Menopause - Stages, Symptoms & Treatment

Menopause ^[1] is a significant milestone in a woman's life, typically occurring between the ages of 45 and 55. It marks the end of the reproductive years and is driven by the natural ageing process, resulting in a decline in the production of hormones like oestrogen and progesterone.

This hormonal shift brings about a range of symptoms, including hot flashes, irregular menstrual cycles, mood swings and more. Menopause can also have health implications, such as an increased risk of osteoporosis ^[2] and heart disease due to the decline in oestrogen.

Management options include hormone replacement therapy (HRT), lifestyle modifications, non-hormonal treatments and maintaining bone health through diet and exercise.

While menopause can be challenging, with the right support, women can navigate this transition confidently.

Stages of menopause

There are three stages of menopause, one that occurs before, during and after. Most women will experience the menopause between the ages of 45 and 55, but some can go through it earlier.

Early and premature menopause

Menopause that happens before the age of 45 is called early menopause ^[3], whereas menopause that happens before the age of 40 is called premature menopause ^[4].

It can happen naturally, or as a result of some treatments.

Perimenopause

This is the transitional phase leading up to menopause. During perimenopause ^[5], hormone levels, particularly oestrogen, begin to fluctuate irregularly.

Women may experience symptoms such as irregular menstrual periods, hot flashes, night sweats, mood swings and changes in libido. Perimenopause can last for several years and continues until menopause is officially reached.

Menopause

Menopause is officially defined as the point when a woman has not had a menstrual period for 12 consecutive months. It typically occurs in the late 40s to early 50s but can vary widely among individuals.

At this stage, the ovaries have largely ceased producing eggs, and oestrogen and progesterone levels have significantly decreased.

Menstrual periods cease entirely, and many of the symptoms experienced during perimenopause continue into the early stages of menopause.

Postmenopause

Postmenopause ^[6] refers to the phase that follows menopause and extends throughout a woman's later years. During postmenopause, hormone levels stabilise at their lower levels, and most menopausal symptoms gradually subside.

However, health concerns related to the long-term effects of reduced oestrogen, such as an increased risk of osteoporosis and heart disease, become more significant.

Women in postmenopause may also experience changes in their vaginal and urinary health, which can include vaginal dryness and an increased risk of urinary tract infections.

Symptoms

Common menopausal symptoms include:

• Hot flashes
• Night sweats
• Irregular menstrual cycles
• Vaginal dryness
• Mood swings
• Sleep disturbances
• Changes in libido
• Potential weight gain
• Cognitive changes
• Increased risk of osteoporosis

Additionally, post-menopausal women face a higher risk of heart disease due to the loss of oestrogen's protective effects on the cardiovascular system. These symptoms and their intensity can vary among women.

Treatment

Menopause treatment aims to manage the symptoms and health risks associated with this natural transition in a woman's life. Treatment options vary based on individual symptoms and preferences.

It may take some time to find the right treatment that works for you.

Lifestyle changes

Regular exercise, comprising a mix of cardio, strength training and flexibility exercises can alleviate hot flashes and mood swings while managing weight gain.

A balanced diet rich in fruits, vegetables, whole grains, lean protein and essential nutrients supports bone health and overall vitality.

Reducing caffeine and alcohol intake, quitting smoking and practising stress-reduction techniques such as meditation and yoga can further enhance one's physical and mental state.

Prioritising sleep, maintaining a healthy weight through sustainable measures and seeking social support can also positively impact you during the menopause.

Medication

Medications can be used to manage specific symptoms of menopause when lifestyle changes haven’t worked or when symptoms are severe.

It's important to consult with a healthcare provider to discuss the most appropriate medication options based on your individual needs and health history. Here are some common medications used to manage menopausal symptoms.

Hormone replacement therapy (HRT)

HRT ^[7] is one of the most effective treatments for managing a wide range of menopausal symptoms, including hot flashes, night sweats, vaginal dryness and mood swings.

Oestrogen therapy is prescribed for women who have undergone a hysterectomy, as they do not require progestin to protect the uterine lining. For women with an intact uterus, a combination of oestrogen and progestin is typically used to reduce the risk of endometrial cancer.

HRT comes in various forms, including pills, patches, creams, gels and vaginal rings.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) ^[8] and serotonin-norepinephrine reuptake inhibitors (SNRIs)^[9] are sometimes prescribed to manage mood swings, irritability and hot flashes.

These medications can help balance neurotransmitters in the brain and reduce the frequency and intensity of hot flashes.

Gabapentin

Gabapentin ^[10], an anti seizure medication, has been found to be effective in reducing the frequency and severity of hot flashes.

Clonidine

Clonidine ^[11], a medication primarily used to treat high blood pressure, may also help alleviate hot flashes in some women.

Vaginal oestrogen

For women experiencing vaginal dryness, discomfort during intercourse or urinary symptoms, topical vaginal oestrogen ^[12] creams, tablets or rings can provide localised relief without the systemic effects of oral HRT.

Osteoporosis medications

Women at risk of osteoporosis may be prescribed medications like bisphosphonates ^[13] or selective oestrogen receptor modulators (SERMs)^[14] to strengthen bones and reduce the risk of fractures.

Low-dose birth control pills

Some women may use low-dose birth control pills ^[15] to regulate menstrual cycles and manage menopausal symptoms, particularly when experiencing irregular bleeding.

Herbal supplements

Some women turn to herbal supplements like black cohosh, soy or red clover to manage symptoms. However, the effectiveness and safety of these supplements vary, and they should be used with caution and under the guidance of a healthcare provider.