Menopause and HRT

Menopause is the time in life when you stop having monthly periods. This marks the natural end of the reproductive stage of your life, when your ovaries no longer have eggs to release.

Key facts

• Menopause is when a woman stops having her monthly periods.
• Most women become menopausal between 45 and 60 years of age — this marks the end of the reproductive stage of their life.
• Symptoms during menopause include changes to the menstrual cycle, hot flushes, night sweats, muscle and joint aches, tender breasts and emotional changes.
• Ways to manage the symptoms of menopause include lifestyle changes, menopausal hormone therapy, and complementary therapies.

 

What is menopause?

Menopause is the time in life when you stop having monthly periods. This marks the natural end of the reproductive stage of your life, when your ovaries no longer have eggs to release. Most Australian women experience menopause between 45 and 60 years of age. The average age of menopause is 51 years. You have reached menopause when you have gone 12 months without having your period.

Some women experience early menopause due to health conditions, such as primary ovarian insufficiency (where ovaries stop working normally). Menopause can also occur after surgery to remove your ovaries or uterus, or cancer treatment.

Each woman experiences menopause differently. Many feel only minor discomfort, while others have more severe symptoms. Menopause symptoms are usually temporary, but sometimes last for several years.

What are the symptoms of menopause?

Every woman experiences menopause differently, but symptoms may include:

• Menstrual cycle changes — your monthly periods may become either less frequent or more frequent in the lead up to menopause (perimenopause).
• Hot flushes or night sweats — a sudden feeling of warmth in the neck and chest with changes to your heart rate and tiredness.
• Problems sleeping (insomnia) and/or lower energy levels.
• Muscle or joint pain.
• Vaginal and urinary symptoms — as the vaginal lining becomes thinner and dryer, you may experience discomfort during sex and/or need to urinate more often.
• Mood changes — you may feel anxious, upset, sad or angry in more situations.

Menopause symptoms often emerge before your periods stop. Symptoms may be more severe if menopause is caused by surgery or cancer treatment. Women from different cultures may also experience symptoms differently. For example, hot flushes and night sweats are more common in women from Western cultures, while Asian women report more aches and pains, insomnia and mood changes.

 

What causes menopause?

Natural menopause

Menopause occurs naturally when a woman’s ovaries no longer have any eggs to release, and its symptoms are caused by a drop in the levels of the hormone oestrogen.

In the lead-up to natural menopause, hormone levels can swing from high to low as the body transitions (perimenopause).

 

Early menopause

Early (or premature) menopause can occur due to:

• medical treatments that stop ovaries from functioning, such as chemotherapy or radiotherapy for cancer
• surgery to remove a woman’s ovaries (oophorectomy) — for example, to prevent or treat ovarian-cancer or breast cancer
• surgery to remove the uterus (hysterectomy) in some cases
• primary ovarian insufficiency — for example, due to certain genetic, autoimmune or metabolic conditions
• some unknown cause — for 6 in 10 women with early menopause, the cause is unknown

 

How is menopause diagnosed?

There isn’t a specific test for menopause. Your doctor will help you determine if you are menopausal based on how frequent your periods are and what symptoms you are experiencing. Menopause is confirmed 12 months after your last period. Blood tests are unlikely to accurately predict menopause.

Seek medical advice if you are concerned about irregular cycles, heavy or abnormal bleeding, or symptoms that interfere with your daily life. Your doctor may also suggest other health checks such as a mammogram, pelvic examination or cervical screening.

How is menopause treated?

Most women can manage mild menopause symptoms without any medication. If you feel you need treatment for menopausal symptoms seek medical advice to find the best treatment for your individual circumstances.

Prescribed treatments

Menopausal hormone therapy (MHT), or hormone replacement therapy, involves replacing your hormones (oestrogen and progesterone, and sometimes testosterone) to relieve menopausal symptoms. It is an effective treatment for hot flushes, sweats, mood swings, irritability, insomnia, joint aches and vaginal dryness.

The most recent and comprehensive reviews of MHT show that many healthy women can safely use it for years to manage menopausal symptoms, but it’s important to first check with your doctor to see if MHT is right for you. If you opt to start MHT, take the lowest effective dose for only as long as you need to, and review with your doctor regularly whether to continue treatment.

MHT is not appropriate if you have a history of oestrogen-dependent cancer, such as breast or uterine cancer.

Other conditions that rule out MHT include:

• undiagnosed vaginal bleeding
• untreated thickening of the uterine lining
• unmanaged high blood pressure
• current thrombosis (such as deep vein thrombosis, or DVT), or conditions that increase your risk of blood clots
• coronary heart disease, stroke or dementia

Your doctor might also suggest some non-hormonal prescription medicines to manage menopausal symptoms. These include certain antidepressants and other medicines.

Complementary treatments

Many women try non-hormonal options to manage menopause symptoms such as hot flushes and night sweats. These options include:

• herbal remedies such as black cohosh and red clover and plant-based oestrogens (phytoestrogens), found, for example, in soy
• hypnotherapy
• cognitive behaviour treatment
• mindfulness therapy
• acupuncture and traditional Chinese medicine

For a dry vagina, drug-free treatments include the use of lubricants, oils, vaginal moisturisers, or black cohosh.
It’s important to seek medical advice before trying any treatment — including herbal therapies. Some remedies may be expensive and unproven, or they may interact with other treatments.

Living with menopause

Lifestyle changes to help ease the symptoms of menopause include:

• avoiding caffeine, alcohol and spicy foods to help reduce hot flushes
• having a fan or air conditioning on where possible
• dressing in layers that you can easily remove if you’re feeling hot
• getting regular exercise, since this will help with feelings of low mood

What are the complications of menopause?

Menopause occurs alongside a range of lifestyle and metabolic changes in women.

These include:

• Heart disease — Menopause has a significant impact on a woman’s risk of getting heart disease.
• Osteoporosis — during menopause, your body starts to break down bone tissue more quickly than it replaces it.
• Sex drive — Women often find their sexual feelings and desires change around the time of menopause.

These changes are common, and it may help to discuss them with your partner, your doctor or a trusted friend.