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Menopause: The stages, symptoms, and solutions.

Coined the ‘change of life’, menopause is a normal and natural transition in life that marks the end of a woman’s reproductive years. No more premenstrual tension. No more periods. And no more pregnancies. Despite its inevitability, menopause can be a mysterious and daunting time that can trigger profound changes in women. From hot flashes to hormone replacement therapy, here’s what you need to know to ease the transition.

What is menopause?

Menopause is diagnosed when a woman has not had a menstrual period for twelve months. Her ovaries no longer release eggs and they cease to produce oestrogen and progesterone that control menstruation. The average age of natural menopause is 51. ‘Premature menopause’ is when the final menstrual period occurs before a woman is 40. ‘Early menopause’ is when the final menstrual period occurs before a woman is 45.

What are the different stages of menopause?

There are three stages to natural menopause: perimenopause, menopause, and postmenopause.

Perimenopause (the menopause transition) is often confused with menopause. In fact, it’s the 3-to-5 year time period leading up to menopause. During this time the ovaries gradually produce less oestrogen. In the last 1-2 years of perimenopause, oestrogen levels drop significantly. It is at this stage that you might experience menopause symptoms - both emotional and physical - ranging from mild to severe.

Menopause marks the monumental moment when you have gone without a menstrual period for 12 consecutive months. The ovaries have stopped releasing eggs and producing most of their oestrogen.

Once in menopause and on into postmenopause (the years that follow menopause), the symptoms may continue for an average of 4-5 years, though they decrease in frequency and intensity.

What are the symptoms?

During perimenopause, you might experience a wide range of symptoms at varying levels. These include:

Irregular menstrual periods, lower fertility, vaginal dryness, dry skin, hot flashes, night sweats, sleep problems, heart palpitations, joint aches, emotional distress, cognitive symptoms, changes in weight, and low confidence.

Apart from periods and fertility issues, which come to an end at menopause, symptoms may continue up to four years postmenopause.

It's important to remember every woman is unique and will experience menopause differently.

What are the solutions?

The good news is that there are multiple ways to reduce and relieve many of the troublesome symptoms associated with menopause.

Sources of relief include:

Hormone Replacement Therapy (HRT), low-dose birth control pills, low doses of anti-depressants, non-hormonal medications, acupuncture, herbal supplements, exercise, meditation, and nutrition changes.

What is Hormone Replacement Therapy?

HRT replaces the oestrogen and progesterone hormones that your body is no longer producing due to menopause.

There are multiple types of HRT that fall under two categories: Estrogen Therapy and Combined Therapy.

Estrogen Therapy

Whilst it’s the drop off in oestrogen that triggers most of the menopause symptoms, taking the hormone on its own can increase the risk of endometrial cancer (uterine cancer). Estrogen Therapy is therefore only recommended if you have had a hysterectomy. Oestrogen can be given in the form of daily pills, skin patches, a vaginal ring, gels, creams, or sprays.

Combined Therapy

Combining oestrogen with progestogen reduces the risk of endometrial cancer in women who have a uterus. HRT uses a synthetic version of progesterone called progestogen, which is easier for the body to absorb. Progestin may come in the form of pills, skin patches, vaginal creams and vaginal suppositories.

Cyclical HRT is recommended during perimenopause when you still have your periods. How often you’re advised to take oestrogen and progestin will depend on the regularity of your menstrual periods. Continuous Combined HRT is recommended if you are postmenopausal. This means taking oestrogen and progestin every day.

HRT is not an option if you have a history of breast cancer, ovarian cancer, endometrial cancer or blood clots. It is also not suitable if you have untreated high blood pressure, liver disease, or you are pregnant or think you are pregnant.

In these circumstances, alternatives to HRT will be recommended instead.

What are the pros and cons of HRT?

HRT is believed to be the most effective treatment for the majority of menopausal symptoms.

Furthermore, it reduces the risk of various chronic conditions that affect postmenopausal women, including diabetes, osteoporosis, bowel cancer and cardiovascular disease.

However, during the early stages of treatment, and depending on the type and dose of HRT, you may experience side effects, including:

Vaginal bleeding, bloating, breast swelling and tenderness, headaches, mood changes and nausea.

HRT can also increase the risk of blood clots (when given in tablet form) and breast cancer (when some types are used long-term).

For the short-term treatment of symptoms of menopause, the benefits of HRT are considered to outweigh the risks. For the majority of women who use HRT the lowest effective dose for the shortest duration of time are a welcomed respite from the bothersome symptoms of menopause.

Women wishing to start HRT should carefully discuss the benefits and risks of treatment with our gynaecologist to see what is right for them, taking into account their age, medical history, risk factors and personal preferences.

To learn more about menopause or to make an appointment with our gynaecologist, please call 2715 4577 or email


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