Menopausal problems

The menopause, the time at which a woman stops menstruating, is a normal consequence of the aging process. More than 8 in 10 women feel well throughout the menopause or experience only mild symptoms, but some women have severe problems that affect their lifestyle.


The onset of the menopause usually occurs between the age of 45 and 55, although some women develop symptoms before or after this time. Smoking can lower the age at which the menopause takes place. A woman is generally considered to be menopausal if she has not had a period for at least 6 months and there is no other underlying cause. The tendency to have either an early or late menopause can run in families.

What are the causes?

As women age, their ovaries gradually become less active and produce smaller amounts of the sex hormone oestrogen. The menopause occurs as a result of this reduction in oestrogen levels. As levels of oestrogen in the body decline, the pituitary gland begins to secrete more follicle-stimulate hormone (FSH) to try to stimulate the ovaries. Most of the symptoms associated with the menopause are a consequence of the reduced levels of oestrogen or increased levels of FSH. These tend to be more severe when the menopause takes place prematurely or abruptly. A sudden menopause can be brought about by surgical removal of the ovaries or anticancer treatments that can damage the ovaries, such as chemotherapy and radiotherapy.

What are the symptoms?

Menopausal symptoms may begin up to 5 years before menstruation finally stops and usually last for a year or two. Many women find that one of the first signs of the menopause is, irregularity in their menstrual cycle. Menstrual bleeding may also become heavier. Increased levels of FSH in the body cause many of the other common symptoms that can occur during the menopause. These include:

- Hot flushes, in which the head, chest, and arms become red and feel hot, lasting from a couple of minutes to as long as an hour.
- Heavy sweating, which is often especially troublesome at night.
- Feelings of anxiety, panic, or depression, which may be made worse if the menopause coincides with a stressful life event such as the departure of adult children from the home.

The longer-term effects of a decline in oestrogen levels include:

- Drying of the skin, which encourages the formation of wrinkles.
- Vaginal dryness and discomfort during sexual intercourse as a result of thinning of the lining of the vagina.
- Urinary infections that occur due to thinning of the lining of the urethra (the passage leading from the bladder to the outside of the body).

The decline in oestrogen levels following the menopause may also increase your risk of developing certain long-term conditions, such as coronary artery disease and age-related thinning of the bones.

What may be done?

Hormone replacement therapy, commonly known as HRT, may help to relieve many of the symptoms that occur at the menopause by boosting the levels of oestrogen in the body and reducing the production of FSH. Your doctor may prescribe HRT as pills, implants under the skin, or skin patches. To achieve maximum benefit, HRT is usually given for at least 5 years. However, long-term use may carry certain risks, which you should discuss with your doctor.

Alternative treatments are available in the form of oestrogen creams, which help to control vaginal dryness and discomfort, and the drug clonidine, which can be used to relieve hot flushes. Some women find complementary therapies, such as homeopathy, helpful.

The process of the menopause normally lasts between 1 and 5 years, after which symptoms usually disappear.