Patient information from BMJ

Menopause: what is it?

Last published:Apr 12, 2021

The menopause is when your periods stop for good. It isn't an illness but a normal part of every woman's life. However, sometimes it causes symptoms that can be distressing. You can get symptoms of the menopause for several years. But there are some treatments that might help.

What happens in the menopause?

Your doctor will say you have gone through the menopause when you haven't had a period for 12 months in a row.

You can get symptoms of the menopause long before your periods stop for good. This is because the changes in your body that lead to the menopause start much earlier, even as early as 10 years before your last period.

As you approach the menopause your ovaries make less of two important hormones: oestrogen and progesterone. In the years before you reach the menopause you might notice that your periods aren't as regular as they once were.

This is often one of the first signs that your hormone levels are changing. It usually begins in your 40s and it can last for several years.

Eventually your ovaries make so little oestrogen and progesterone that your menstrual cycle and your periods stop completely. This is the menopause.

You can’t get pregnant once your periods have stopped for good. But you should still use contraception until you have not had a period for 12 months, just to be sure that your periods have stopped completely.

Most women will go through their menopause between the ages of 45 and 55, but some have an early menopause. Doctors say a woman has an early menopause when it happens before she is 40.

Some women still have periods even when they're over 55. These women are said to have a late menopause. Having a late menopause usually runs in families, but it can also happen if you are overweight.

What are the symptoms?

Some women don’t have any problems when they go through the menopause. But most women get at least one symptom. The severity of these symptoms can vary between mild and very distressing.

Some symptoms, such as hot flushes, are caused directly by changes in your hormones. But other changes might be affected by other things going on in your life.

For example, you might find it hard when your children leave home, or you might have to look after elderly parents. Things like this can make the changes that the menopause brings harder to deal with.

Irregular periods can be an early sign of the menopause. You might find your periods are lighter than before, or heavier. They might last longer, or just a few days, and they might be more or less frequent.

All of these things are normal. But if you have very heavy periods (needing to change pads or tampons every hour) or if you get bleeding after sex or ‘spotting’ mid-cycle, see your doctor.

These are common symptoms of the menopause:

• Hot flushes, where you suddenly feel hot and might go red in the face. They might be mild, or bad enough to wake you at night. Some women find that hot flushes can be triggered by caffeine, spicy foods, hot drinks, or alcohol.

• Night sweats, usually caused by hot flushes at night. But night sweats can be caused by other things, like an infection, so see your doctor if you get them.

• Symptoms caused by the lining of your vagina becoming drier and thinner during the menopause. This can cause itching and make sex painful.

• Losing interest in sex.

• Problems sleeping. You might find it hard to get to sleep, wake up because of hot flushes, or wake up very early and be unable to get back to sleep.

• Putting on weight and other physical changes, such as a loss of muscle tone and increased fat around your middle. Doctors don’t know if this is because of hormone changes or just part of getting older.

• Feeling low or depressed, or having mood swings. These negative feelings can include being irritable, anxious, panicky, and forgetful.

Your doctor will usually be able to tell from your symptoms and your age whether you are going through the menopause. But if you are younger than 40 you might need a blood test (called the FSH test) to find out for sure.

What will happen to me?

Women experience the menopause in different ways. You might sail through the menopause with few problems or you might have severe symptoms that affect your quality of life.

Your experience of the menopause might depend on what else is going on in your life. You might find it more difficult to cope with if you're under stress for other reasons.

Your feelings about this time in your life will affect how you experience the menopause. Some women see the menopause as a positive step in moving on to the next stage of life. Other women feel anxious or depressed about the physical changes.

Some women choose to take hormone replacement therapy (HRT) to help with menopausal symptoms. Many women find this helpful but it can cause side effects. For more information see our leaflet Menopause: should I take HRT?

Once you have been through the menopause it’s important to look after your health, especially to keep your bones strong and look after your heart. You can do this by:

• eating a balanced diet with plenty of fruit and vegetables and plenty of calcium (found in dairy products)

• limiting alcohol to moderate levels

• maintaining a healthy weight

• not smoking

• doing regular exercise, including weight-bearing exercise like walking or jogging.