In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

Menopause

Hormone replacement therapy (HRT) is used to reduce the symptoms of menopause, which is a natural part of ageing for women. Menopause happens when your ovaries stop releasing eggs as a result of falling levels of oestrogen. This reduction in oestrogen causes the symptoms usually associated with menopause.

About the menopause 

Menopause happens when your ovaries stop producing eggs, leading to a drop in blood oestrogen levels. This fall in hormone levels disrupts your menstrual cycle and produces the other symptoms associated with menopause.

When does the menopause happen? 

Menopause usually happens gradually. For a few years before menopause, your periods may become longer, shorter or irregular, happening more or less often than they used to. There may be a change in the amount of bleeding, which may become lighter, although slightly heavier periods are more common.

If you’ve started noticing these changes or other menopause symptoms (see Symptoms of menopause), you are said to be perimenopausal. Perimenopause can last for several years and in most women starts between 45 and 47 years of age.

You’re considered to be through the menopause, or postmenopausal, when it's been a year since your last period.

Surgery that removes the ovaries causes immediate menopause. Surgery to remove the womb (hysterectomy), some types of radiotherapy and some types of chemotherapy can also result in early menopause.

When menopause happens before the age of 45, it's considered premature (early) menopause. See your GP for advice if you’re under 45 and you begin to get menopause symptoms. Women who smoke go through the menopause an average of two years early.

You can still become pregnant while going through the menopause. You should keep using contraception for one year after your last period if you're over 50, and for two years after your last period if you're under 50.

Symptoms of menopause 

Although some women have no symptoms other than the ending of their periods, eight in 10 women experience menopause symptoms. These may be worse if your menopause happens suddenly rather than gradually, for example after surgery. They can include:

  • Hot flushes and night sweats, sometimes associated with feeling faint or feeling your heart thumping fast (palpitations) - eight in 10 women experience flushes, most commonly in the first year after the last period
  • Vaginal changes, such as dryness and loss of tone
  • Mood changes such as irritability, depression or anxiety, although these may be due to life changes rather than the menopause itself
  • Difficulty sleeping due to night sweats or mood changes
  • Loss of interest in sex (libido), related to vaginal changes, sleep problems or mood changes
  • Headaches
  • Urinary changes – you may find you have reduced control of urination (incontinence) around the time of the menopause, but this is more likely to be caused by being overweight or by having had children in the past, especially if you have had more than one baby.

The reduced levels of hormones can increase the risk of various health problems in the long term. These include:

  • Osteoporosis (loss of bone density) – bones become brittle and break more easily
  • Heart disease, increasing the risk of having a heart attack
  • Stroke
  • Weakness of the pelvic floor and vaginal muscles.

Keeping healthy during menopause 

Physical activity

Regular exercise can help improve some symptoms of the menopause, including hot flushes and night sweats, difficulty sleeping and mood changes.

Physical activity that stresses the bones, such as running and walking, can help your bones to become stronger, slowing down the loss of bone density. Physical activity can also help protect against heart disease and stroke.

According to Australia’s National Physical Activity Guidelines, everyone should aim for at least 30 minutes of moderate-intensity exercise five or more days of the week. Get your heart rate up — go at a pace that’s comfortable enough to talk, but not to sing. You can even break up your 30 minutes into two or three separate 10-15 minute sessions, whatever works best for you.

You should also build and maintain your muscle strength with regular weight resistance exercises. The Go for your life program recommends two to three sessions a week, lasting up to an hour. This can also be broken up into smaller sessions.

Check with your GP if you’re starting a new exercise program of if you haven’t exercised for a while. They can help make sure the activity is appropriate for you.

Diet

A healthy diet can help protect your body against some of the long-term effects of the menopause. Your diet should include around 1300mg of calcium per day, which helps keep bones strong and reduces the risk of osteoporosis. You can get this from milk and dairy products, tinned fish with bones such as sardines and salmon, tofu, almonds and leafy green vegetables.

Eating too much food containing vitamin A may increase your risk of osteoporosis. High levels of vitamin A are found in liver and liver products such as pate, so only have these once a week, or eat small portions.

You’re more likely to gain weight around your waist as you get older. Gaining weight puts you at a higher risk of heart disease so it's important that you try to keep at a healthy weight for your height.

Vitamin D

Vitamin D is important for bone health. It’s produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. Many Australians have low vitamin D levels so looking after your vitamin D intake is important.

For your body to make enough of its own vitamin D, it’s important that your hands, face and arms (or an equivalent area of skin) are exposed to some sunlight on most days. However this must be balanced against the risk of sunburn and skin cancer. Deliberate sun exposure during the hours of 11am to 3pm during summer is not recommended. You only need a few minutes of exposure before 10am or after 3pm, as this is outside the peak UV radiation period so it’s safe to leave your hat and sunscreen off for the few minutes you need.

