Menopause: What is it?

Menopause is the permanent end of menstruation. It's a transition phase, not a disease, but it can have a big impact on a woman's wellbeing. Although menopause can bring physical upheaval from hot flushes, night sweats and other symptoms, it can also be the start of a new and rewarding phase of a woman's life - and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

What causes menopause?

Age is the leading cause of menopause. It's the end of a woman's potential childbearing years, brought on by the ovaries gradually slowing down their function. Certain operations and medical treatment can induce menopause. Those include surgical removal of the ovaries (bilateral oophorectomy), chemotherapy and pelvic radiotherapy. Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not lead to menopause, although you will not have periods anymore.

When does menopause start?

On average, women in the UK are 52 at natural menopause, but menopause can start earlier or later. A few women start menopause as young as 40 and a very small percentage as late as 60. Women who smoke tend to go through menopause a couple of years earlier than non-smokers. There is no proven way to predict menopause age. It's only after a woman has missed her periods for 12 months in a row, without other obvious causes, that menopause can be confirmed.

Before menopause, perimenopause

Natural menopause happens gradually. The ovaries don't abruptly stop - they slow down. The transition to menopause is called perimenopause. Menopause is a milestone - it's the day that marks 12 months in a row since a woman's last period. During perimenopause, it's still possible to get pregnant - a woman's childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still functioning and she still may ovulate, though not necessarily every month.

Menopause: What to expect

Menopause isn't a one-size-fits-all event. It affects each woman differently. Some women reach natural menopause with little to no trouble; others experience severe symptoms that drastically hamper their lives. When menopause starts suddenly as a result of surgery, chemotherapy or radiotherapy, the adjustment can be difficult. Here is a look at menopausal symptoms that many women experience, though the intensity can vary.

Menopause sign: Period changes

As menopause approaches, a woman's menstrual periods will probably change. However, those changes can vary from woman to woman -- periods may get shorter or longer, heavier or lighter, with more or less time between periods. Such changes are normal, but seek medical advice if your periods come very close together, if you have heavy bleeding or spotting, or if your periods last more than a week.

Menopause symptom: Hot flushes

Hot flushes are common around menopause. A hot flush is a brief feeling of heat that may make the face and neck flushed, cause temporary red blotches to appear on the chest, back and arms. Sweating and chills may follow. Hot flushes vary in intensity and typically last between 30 seconds and 10 minutes. Dressing in light layers, using a fan, getting regular exercise, avoiding spicy foods and heat, and managing stress may help you deal with hot flushes.

Menopause symptom: Sleep problems

Night-time hot flushes can hamper sleep and cause night sweats. Try these sleep tips:

• Use a fan in your bedroom.
• Avoid heavy bedding.
• Choose light cottons or sheer materials for your nightclothes.
• Keep a damp cloth nearby to cool yourself quickly if you wake up feeling hot and sweaty.
• Keep pets out of your bedroom - they can give off heat.
• Seek medical advice if menopause sleep problems persist.

Menopause symptom: Sex problems

Less oestrogen can lead to vaginal dryness, which may make intercourse uncomfortable or painful. Try using a water-soluble lubricant. Libido may also change, for better or worse, but many factors besides menopause - including stress, medication, depression, poor sleep and relationship problems – can affect sex drive. Talk to your doctor if sex problems occur - don't settle for a so-so sex life. And remember, the risk of sexually transmitted infections (STIs) doesn’t end with menopause; "safer sex” is still important.

Menopause: Managing severe symptoms

If menopause symptoms are a problem, talk to your GP. He or she can help you weigh up the risks and benefits of hormone replacement therapy. Other treatments include low-dose contraceptive pills if you're perimenopausal; antidepressants, blood pressure drugs or other medications to help with hot flushes; and vaginal oestrogen cream or vaginal lubricants to help with dryness. Your doctor may also have lifestyle tips about adjusting your diet, exercise, sleep and stress management.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) can ease menopausal symptoms. Various prescription products are available to treat hot flushes and vaginal symptoms. Some are also recommended to prevent osteoporosis. The NHS says most experts agree that if HRT is used in the short-term - for no more than five years - then the benefits of it outweigh any associated risk. Studies have linked long-term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots and breast cancer.

Alternative menopause treatments

Interested in trying alternative or complementary treatments for menopause symptoms? There hasn't been a lot of well-designed research on this topic to show what works and what doesn't. Black cohosh is a traditional herbal medicine product registered with the regulator MHRA and used for the relief of symptoms associated with the menopause. These include hot flushes, night sweats, poor sleep, mood changes and irritability. Always discuss alternative therapies with your doctor so that possible medication interactions can be checked.

Menopause health risks

With menopause comes a greater chance of heart disease. Coronary heart disease (CHD) is the UK's biggest killer: around one in seven women die from the disease. Loss of oestrogen may play a role in heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke. Of course, heart and bone health is important throughout a woman's life, but menopause means it's really time to get serious about it, if you haven't already.

Menopause: Staying healthy

Living a healthy lifestyle is important throughout a woman's life, and, it’s not too late to start at menopause. Get a check-up that includes measuring your blood pressure, cholesterol and blood sugar and keep appointments for routine screening such as mammograms. Menopause is also a great time to upgrade your diet, physical activity and stress management skills. Your doctor can give you pointers as you work together to plan for a healthy future.

Active menopause a must

One of the best things a woman can do as she transitions to menopause and afterwards is to take regular physical activity. That includes aerobic exercise for her heart and weight-bearing exercise for her bones -- both of which may help ward off weight gain and provide a mood boost. Even if a woman hasn't been very active in her younger years, it's never too late to start. Menopause is a new beginning and the perfect time to weave more activity into your life.

Menopause: A new era starts

Western culture has long been obsessed with youth, but today's menopausal women are making the most of -- and even celebrating -- their new phase of life. Instead of looking back mournfully, some experts recommend using menopause as a time to redefine yourself with positive thoughts, love yourself, explore what brings you pleasure and revive (not retire) your sex life.

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