Menopause (更年期, 停經) is a natural part of ageing but is often considered a taboo subject. Not many women are willing to talk about it openly, knowing what to do or where to seek help. Several women deal with menopause in silence, believing they must "live with it".
To shed some light on this topic, we cover the most common questions about menopause in this blog.
Menopause is when a woman stops having periods and can no longer get pregnant naturally.¹ It is diagnosed after you have gone 12 months without a menstrual period.² When a woman reaches the age of 45 to 55, her ovaries produce less oestrogen and progesterone, which will affect the monthly thickening, sloughing and discharge of the endometrium. Menstruation will become irregular in timing and account.³
Menopause is a natural biological process. Physical and emotional symptoms such as hot flashes (hot flushes) may lower energy, disrupt sleep, or affect emotional health.² Menopause can also cause weight gain. For most women, medical treatment is not needed for menopause.⁴
Men experience menopause too. To know more about “male menopause”, read here.
Menopause can occur between 45 and 55 years of age. Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a woman’s last period. In Hong Kong, the average age of menopause recorded is 51.⁵
Natural menopause, which happens without medical intervention, occurs in three stages:⁶
During perimenopause, menstrual periods become irregular. You may completely skip one or more periods or may be late. Menstrual flow may also become lighter or heavier. Menopause is defined as the lack of menstruation for one full year. Postmenopause refers to the years after menopause has occurred, a phase that lasts for the rest of a woman’s life.⁴
Symptoms of menopause usually start a few months or years before your period stops, during perimenopause. It can also persist for some time afterwards. On average, most symptoms last around 4 years from your last period.⁷ Symptoms include:⁸
Menopause can also increase your risk of developing some other issues such as weak bones (osteoporosis).⁷ Talk to your doctor about how to best manage menopause.
Perimenopausal symptoms can last four years on average. The symptoms associated with perimenopause will gradually ease during menopausal and postmenopausal stages. Hot flashes are a common symptom of perimenopause.⁶ Research has found that moderate to severe hot flashes could continue past perimenopause and last for a median of 10.2 years.⁹
There are different causes of menopause, which includes:²
As you age, your ovaries will start producing less progesterone and oestrogen (hormones that regulate menstruation) and fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent until eventually, the ovaries stop releasing eggs and period stops.
Around 1% of women experience menopause before 40 years old. This may result from the failure of your ovaries to produce normal levels or reproductive hormones known as primary ovarian insufficiency. This can stem from genetic factors or auto-immune diseases. For those affected, hormone therapy is typically used at least until the natural age of menopause to protect the brain, heart, and bone functions.
As your ovaries produce hormones that regulate the menstrual cycle, surgery to remove your ovaries causes immediate menopause. Your period stops, and you are more likely to have hot flashes and experience other menopausal symptoms and signs. These can be severe, as hormonal changes occur abruptly rather than gradually over several years.
Hysterectomy (surgery that removes your uterus, and not ovaries) usually does not cause immediate menopause. Although you no longer experience periods, your ovaries produce oestrogen and progesterone and release eggs.
Cancer therapies can induce menopause, causing menopausal symptoms during or shortly after the course of treatment. The stop of menstruation and fertility is not always permanent following chemotherapy as such, birth control measures should still be used. Radiation therapy only affects ovarian function if the radiation is directed at the ovaries. Radiation therapy to other parts of the body will not cause menopause.
Read the information here to know how menopause can be diagnosed.
As the tissues of your urethra and vagina lose elasticity, you may experience strong, sudden, frequent urges to urinate, followed by the loss of urine with coughing, laughing, lifting or an involuntary loss of urine. You may also experience urinary tract infections more often.²
This condition causes the bones to become weak and brittle, 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 with osteoporosis are especially susceptible to fractures of their spine, hips, and wrists.²
When your oestrogen levels decline, your risk of cardiovascular disease increases. Heart disease risk rises for everyone as they age, but for women, symptoms can become more evident after the onset of menopause. More than one in three female adults has some form of cardiovascular disease. An overall increase in heart attacks among women is seen about 10 years after menopause.¹⁰
Many women gain weight during the menopausal transition and after menopause because metabolism slows.²
Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity.²
Many of the symptoms and signs associated with menopause are temporary. Steps can be taken to help reduce or prevent their effects:²
Menopause does not require any medical treatment. Treatment focuses on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with ageing. These treatments include:²
Before deciding on any treatment, talk to your doctor about your options and the risks and benefits involved.