive in your language and practice (e.g. using people’s correct pronouns such as he/him or they/them and using the word ‘people’ instead of ‘women’) in order to ensure that healthcare for menopause and other areas of reproductive health is accessible for all patients (Sutton 2021).
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