Menopause: What it is and how to manage symptoms

Menopause has a direct impact on half of the population (not to mention their partners and families).

Up to 60% of women (and some gender diverse people) will experience mild to moderate symptoms as they navigate perimenopause and menopause. For around 20%, these symptoms will be severe.¹

While things have certainly moved on in the past few years, menopause for some is still considered a taboo subject.

The lack of discussion and education around this key health issue might leave you feeling confused, angry or worried as you navigate significant changes in your body and mood.

So, what exactly happens before and during menopause, and what can you do to manage your symptoms? Read on.

‘Menopause’ refers to your last monthly period, and is a natural part of ageing. The word itself comes from the Greek ‘mens’ (month) and ‘pausis’ (cessation).

Its triggered when the ovaries stop releasing eggs, which leads to a drop in levels of the female sex hormones oestrogen and progesterone. This disrupts the menstrual cycle and can cause menopausal symptoms.²

Menopause can also be triggered by:

• surgery to remove your uterus (hysterectomy) or ovaries (oophorectomy).
• medical treatments such as chemotherapy or radiotherapy to your pelvis.
• genetic conditions, and autoimmune and metabolic diseases.³

You’re considered to be post-menopausal when you haven’t had a period for 12 months, signalling the end of your reproductive years.

The average age of natural menopause in Australia is 51, but it’s common for it to begin anywhere between 45 and 55.⁴ Around 12% of women will experience menopause before the age of 40. This is called premature menopause.⁵

Menopause usually happens gradually. For a few years before menopause, your periods may become longer, shorter or irregular, and you might see a change in the amount of bleeding.

If you’ve started noticing these changes or other menopause symptoms, you are said to be ‘perimenopausal’.

Perimenopause can last for several years, during which time you can still become pregnant. If you’re trying to avoid becoming pregnant, you should keep using contraception for one year after your last period if you're over 50, and for 2 years after your last period if you're under 50.⁶

You may experience few to no symptoms during perimenopause, but many people notice mental and physical changes.

Not everyone will experience the same signs and symptoms of perimenopause and menopause. Common symptoms can include:

• irregular periods
• night sweats
• brain fog
• hot flushes
• mood changes
• loss of libido
• sleeping problems
• joint pain
• vaginal dryness and painful sex
• irritable or overactive bladder
• difficulty focusing or concentrating

Along with the symptoms above, the drop in hormone levels during perimenopause and menopause can raise your risk of various health problems, including:⁷

• Osteoporosis: Declining levels of oestrogen cause loss of bone density, which results in a higher risk of brittle bones that break more easily.
• Heart disease and stroke: Oestrogen is a protective factor against heart disease and stroke because it helps to keep blood vessels healthy and control cholesterol levels. As levels drop, the risk of heart disease (including heart attack) increases.
• Weakness of the pelvic floor muscles: Pelvic floor muscles prevent the loss of urine and faeces, so any weakness resulting from a drop in oestrogen can mean a more frequent urge to visit the toilet, control wind or gas, and can also play a part in pelvic organ prolapse.⁸

The symptoms of perimenopause and menopause can be extremely challenging. It’s important to get help from your GP or an endocrinologist if symptoms are impacting your life, including your ability to exercise, concentrate at work, and regulate your mood.

Menopausal hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), is a treatment that replaces some of the hormones that are reduced during and after menopause.

If MHT isn’t right for you, there are other medical treatment options available. These include:

• Prescription medicines for hot flushes and night sweats.
• Prescription medicines such as antidepressants or counselling to help with mood fluctuation.
• Vaginal lubricants or prescription medicines to combat loss of libido and vaginal dryness.

Complementary therapies that promote relaxation and wellbeing may help to ease some symptoms. These could include counselling, meditation, acupuncture, and yoga.

Some complementary products such as herbal supplements claim to reduce menopausal symptoms. Because these are derived from plants and other sources, it’s easy to believe they are ‘natural’ and so safer than prescription medications. While some of them have proven benefits, others can potentially be harmful and interact with prescription medications.⁹

Always speak to your GP before starting any new treatment, whether it’s a natural supplement or exercise, or if you want a referral to see a mental healthcare professional.

Depending on your symptoms, some small changes can help to ease severity including:  

• Staying hydrated and physically active.
• Avoiding possible triggers to hot flushes such as spicy food and hot drinks.
• Reducing alcohol and stopping smoking.

Jean Hailes for Women's Health offers multi-lingual resources on perimenopause and menopause, including advice on how to talk to your GP about menopause and managing your symptoms.

Australasian Menopause Society has multi-lingual fact sheets and videos available. You can also search their database to find a doctor who specialises in menopause.