Menopause - is there an upside?

Menopause is a natural part of every woman’s life. However, it's a subject often not spoken about, and it can feel confusing or even overwhelming without the right information. Whether you’re approaching it, in the middle of it, or supporting someone who is, understanding the changes in a woman's body, the symptoms to look out for, and the treatment options available can make a big difference.

What Is Menopause?

Menopause marks the end of a woman’s menstrual cycle and fertility. It is the time in a woman's life when the monthly menstrual cycle stops. The monthly menstrual cycle is a process that a woman's body goes through to prepare for a possible pregnancy. Each month, hormones cause the lining of the uterus or womb to thicken with extra blood and tissue. An egg is released from one of the woman's ovaries, called ovulation. If the egg isn't fertilised by sperm, the body sheds that extra uterine lining through the vagina, which is menstruation bleeding or a period. This cycle typically begins during puberty, usually between ages 10-16, though it can start earlier or later. Once started, the cycle generally repeats approximately every 21-35 days until menopause.

Menopause is officially diagnosed when a woman has gone 12 months without a period. Most women experience menopause between ages 45 and 55, with the average age being 51. Before menopause comes perimenopause, a transition phase that can last several years. Hormone levels fluctuate, causing irregular periods and various symptoms. After menopause, a woman enters postmenopause, when symptoms may ease but certain long-term health risks increase due to lower estrogen levels.

How does menopause work?

Over time, a woman's ovaries gradually produce less estrogen and progesterone. These are the two main hormones involved in reproduction. These hormones don’t just control the menstrual cycle, they also affect the brain, heart, bones, skin, and other parts of the body.

When a woman's hormone levels decline:

• Ovulation stops

• Menstruation ends

• The body adjusts to lower hormone levels, triggering various physical and emotional changes.

What are the common symptoms of menopause?

Each woman can experience different and varying symptoms associated with menopause. They can range from mild to severe and may last for several years. However, some of the most common symptoms are:

• Hot flashes – sudden feelings of heat, often with sweating and flushing  

• Night sweats – hot flashes that happen during sleep  

• Irregular periods – cycles may become shorter, longer, lighter, or heavier  

• Sleep disturbances – difficulty falling or staying asleep  

• Mood swings – anxiety, irritability, or depression  

• Brain fog – trouble with memory, focus, and concentration  

• Vaginal dryness – leading to discomfort or pain during sex  

• Low libido – reduced interest in sex  

• Weight gain – especially around the abdomen  

• Thinning hair and dry skin.

Are there health risks associated with menopause?

Because estrogen supports many body systems, lower levels can increase the risk of certain health conditions. These include:

• Heart disease - estrogen protects blood vessels and cholesterol levels. After menopause, the risk of heart attack and stroke increases.

• Osteoporosis - lower estrogen leads to bone loss. Women can lose up to 20% of bone density in the five to seven years after menopause, increasing the risk of fractures.

• Urogenital issues - thinning of vaginal and urinary tract tissues can lead to; vaginal dryness and pain during sex, increased risk of urinary tract infections (UTIs) and urinary urgency or leakage.

• Possible cognitive changes  - emerging research suggests menopause may be linked to an increased risk of memory problems and even Alzheimer’s disease, though the connection is still being studied.

Are there any benefits?

It’s not all negative! Menopause has its upsides too:

• No more periods or birth control - women can experience the freedom from monthly bleeding, premenstrual symptoms and worrying about contraception. This can be a major relief.

• Relief from hormone driven conditions - issues like endometriosis, fibroids, or hormonal migraines can improve and even disappear.

• Greater emotional stability - without monthly hormone changes, women can feel more mentally balanced, focused, and self-assured.

• Increased self confidence - this can be a time of personal growth, freedom from social pressures, and new life goals.

• A Health Reset - menopause can motivate women to prioritise health, fitness, and mental well-being.

This sounds like a lot. Is there any therapies available to support women through this journey?

One commonly used hormone based therapy available is Hormone Replacement Therapy (HRT). HRT provides estrogen (and sometimes progesterone) to relieve menopause symptoms and reduce long-term risks like bone loss. It’s one of the most effective treatments for moderate to severe symptoms.

HRT can help women by:

• Reducing hot flashes, night sweats, and mood swings  

• Improving sleep, libido, and vaginal health  

• Helping prevent bone loss and osteoporosis  

• Supporting skin elasticity and joint health.

Are there any risks associated with HPT? According to the Women’s Health Initiative (WHI) study, risks may include; slightly increased risk of breast cancer (mostly with combined therapy) and higher risk of blood clots, stroke, or heart disease in some women - especially if started after age 60.

HRT can be a great options for women who are experiencing moderate to severe symptoms of menopause, who are generally under 60 years old, generally healthy and low bone density. However, HRT may not be the most suitable option for women who have suffered with breast or uterine cancer, have a history of stroke, blood clots or heart attacks, or have untreated blood pressure or liver disease, and there are non-hormonal options available, such as:

• Changes in lifestyle - exercise, healthy eating, and stress reduction  

• Antidepressants or other medications for hot flashes and mood  

• Cognitive behavioural therapy (CBT) for sleep or anxiety  

• Vaginal moisturisers and lubricants  

• Calcium and vitamin D for bone health.

Menopause - the beginning of a new age

Menopause is not a disease. It’s a normal, natural part of life. It can bring challenges, but it also offers a chance to reset, reflect, and embrace a new stage of life. Whether you manage symptoms with lifestyle changes, hormone therapy, or a combination of approaches, the most important thing is to be informed and supported.

Every woman’s experience is unique, and there is no one-size-fits-all solution. Talk to your healthcare provider to find what works best for you.

References:

1. Hillard, P. J. A. (2018). Menstruation in adolescents: what's normal? The Medscape Journal of Medicine, 20(1), 426.

2. American College of Obstetricians and Gynecologists. (2022). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Committee Opinion No. 651.

3. Reed, B. G., & Carr, B. R. (2023). The normal menstrual cycle and the control of ovulation. In K. R. Feingold et al. (Eds.), Endotext. MDText.com, Inc.Nelson, H.D. (2008). Menopause. The Lancet, 371(9614), 760–770. 

4. Rosano, G.M.C., et al. (2007). J Am Coll Cardiol, 50(5), 477–485.  

5. Kanis, J.A., et al. (2008). Osteoporosis International, 19(4), 399–428.  

6. Bachmann, G.A., et al. (2005). Obstetrics & Gynecology, 106(5), 1079–1085.  

7. Mosconi, L., et al. (2021). Scientific Reports, 11, 10867.  

8. Women’s Health Initiative. (2002). JAMA, 288(3), 321–333.

Assessed and Endorsed by the MedReport Medical Review Board