Menopause is a natural biological process that marks the end of a woman’s menstrual cycles and reproductive years.
Although it is a normal part of ageing, the transition can bring physical, emotional and psychological changes that may affect everyday life.
Despite its prevalence, menopause remains surrounded by misconceptions, with some women experiencing symptoms in silence because of embarrassment, limited information or difficulty accessing appropriate healthcare.
Health experts emphasise that understanding menopause is essential to helping women recognize its symptoms, make informed decisions about treatment and seek medical attention when necessary.
What is menopause?
Menopause occurs when a woman has gone 12 consecutive months without a menstrual period, provided the absence of menstruation is not explained by another medical condition or treatment.
According to standard medical definitions, menopause commonly occurs between the ages of 45 and 55, although the timing varies from woman to woman.
The process is associated with declining ovarian function and reduced production of hormones, particularly oestrogen and progesterone.
These hormonal changes eventually end ovulation and menstruation.
Menopause is not a disease, nor does it mean that a woman is suddenly unhealthy or unable to enjoy an active life.
However, the hormonal changes associated with it can cause symptoms that range from mild discomfort to problems requiring medical treatment.
What are the stages of menopause?
Menopause generally involves three stages.
Perimenopause: This is the transition leading up to menopause. Hormone levels fluctuate, periods may become irregular, and symptoms such as hot flashes, sleep disturbances and mood changes may begin. It can last several years.
Menopause: This is confirmed after 12 consecutive months without a menstrual period, when other causes have been excluded.
Postmenopause: This refers to the years following menopause. Some symptoms, including hot flashes and vaginal dryness, may continue for years, while the long-term effects of reduced oestrogen become increasingly important to bone and cardiovascular health.
What causes menopause?
The most common cause is the natural decline in ovarian function as women age. As the ovaries produce less oestrogen and progesterone, menstrual cycles become irregular before eventually stopping.
However, menopause can also occur earlier for other reasons.
Surgical removal of both ovaries causes immediate surgical menopause. Certain cancer treatments, including chemotherapy and pelvic radiation, can damage ovarian function and trigger early or treatment-related menopause.
Some women experience premature ovarian insufficiency, in which the ovaries stop functioning normally before age 40.
This condition is different from typical age-related menopause and requires medical assessment.
Smoking and some other factors may influence the timing of menopause, although the experience varies widely among individuals.
What are the common symptoms?
Menopause symptoms differ considerably. Some women experience few noticeable changes, while others find that symptoms interfere with work, relationships and sleep.
Common symptoms include:
- Hot flashes and night sweats: Sudden feelings of heat, sweating and flushing that may occur during the day or night.
- Irregular periods: Menstrual cycles may become shorter, longer, heavier or lighter before stopping.
- Sleep problems: Difficulty falling or staying asleep, sometimes worsened by night sweats.
- Mood changes: Irritability, anxiety, low mood or emotional fluctuations.
- Vaginal dryness: Reduced lubrication and discomfort or pain during sexual intercourse.
- Changes in sexual desire: Libido may increase, decrease or remain unchanged.
- Urinary symptoms: Increased urgency, discomfort or recurrent urinary tract infections may occur.
- Concentration difficulties: Some women report forgetfulness or difficulty concentrating, sometimes described as brain fog.
- Joint aches and changes in body composition: Muscle and joint discomfort and changes in fat distribution may occur during midlife.
These symptoms are not exclusive to menopause. Persistent fatigue, severe mood changes, unusual bleeding or other concerning symptoms should be evaluated by a healthcare professional rather than automatically attributed to hormonal changes.
How is menopause diagnosed?
For women aged 45 and above with typical symptoms and changes in menstruation, healthcare professionals can often identify menopause from a medical history and symptoms without extensive testing.
Hormone tests are not routinely necessary in these cases because hormone levels fluctuate during perimenopause. Testing may be considered for younger women, suspected premature menopause or situations in which the diagnosis is uncertain.
Any bleeding after menopause should be assessed promptly, as it may indicate a condition requiring investigation.
