Menopause

What is the menopause?

Sally Hope is a retired GP. She is a researcher with a special interest in women's health. She is the co-author of several books on the menopause (see ‘Resources and information’), and talks about the menopause from a medical perspective. You’ll also find clips from Sally’s interview in some of the other topic summaries. As a menopausal woman, Sally also has a personal interest in the menopause.

What is the menopause?
Menopause means the ‘last menstrual period’. However, many women say they are ‘going through the menopause’ when talking about the time leading up to their final period when they notice changes in their menstrual cycle and the onset of symptoms such as hot flushes and sweats. Women are said to have reached the menopause when they haven’t had a period for one year. In the UK the average age at which women reach the menopause is around 51, however, some women can go through the menopause earlier or later. A menopause before the age of 45 is an ‘early’ or ‘premature’ menopause (see ‘Early (premature) menopause’).
Women often ask how long the menopause is likely to go on for. It varies a lot. While a third of women have no symptoms at all, most women have at least two or three years of ‘hormonal chaos’ as their oestrogen levels decline before the last period. This is called the perimenopause. Women are said to be postmenopausal any time after their last period. However, a small minority still have hot flushes in their eighties.
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What are the symptoms?
Irregular periods and hot flushes and sweats are usually the first signs that the menopause has begun. Other symptoms that may occur include sleep disruption, loss of sex drive (libido), vaginal dryness, urinary problems, joint and muscle aches, changes in skin and hair, weight gain, anxiety, mood swings, depression, and poor memory and concentration.
Sometimes it’s hard to tell whether symptoms are caused by the menopause or by other factors in midlife. Women may be working full-time, caring for teenage children as well as elderly parents, or going through marital problems - all can add to the burden of coping with menopausal symptoms (see ‘Family, health and life events’).
What treatments are available?
According to Sally, most women see the menopause as ‘a natural milestone in their lives and get through it on their own’. Alongside diet and exercise, most choose commonsense self-help approaches to minimise the effects of their symptoms (e.g. wearing cotton clothing and using a fan to help with hot flushes) rather than take prescription medication.

A considerable number of women have tried complementary therapies for symptom relief. However, as Sally says, ‘very few trials have been done and the ones that have been done have shown very poor results’. She does, however, recommend a diet rich in phytoestrogens such as soy, lentils and chick peas.
For some women, hormone replacement therapy (HRT) continues to offer relief from menopausal symptoms such as hot flushes by replacing oestrogen. It's available in many forms including tablets, cream or gel, a skin patch or an implant (see ‘Hormone replacement therapy (HRT)’).

Hormone replacement therapy (HRT) is recommended for some women, for effective relief of severe menopause symptoms such as hot flushes and in young women following early menopause up until about 50 years old. As with any medication, HRT has benefits and risks and these should be discussed with your doctor. For most symptomatic women under 60 years or within 10 years after menopause, use of HRT for up to 5 years is safe and effective, Most experts agree that if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks (NHS choice 2015). However it will not be suitable for some women because of their medical history.

How can GPs help women through the menopause?
According to Sally, women sometimes consult their doctor during the menopause for reassurance that their symptoms are ‘normal’ and that they are ‘not going mad’. She sometimes runs menopause evenings to talk about women’s health issues and to provide an opportunity for ‘women to get together and talk over a coffee’. She acknowledges, however, that lack of time, knowledge and interest in the menopause can make it difficult for GPs to provide the type of support which women need at this stage of their lives (see ‘Consulting the doctor’ and ‘Advice for health professionals).
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She recommends that women look for information on the menopause and how to keep healthy on websites such as Menopause Matters, The British Menopause Society, and the National Osteoporosis Society (see ‘Support networks’ and  ‘Sources of Information’).
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NICE - National Institute for Health Care Excellence recommends that GPs:
"Give information to menopausal women and their family members or carers (as appropriate) that includes:
•    an explanation of the stages of menopause 
•    common symptoms and diagnosis 
•    lifestyle changes and interventions that could help general health and wellbeing
•    benefits and risks of treatments for menopausal symptoms
•    long-term health implications of menopause. 

Give information on menopause in different ways to help encourage women to discuss their symptoms and needs." (NG23 November 2015)

What is the latest research about the menopause?
As the debate about using HRT as a medicine of choice for women going through the menopause continues, research has turned to finding alternative treatments which relieve menopausal symptoms while protecting women from the risk of breast cancer, strokes, and heart disease. Sally believes that Selective Estrogen Receptor Modulators (SERMs), such as Tamoxifen which is currently used in treating breast cancer, may hold the key to developing an alternative hormone replacement therapy which offers women both protection against breast cancer as well as minimising menopausal symptoms. As Sally explains, however while research is underway, 'we wait in hope' for a breakthrough.
It’s important to remember that although for some women the menopause can have a significant effect on their quality of life, not everyone has problems. As Sally points out, ‘thirty three per cent of women have no symptoms at all and don’t even know they’ve gone through the menopause’.
 

Last reviewed November 2015.

Last updated November 2015.

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