Menopause
There is an old joke that everything that ever goes wrong in the world somehow involves men — and so we arrive at men-o-pause. A time when women may well pause and reconsider many things in life. But in reality, menopause is far more than a play on words.
Menopause is a natural stage in every woman’s life. It is defined as the permanent cessation of menstruation and can only be confirmed retrospectively, once 12 consecutive months have passed without a menstrual period.
The years leading up to this point are known as perimenopause. During this transition, cycles may become irregular, skipped or unpredictable, and symptoms can fluctuate.
The average age of menopause is around 50, although it commonly occurs anywhere between 45 and 55. Some women experience it earlier or later. Menopause before the age of 40 is considered premature and requires further medical evaluation.
Menopause marks the end of natural fertility. For some women, this brings a sense of loss. For others, it brings relief. Emotionally and physically, it can be a significant transition.
What Happens in the Body?
A woman is born with a finite number of eggs (oocytes) in her ovaries. Over time, this number steadily declines. As egg numbers decrease, the ovaries produce less estrogen.
The brain responds by increasing production of Follicle Stimulating Hormone (FSH) in an effort to stimulate the ovaries. When estrogen levels fall and remain low, FSH levels stay persistently elevated. This hormonal pattern is used as a biochemical marker of menopause, particularly in women who no longer have a uterus and cannot rely on menstrual patterns.
Estrogen plays a vital role throughout the body — not only in reproduction, but also in skin health, bone strength, cardiovascular protection, brain function and vaginal tissue integrity. When estrogen levels decline, a wide range of symptoms may occur.
Common Symptoms
Hot Flushes and Night Sweats
About 70–80% of women experience vasomotor symptoms such as hot flushes and night sweats. These occur because hormonal changes affect the body’s temperature regulation centre in the brain. Episodes may last from seconds to several minutes and can disrupt sleep.
For many women, symptoms gradually improve over time. A small percentage experience minimal symptoms, while others may have more persistent challenges.
Skin and Vaginal Changes
Estrogen contributes to skin hydration and elasticity. Reduced levels may lead to thinner, drier skin and increased fine lines.
Vaginal tissues may also become thinner and drier, which can result in discomfort during intercourse. Reduced testosterone levels can contribute to changes in libido. The good news is that effective treatments are available for these symptoms.
Mood and Cognitive Changes
Hormonal fluctuations can influence neurotransmitters in the brain. Some women notice mood changes, irritability, anxiety, reduced concentration or low mood during the transition. Sleep disruption from night sweats can further affect emotional wellbeing.
Bone and Heart Health
Estrogen plays an important protective role in bone density. After menopause, bone loss accelerates, increasing the risk of osteoporosis and fractures.
Cardiovascular risk also rises after menopause. Cholesterol profiles may shift unfavourably, and the long-term risk of heart disease increases. Joint stiffness and aches are also commonly reported.
Menopause Is Not a Disease
Menopause is a natural life stage, not an illness. However, because women are living longer than ever before, understanding its impact on long-term health is important.
It is helpful to reflect on questions such as:
- Are hot flushes or night sweats affecting your sleep?
- Has vaginal dryness made intimacy uncomfortable?
- Have you noticed changes in mood, patience or energy?
- Are joint pains or bone health concerns emerging?
Validated menopause questionnaires can help assess symptom severity and guide management decisions.
To Treat or Not to Treat?
Management is highly individual.
Hormone therapy remains the most effective treatment for moderate to severe menopausal symptoms, particularly hot flushes and vaginal dryness. When prescribed appropriately for healthy women in early menopause, the benefits often outweigh the risks.
Current evidence shows that hormone therapy, when started in women under 60 or within 10 years of menopause onset, can:
- Effectively relieve vasomotor symptoms
- Protect bone density and reduce fracture risk
- Improve vaginal health and sexual function
- Potentially reduce the risk of type 2 diabetes and colorectal cancer
The relationship between hormone therapy and breast cancer is complex and depends on the type of hormones used, duration of therapy and individual risk factors. Combined estrogen-progestogen therapy may slightly increase breast cancer risk with long-term use, while estrogen-only therapy in women without a uterus does not appear to carry the same risk profile. Decisions should always be individualised.
Non-hormonal options are also available for women who cannot or prefer not to use hormones.
The Bigger Picture
Lifestyle remains foundational:
- Regular weight-bearing exercise
- Balanced nutrition
- Adequate calcium and vitamin D
- Smoking cessation
- Moderation with alcohol
- Stress management and sleep care
Menopause represents a transition — not an ending. With the right information and individualised care, it can be navigated confidently and healthily.