The menopause is a natural stage of life that millions of women experience. It is marked by changes in hormones and the ending of menstruation. It can also bring many other physical and emotional changes. The good news is, you’re not alone. Millions of women go through the menopause and there is now great support available, along with a lot more knowledge and understanding about this.

In the UK, the average age for a woman to reach the menopause is 51, but the menopause commonly happens any time between the ages of 42 and 56 as a woman’s oestrogen levels decline. But around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause and may be caused by hormonal imbalances, chemotherapy, radiation or a hysterectomy.

The menopause is a natural turning point in a woman’s life that marks the end of the menstrual cycle.

Please note this guide is not intended to replace professional consultation. Please see your doctor for all medical concerns.

Stages of the menopause

The menopause usually happens over a few years and occurs in three stages:

• Peri-menopause. The ovaries gradually produce less oestrogen in the four to five years leading up to menopause. In the last two years of peri-menopause, oestrogen levels drop significantly. This is usually the stage where the most severe menopausal symptoms are experienced.
• Menopause. Twelve months after the last period marks the official stage of the menopause. At this point, the ovaries produce no progesterone, low levels of oestrogen and stop releasing eggs.
• Post-menopause. In the years after the menopause, symptoms like hot flushes usually ease while health risks caused by decreased oestrogen levels typically increase.

Symptoms

There are many possible symptoms of the menopause and each woman feels them differently but most women will experience some menopausal symptoms. The duration and severity of these symptoms varies from woman to woman. About 8 in every 10 women will have additional symptoms for some time before and after their periods stop. Some of these can be quite severe and can have a significant impact on everyday activities for some women.

Common symptoms include:

Menopausal symptoms can begin months or even years before your periods stop and last around 4 years after your last period, although some women experience them for much longer.

Low levels of oestrogen are linked to a number of health problems common in older women. Postmenopausal women are more likely to suffer from:

• osteoporosis
• cardiac disease
• bladder and bowel difficulties
• vision problems
• poor muscle power and tone

When to see a GP

It’s worth talking to a GP if you have menopausal symptoms that are troubling you or if you’re experiencing symptoms of the menopause before 45 years of age.

They can usually confirm whether you’re menopausal based on your symptoms, but a blood test to measure your hormone levels may be carried out if you’re under 45.

If you’re experiencing severe depression or anxiety, bleeding after menopause, or your symptoms are interfering with daily life, you should seek medical attention straight away.

Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life.

These include:

• hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
• vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
• cognitive behavioural therapy (CBT) – a type of talking therapy that can help with low mood and anxiety.

If your symptoms are giving you discomfort, your doctor may recommend hormone replacement therapy (HRT), which provides almost instant relief from many symptoms by replacing the hormones that you are losing.

Different HRTs contain different levels of oestrogen and progesterone, obtained from different sources. Your doctor will recommend the best type for you. Some women are not suitable candidates for HRT. Your doctor will discuss this with you. Unsuitable candidates for HRT may include women with a personal or family history of breast cancer, or women with unexplained vaginal bleeding or active liver disease.

Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.

It’s crucial that you see your doctor regularly in the years leading up to and following menopause. Get regularly screened and checked to keep an eye on these conditions. Stopping smoking, reducing your blood pressure, regular exercise and a healthy diet will all help lower the risks for the concerns above.

Self-care

There are many ways to help relieve your symptoms yourself and make the transition as comfortable as possible. Here are some things you could try:

Make some time for yourself: It’s extremely important that you look after your own wellbeing and this includes finding time for yourself. This may be regularly meeting friends, doing exercise, yoga, meditation, going for a walk, having a bath or just sitting reading a book.

Hot Flushes:  Your hot flushes may be triggered by something, so try documenting what you’re doing when they start. It could be things like spicy food, alcohol, weather changes and hot beverages. Once you know the cause, you can try and avoid the trigger and reduce their effects.  Another tip is always to dress in layers, it’s then much easier to take off an item of clothing.  Confined spaces can increase hot flushes for some people, if this is the case for you, then try to avoid them.

Sleep: You may be struggling to sleep, if this is the case try to avoid caffeine and instead exercise in the morning. Use relaxation techniques before going to bed and stick to a regular schedule. If hot flushes are disrupting your sleep, adjust the temperature in the room and always sleep with layers. If you are struggling to sleep read our sleep guide here.

Weight: It's common to gain weight during the menopause. It’s thought that this may be due to hormonal changes, ageing or lifestyle. During the menopause your metabolism starts to slow down, which leads to weight gain unless you change your lifestyle. Eating more healthily and exercising regularly will not only help you lose weight but it may also help you avoid heart disease and other health problems. Losing weight has also been found to help reduce hot flushes and night sweats.

Exercise: Aim for at least 30 minutes of physical activity every day, this will help you feel good, improve your sleep and help you remain at a healthy weight, which is likely to increase during the menopause, as well as keeping your heart healthy and bones strong. Other forms of exercise like yoga have also been proven to help reduce hot flushes and help you to relax.

Your diet: Ensure you are eating a healthy, balanced diet that’s low in saturated fats, sugars and oils and high in fruit, vegetables and whole grains. Make sure you’re getting enough calcium and vitamin D or take a supplement. Some women find that soya products (soya milk, tofu, etc.) and whole-grain foods bring relief. This may be due to the oestrogen-like effects of the phytoestrogens contained in these foods.

Drink water: During menopause, women often experience dryness. This is likely caused by the decrease in oestrogen levels. Therefore, keeping hydrated is essential. Drinking at least 2 litres of water a day can help with these symptoms. Drinking water can also reduce the bloating that can occur with hormonal imbalance.

Vitamins: It is commonly known that changes in hormones can cause bones to weaken, increasing the risk of osteoporosis. Calcium and vitamin D are linked to good bone health, so it’s vital to get enough of these nutrients in your diet. There is a wide range of foods that are calcium-rich, for example dairy products (yogurt, milk and cheese), green leafy vegetables (kale, spinach), tofu, beans, sardines are also worth considering.

For vitamin D, sunlight is your main source, since your skin produces it when exposed to the sun. However, as you get older, your skin gets less efficient at making it. The main foods sources are oily fish, eggs, cod liver oil and foods fortified with vitamin D.

If you struggle to eat the vitamin rich foods, then take a general vitamin tablet every day.

Smoking: As well as all the health problem associated with smoking, it’s also linked to early menopause and may increase hot flushes. For help quitting smoking click here.

Alternative therapies:  Acupuncture, meditation and relaxation techniques may be able to reduce the stress of menopause.

Natural remedies: Try evening primrose oil, licorice, ginseng or wild yam. There is limited scientific evidence on their safety or effectiveness so talk to your doctor before trying alternative treatments.

Before selecting a type of treatment or making a dramatic change to your lifestyle, though, you should always talk to your doctor.

Menopause brings many changes, and it can sometimes feel overwhelming. It’s important that during this time, you make your health a priority.

Further help and support

• NHS
• Daisy Network
• Menopause Support
• My Menopause Doctor
• Menopause in the Workplace