Menopause

When it happens:

• It is common for people to experience menopause between 45 and 55 years old as a natural part of aging, but it can also happen earlier or later.
• If someone experiences menopause before 40 years old, this is called ‘premature menopause.’

How it Happens  

Menopause can happen naturally or because of surgical/medical procedures.  

• It is considered to be ‘natural menopause’ after 12 consecutive months without a period for which there is no other obvious physiological or pathological reason and without clinical intervention (not caused by surgical/medical procedure).  
• Examples of surgical or medical procedures that can lead to menopause include:  
  • Surgery to remove the ovaries (oophorectomy)  
  • Surgery to remove the uterus (hysterectomy) 
  • Cancer treatments such as chemotherapy or radiation therapy 
  • Genetic reason 

Premature menopause can occur due to surgical/medical procedures, autoimmune disorders, certain chromosomal abnormalities, or other unknown causes.  

Disclaimer: There are times where the reason for the menopause is unknown.  

Perimenopause  

The transition to menopause can be gradual and usually starts with changes to the period (menstrual cycle). ‘Perimenopause’ is a term for when someone experiences menopause symptoms, but they still experience a period. Perimenopause ends and menopause begins when a period hasn’t happened for 12 consecutive months.  

Perimenopause can last several years and can affect physical, emotional, mental and social wellbeing.  

There are hormonal and non-hormonal treatment options that can help manage perimenopausal symptoms.  

• Hormonal means a treatment containing hormones and non-hormonal means the treatment does not contain hormones.  

Symptoms  

The hormonal changes that occur with menopause can impact mental, physical, emotional, and social wellbeing. Symptoms of menopause can be experienced during and after the menopausal transition. Individuals can experience menopausal symptoms for several years.  

Symptoms vary person to person. Some have little to no symptoms while for others it can be severe and affect their day to day and quality of life.  

It is recommended that symptoms affecting an individual’s health and wellbeing are discussed with a healthcare professional to see if there are ways to manage these symptoms with consideration to medical history, values, and preferences.  

 Symptoms associated with menopause & perimenopause:  

• Hot flushes and night sweats
  • Hot flushes = sudden feeling of heat in the chest, neck and face and are often partnered with sweating, flushing of the skin, pounding of the heart (palpitations), and feelings of physical discomfort that can last for several minutes
  • Night sweats = sweating to the point that night clothes and bedding are soaking wet even though the environment for sleep is cool
  • To learn more about night sweats, please visit: Night sweats – NHS (www.nhs.uk)
• Period changes
  • Changes to regularity and flow of the period (menstrual cycle)
  • No longer gets a period (menstruation)
• Changes in mood, depression and/or anxiety
  • Example: low mood, low self-esteem, mood swings
• Vaginal dryness
  • Symptoms of vaginal dryness include:
    • Feeling sore or itchy in or around the vagina
    • Feeling pain or discomfort during sex
    • Needing to pee more often than usual
    • Keep getting urinary tract infections (UTIs)
  • Vaginal dryness and the symptoms that someone experiences as a result may make them less interested in having sex
• Pain during sex (sexual intercourse)
• Reduced libido (desire to have sex)
• Difficulty sleeping / insomnia
  • Insomnia = Regularly have problems sleeping
    • Finding it hard to go to sleep
    • Wake up several times during the night
    • Lie awake at night
    • Wake up early and can’t go back to sleep
    • Still feel tired after waking up
    • Find it hard to nap despite being tired
    • Feel tired and irritable during the day
    • Find it difficult to concentrate due to being tired
  • Short-term insomnia = Having insomnia for less than 3 months
  • Long-term insomnia = Having insomnia for 3 months or more
• Changes to body shape and weight gain
• Muscle aches and joint pains
• Skin changes including dry and itchy skin
• Problems with memory or concentration (brain fog)
• Sensitive teeth, painful gums or other mouth problems
• Headaches and migraines that are worse than usual
• Urinary incontinence
  • • Urinary incontinence = unintentionally passing urine
    • Several types of urinary incontinence include:
      • Stress incontinence = Urine (pee) leaks out at times when the bladder is put under pressure like when someone coughs, laughs, or sneezes
      • Urge incontinence = Urine (pee) leaks as someone feels sudden, intense urge to urinate (pee)
      • Overflow incontinence = Also known as chronic urinary retention happens when someone is not able to fully empty their bladder, which causes frequent leaking
      • Total incontinence = Bladder cannot store any Urine (pee) at all, which causes someone to pass urine (pee) constantly or have frequently leaking.
    • Disclaimer: It is possible to have a combination of both stress and urge urinary incontinence
      • To learn more about urinary incontinence, please visit:
        • ​​​​​​​Urinary incontinence | NHS inform
        • Urinary incontinence – NHS (www.nhs.uk)

Pregnancy and Sexually Transmitted Infections (STIs) 

It is still possible to become pregnant during perimenopause. Therefore, it is recommended to use contraception to avoid unintended pregnancy until after 12 consecutive months without a period.  

Pregnancy after menopause is unlikely without the assistance of fertility treatments that involve using donor eggs or frozen embryos.  

It is possible to contract a sexually transmitted infection at any stage of life, including menopause and perimenopause stages. Therefore, there is still a need to consider taking precautions to avoid sexually transmitted infections (STIs). For example, using condoms can help protect against sexually transmitted infections (STIs).  

• For more information on STI visit NHS Inform: https://www.nhsinform.scot/campaigns/how-to-prevent-stis/ 

Other changes  

Menopause can also affect body composition.  

• Body composition = The percentage of fat, water, bone, muscle, skin, and other tissues that make up the body.  

The pelvic support structures can also become weaker, increasing the risk of pelvic organ prolapse.  

• Pelvic organ prolapse = When there is a loss of support to the uterus, bladder and bowel and these organs slip down and bulge into the vagina.  

There is a loss of bone density during menopause which lead to higher rates of osteoporosis and bone fractures (broken bones).  

• Osteoporosis = Condition that weakens bones, which makes weakens bone strength and more likely to break  

Menopause can also impact cardiovascular risk. Due to the decline in oestrogen levels after menopause, women’s risk for cardiovascular disease increases.