Menopause is the medical term for the end of a woman’s monthly menstrual cycle. It usually takes place between the age of 45 and 58, but can happen earlier. It occurs when the ovaries stop making the hormone oestrogen.
Menopause causes may also include surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy. It can also be brought on by an underlying medical condition, such as Down’s syndrome or Addison’s disease.
Premature menopause, also known as premature ovarian insufficiency, is when a woman experiences the menopause before the age of 40.
What are its symptoms?
The majority of women display problematic symptoms during menopause, but the severity varies. The time leading up to menopause may be characterised by irregular periods. Changes such as shorter or longer periods, heavier or lighter bleeding, and varying lengths of time between periods may also be a sign that menopause is approaching.
Talk to your doctor, however, if:
- Bleeding occurs more often than 21 days
- Your period lasts longer than eight days or is very heavy
- Your period occurs after six months or more without a period
Hot flushes are the classic sign of menopause. A flush is a sudden sensation of warmth or intense heat that spreads over the body, especially the chest, face, and head. Flushing and sweating are usually followed by a chill. Some women feel their heart beating very fast or hard and feel anxious.
Common menopause symptoms include:
- Hot flushes
- Night sweats
- Weight gain
- Vaginal dryness
- Sleeping problems such as insomnia
- Low mood
- Brain fog
- Reduced sex drive
- Memory lapses
Menopausal symptoms can begin months or even years before your periods stop and last for about four years after your last period, although some women experience them for much longer.
The most common conditions mimicking menopausal symptoms include depression, anaemia and hypothyroidism (underactive thyroid). They may also occur concurrently. Unstable diabetes may cause hot flushes. Some medication may also cause flushes.
How is it diagnosed?
A typical menopause diagnosis includes your doctor or gynaecologist reviewing your medical history and performing a physical examination.
Tests are not usually needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of follicle-stimulating hormone (FSH) and oestrogen (estradiol). These decrease as menopause occurs.
What are your treatment options?
Not all women choose treatments to relieve menopause symptoms. They are available, however.
The main treatment is hormone replacement therapy (HRT). HRT involves taking oestrogen to replace the decline in your body’s own levels. It can relieve many of the symptoms.
The use of HRT has been controversial because of a link with breast cancer, but many medical experts maintain it is effective and should be offered to women after discussing the risks and benefits. According to the South African Menopause Society, the guiding principle should be to take the smallest possible dose for the shortest time necessary.
There are two main types of HRT:
- Combined HRT (oestrogen and progestogen) – for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer)
- Oestrogen-only HRT – for women who have had their womb removed in a hysterectomy
HRT is available as tablets, skin patches, a gel to rub into the skin or implants.
Treatments for the alleviation of symptoms related to menopause include:
- Medications for hot flushes and night sweats
- Relaxation and talk therapies for mood changes
- Testosterone supplementation for reduced sexual desire
- Over-the-counter vaginal moisturisers or lubricants for vaginal dryness and discomfort
- Healthy diet, regular exercise, access to sunlight, calcium and/or Vitamin D supplement for weak bones
Can it be prevented?
Menopause is a normal part of ageing so cannot be prevented. There are some ways to delay menopausal onset; however, this can only delay early menopause and not timely menopause. Timely menopause cannot be delayed.
For more information, visit the South African Menopause Society.
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