What is it?

Menopause literally means the end of a woman's menstrual periods. There are three types:

• natural menopause, which happens between the ages of 40 and 55 (usually late 40s)
• early, premature menopause - before 40 years. This is more common in women who smoke, who have been ill or had surgery or drug treatments that affect the blood supply to their ovaries, or can be for no obvious reason
• artificial menopause, when the ovaries have been removed, or after cancer treatment. 

This article discusses natural menopause.

What happens?

Your body stops preparing every month for a baby: your ovaries stop releasing eggs, they make less and less female hormones (oestrogen and progestogen), and eventually your periods stop.

What will I feel?

Your periods will change; they may get shorter, longer, lighter or heavier. They may be closer together, or further apart. This may go on for a year or more. Eventually, your period will stop altogether. Note: if you have very heavy periods or bleeding between your periods you must contact your doctor.

For some women, that is all they notice. However, because the female hormones affect other parts of your body, you may also have any of the following symptoms.

• Hot flushes; these feel like someone has poured hot water into your veins. They can start in your face and neck and spread all over your body or be a sudden feeling of heat all over. Many people feel embarrassed and think others will notice, but it's not usually obvious.
• Sweats, which often go with flushes and are common at night,
• Dryness in your vagina and around your urethra can lead to uncomfortable sex, bladder infections or wetting your pants sometimes (urinary incontinence).
• Sleep problems.
• Your pulse or heart may feel like they are racing, or you may feel faint or dizzy from time to time or get ringing in your ears.
• You can feel tired, irritable, depressed, tearful or angry; this can be from hormonal changes, because you are not sleeping well or because you are adjusting to change.
• Your skin may look more tired and be less firm and the hair on your head, armpits and legs may get thinner.
• You won't feel it, but your bones may start getting thinner (osteoporosis). Much later you may break them more easily or start to get shorter or find it hard to straighten up.

How do I know I am beginning the menopause?

Your periods will change and eventually stop and you may have some or all of the problems mentioned above.

What makes it better?

• Understanding that this is a normal part of life and allowing yourself some time to adjust, think about things and pamper yourself.
• Support from others, especially your partner. Help them understand what is happening.
• Relaxation and anything that helps cut down stress.
• Using a lubricant to combat vaginal dryness, or your doctor may prescribe an oestrogen-based vaginal cream.
• Exercising regularly and keeping fit. Weight-bearing exercises (eg, walking) are good for your bones. Doing pelvic floor exercises can help improve any incontinence.
• Keeping your weight down and eating a diet low in fat, sugar and salt but high in calcium and fibre will help protect your bones, joints and heart. Researchers are looking at whether eating phytoestrogens (natural oestrogens contained in foods such as soy, beans, grains and some fruit and vegetables) help menopause symptoms. There is no clear answer as yet. However, these foods are healthy and low fat, so are generally good choices.
• Stopping smoking.
• Getting more sleep. Keep regular hours, make your bedroom cosy, burn some essential oils, play soft music, make sure you don't do anything before you sleep that makes you too worried or think too much, drink hot milk before bed.
• Some women find some alternative therapies such as acupuncture, massage, reflexology, homoeopathy or herbal remedies help.
• Counselling may help if you are emotionally distressed.

What makes it worse?

• Being stressed, overtired and anxious.
• Too much coffee, tea or alcohol and smoking.
• Hot drinks and spicy foods can make the flushes worse. 

How can my doctor help me?

You may be offered hormone replacement therapy (HRT) (see our topic on hormone replacement therapy), or creams to stop dryness in your vagina. If you are at risk of thinning bones (osteoporosis) you may get calcium supplements or other treatments. Until your periods have stopped for more than a year you can still get pregnant, so it is a good idea to ask your doctor about the best form of birth control for this time of your life as well. Menopause is a good time to have a general health examination, including checks for your blood pressure, having a cervical smear, breast examination, mammogram and possibly a bone density scan. You should also discuss ways to look after your health over the coming years with your doctor.

What happens if I use no treatments for menopausal problems?

Menopause is a normal part of life, and many women get through this time without treatment. It depends how much the symptoms affect your life, and how strong your bones are. Discuss this with your doctor.

Most symptoms, such as flushes and disturbed sleep, get less problematic in time and go away in a few years. You can lower your chance of getting thinning bones by living a healthy life (good diet, regular exercise).

This is an important time for you to plan the next phase of your life. While some women may feel 'sad' or 'old', many others feel they get a new lease of life. They enjoy having no periods and no more worries about pregnancy. Many feel more confident and that they have 'come into their own'.

For further information and support talk to your friends and family, find a support group in your area or join our everybody Communities, where there is a Menopause forum (see below). There is also a lot of information available from your doctor, health clinic, family planning centres, women's groups and centres, specialist menopause clinics, on the internet, from your local library and from alternative therapists. Be well informed. It will help you understand why you are feeling the way you do and to decide whether or not you need treatment.

Written by Anna Mickell RCpN. Edited by everybody.