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What is Menopause (Perimenopause)?

Menopause is the point at which menstruation ceases, and marks the end of a woman's fertility. It is typically diagnosed after 12 months without a menstrual period.

Alternative Names

Perimenopause; Postmenopause

Symptoms of Menopause

  • Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
  • Bouts of rapid heart beat
  • Irritability, Mood swings
  • Sudden tears
  • Trouble sleeping through the night (with or without night sweats)
  • Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
  • Loss of libido
  • Dry vagina
  • Crashing fatigue
  • Anxiety, feeling ill at ease
  • Feelings of dread, apprehension, doom
  • Difficulty concentrating, disorientation, mental confusion
  • Disturbing memory lapses
  • Incontinence, especially upon sneezing, laughing; urge incontinence
  • Menopause Diet
    Menopause Diet
  • Itchy, crawly skin
  • Aching, sore joints, muscles and tendons
  • Increased tension in muscles
  • Breast tenderness
  • Headache change: increase or decrease
  • Gastrointestinal distress, belching, indigestion, flatulence, gas pain, nausea
  • Sudden bouts of bloat
  • Depression
  • Exacerbation of existing conditions
  • Increase in allergies
  • Weight gain
  • Hair loss or thinning, head, pubic, or whole body; increase in facial hair
  • Dizziness, light-headedness, episodes of loss of balance
  • Changes in body odor
  • Electric shock sensation under the skin and in the head
  • Tingling in the extremities
  • Gum problems, increased bleeding
  • Burning tongue, burning roof of mouth, bad taste in mouth, change in breath odor
  • Osteoporosis
  • Changes in fingernails: softer, crack or break easier
  • Tinnitus: ringing in ears, bells, 'whooshing' buzzing etc

Causes, and risk factors of Menopause

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause) and you have not had a period for 1 year, you are no longer at risk of becoming pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. The ovaries make less of these hormones over time. The specific symptoms and how significant (mild, moderate, or severe) they are varies from woman to woman.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. Hot flashes and sweats are at their worst for the first 1 - 2 years. Menopause may last 5 or more years.

Estrogen levels may drop suddenly after some medical treatments, as is seen when the ovaries are removed surgically (called surgical menopause). Chemotherapy and anti-estrogen treatment for breast cancer are other examples. Symptoms can be more severe and start more suddenly in these circumstances.

As a result of the fall in hormone levels, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue thins. This is called atrophy of the labia.

Treatment for Menopause


Take practical steps to deal with hot flushes, by keeping cool and avoiding possible triggers such as spicy food, caffeine, smoking or stress.

Hormone replacement therapy

Hormone replacement therapy (HRT) replaces some of the hormones that are reduced during and after the menopause. It usually includes a combination of oestrogen and progesterone, rather than just oestrogen. This is because taking oestrogen on its own increases the risk of cancer in the lining of the womb. You can have oestrogen-only HRT if you have had an operation to remove your womb (a hysterectomy).

Combined HRT (oestrogen and progesterone) comes in tablets, patches, skin gels and implants. Vaginal creams, pessaries or a vaginal ring may be helpful for vaginal problems such as dryness. You normally take HRT for two to three years. Symptoms can come back in some women for a short time after stopping HRT.

HRT can have side-effects, including tender breasts, heavier periods, water retention, weight gain, depression, feeling sick and headaches. Changing the type and dose of HRT may reduce the side-effects. You can ask your GP for more information and advice on different forms of HRT.

The long-term benefits of HRT are a reduced risk of osteoporosis, and, for combined HRT, a reduced risk of colorectal cancer. Other benefits include:

  • relief from hot flushes and night sweats
  • it may improve sleep by reducing night sweats
  • relief of vaginal dryness and urine infections
  • maintenance of vaginal muscle tone, which may help to reduce urinary incontinence

Taking HRT for a long time may slightly increase the risk of developing certain conditions, including:

  • breast cancer
  • endometrial cancer (cancer of the lining of the womb) or ovarian cancer when you take oestrogen-only HRT
  • a blood clot in your leg vein (deep vein thrombosis)
  • gallstones
  • stroke and possibly heart disease

Talk to your GP to help you weigh up the benefits and risks of taking HRT. For most women, the benefits outweigh the risks.

Complications of Menopause

Several chronic medical conditions can develop after menopause:

  • Cardiovascular disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men.
  • Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women are especially susceptible to fractures of their hips, wrists and spine.
  • Urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). Strengthening pelvic floor muscles with Kegel exercises or using a topical vaginal estrogen may help relieve symptoms of incontinence.
  • Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.

Prevention of Menopause

Menopause may not be preventable but most of unpleasant symptoms which can be related to menopause are permanent cessation of menstruation and end of fertility may be accompanied by hot flashes, mood swings, vaginal dryness, increased abdominal fat, urinary incontinence, loss of breast fullness and sleeping disorders which can seriously affect a woman’s quality of life. The good thing about it is that you do not have to put up with these unpleasant symptoms which may start before reaching menopause. Regular exercise helps prevent as well as relieve several menopausal complaints including hot flashes, sleeping disorders, weight gain as well as relieve stress. Aim for at least 30 minutes of moderate exercise most days of the week if having your doctor’s consent. In addition, regular exercise also helps prevent a large number of diseases such as diabetes, osteoporosis and heart disease risk of which typically increases after menopause.

Eat a healthy diet which bases on lots of fresh fruits and vegetables, whole grains and other nutritious foods which promote overall health and well-being. Avoid foods high in fat and sugar and make sure you obtain the recommended amounts of calcium and vitamin D through diet. Consult with your doctor about dietary supplements if you believe you not obtain the required amounts of calcium, vitamin D or other essential nutrients through diet. However, keep in mind that dietary supplements cannot replace a healthy diet. Learn stress management techniques to reduce the harmful impacts of stress. If you smoke you should seriously consider giving up this unhealthy habit. Besides increasing the risk of cardiovascular disease tobacco can also result in earlier onset of menopause and increase the hot flashes. If already experiencing symptoms of menopause and finding no relief in lifestyle changes consult with your health care provider about the available treatments as well as about potential risks.

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