During winter, if you live in the southern parts of Australia where UV radiation levels are less intense, you may need around two to three hours of sunlight over a week to get the vitamin D you need. But if you live in the northern parts of Australia, you can do the same as you would in summer to maintain adequate vitamin D levels.

Although vitamin D is found in small quantities in a few foods it’s unlikely Australians can gain enough vitamin D from diet alone. Therefore a vitamin D supplement of at least 400 IU (10 micrograms) per day is recommended if adequate safe sun exposure isn’t possible.

Ask your pharmacist or GP for advice if you have questions about vitamin D supplements. Also, talk to your GP before taking vitamin D supplements if you’re taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Treatment of menopause

Self-help

Take practical steps to deal with hot flushes by keeping cool and avoiding possible triggers such as spicy food, caffeine, smoking and 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’ve had an operation to remove your womb (a hysterectomy).

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

For more information about HRT, click here.

Other medicines

Other treatment options include:

  • prescription medicines for hot flushes and night sweats
  • vaginal lubricants or prescription medicines containing testosterone for loss of libido and vaginal dryness
  • prescription medicines or counselling for mood disturbances. Your GP may recommend counselling or antidepressant medicines. HRT is not recommended if depression, anxiety or other mood disturbances are your only menopause symptoms.

Complementary therapies

There isn't enough evidence for doctors to recommend taking phytoestrogens (naturally occurring oestrogen-like compounds found in plants), but some studies have found that one type, called isoflavone, may reduce hot flushes. However, there may be an increased risk of endometrial cancer. Dietary sources of phytoestrogens include roasted soy beans, soy milk, tofu and miso.

There’s little evidence to show that herbal remedies such as black cohosh, angelica and evening primrose oil work. Herbal remedies are medicines and, like all medicines, they can have side-effects and interact with other medicines. For example, black cohosh can damage the liver. There is no regulation of herbal medicines, so you can't be sure how much of the active ingredient it contains. Ask your GP or pharmacist for advice if you decide to try any herbal treatments.

Other complementary therapies that promote relaxation, exercise, and wellbeing (such as aromatherapy, acupuncture, yoga and reflexology) may help reduce symptoms in some women.

Further information 

Australian Menopause Society
http://www.menopause.org.au/
The Jean Hailes Foundation for Women’s Health: Managing Menopause
www.managingmenopause.org.au

Sources 

Australian Menopause Society. What is menopause? [online] Buderim, QLD: Australian Menopause Society. July 2010 [Accessed 12 Jul 2011] Available from: http://www.menopause.org.au/images/stories/infosheets/docs/What_is_menopause.pdf (PDF, 127Kb)

Burbos N Morris EP. Menopausal symptoms. Clinical Evidence. 2010; 2: 804-836.

Clinical Knowledge Summaries. Menopause. [online] London: National Institutes for Health and Clinical Excellence. 2007 [last updated Dec 2010, accessed 13 Jul 2011] Available from: http://www.cks.nhs.uk/menopause

Department of Health and Ageing. Physical activity guidelines. [online] Canberra, ACT: Commonwealth of Australia. 2005. [Accessed 9 Jul 2011] Available from:  http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines

Go for your life. Strength training is for over 50s too. [online] Melbourne, VIC: Department of Human Services. 2008 [accessed 13 Jul 2011] Available from: http://www.goforyourlife.vic.gov.au/

Institute for Clinical Systems Improvement (ICSI). Healthcare guideline: menopause and hormone therapy (HT): collaborative decision-making and management. 9th ed. [online] Bloomington, MN: ICSI. 2008 [Accessed 13 Jul 2011] Available from: https://www.icsi.org/

The Jean Hailes Foundation for Women’s Health. Fact Sheet: Menopause. [online] Clayton South, VIC: The Jean Hailes Foundation for Women’s Health. c2011 [Last updated Nov 2010, accessed 12 Jul 2011] Available from: http://www.managingmenopause.org.au/images/stories/Education/Documents/info/menopause.pdf (PDF, 255Kb)

Kellett E Smith A Schmerlaib Y. The Australian Guide to Healthy Eating. [online] Canberra, ACT: Commonwealth of Australia. 1998 [accessed 9 Jul 2011] Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-guide-index.htm

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Management of menopause. [online] East Melbourne, VIC: RANZCOG. 2008 [Last updated Jun 2011, accessed 14 Jul 2011] Available from: http://www.ranzcog.edu.au

Simon C Everitt H Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press. 2005: 732.

Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. MJA. 2005; 182: 281–285.

Last published: 30 July 2011

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

Bupa Australia Pty Ltd makes no warranties or representations regarding the completeness or accuracy of the information. Bupa Australia is not liable for any loss or damage you suffer arising out of the use of or reliance on the information. Except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health. For more details on how we produce our health content, visit the About our health information page.