Signs of Menopause: An Overview to Menopause Symptoms

The menopause is inevitable with the average age being in the early 50s. However, this can range from the 30-60 years dependant on the individual. The symptoms of the menopause can vary across the ages as well. Below we list the first signs of menopause, menopausal symptoms and what you can expect.

What is the menopause?

The menopause is a time in every woman's life when you stop experiencing periods. It is the first sign that means it is highly unlikely you'll fall pregnant naturally from this point on, however, it's important to note that this is still possible and you should not have unprotected sex.

Signs of the menopause usually begin during your 50s with the average age span in the UK being between 45-55 years with the first menopausal-related symptom being unpredictable menstrual bleeds. The average age in the UK is 51 years. That being said, it is not uncommon for the menopause to begin outside these times. This includes approximately 1 in 100 women that will experience early menopause (also known as premature menopause) before the age of 40 years. There is also the time leading up to the menopause, that is otherwise known as perimenopause, where you begin to experience the symptoms of menopause but at a lower severity.

There is a lot of negativity when it comes to the menopause but not experiencing periods anymore can be extremely liberating, especially if you've had troublesome periods in the past. However, some women find menopausal symptoms to be particularly difficult, which is why so much guidance and help is on offer.

On this page, we look at the signs of the menopause, symptoms related to the menopause and how to obtain treatment if needed.

Stages of the menopause

Perimenopause is different to early menopause. Perimenopause is simply the time running up to the menopause. So you may find symptoms are mild and infrequent, giving you an indication that the menopause is approaching. Then you'll go into the menopause for a number of years. In the latter stages of the transition, the symptoms will begin to ease again. This final stage is called postmenopause.

First signs of menopause

There can be some early symptoms that are a strong indication you're transitioning towards the menopause. At this point, you are going through the perimenopause phase where you need to see a doctor to talk about the next steps.

The first sign that the menopause is approaching is a change to your periods. This could be a difference in flow or the frequency. You will know your cycle and what has changed.

The perimenopause can take place over a number of years leading up to the menopause. This can be up to 10 years, or a few months, it's all dependant on the individual. You can still fall pregnant during time even though ovulation is unpredictable. If you wish to become pregnant, speak to your doctor about your options. If you don't, continue to stay protected using condoms that also significantly reduce the chances of you getting a sexually transmitted infection (STI).

Symptoms of menopause

It is common for women to experience symptoms of the menopause before going through the transition, as referred to as 'perimenopause'.

It's difficult to predict what level of symptom severity you will experience as every woman is different. Some women can go through the menopause with no unmanageable symptoms at all, others may find it only lasts a couple of years. Whatever your scenario, inform your doctor and research options to make this time as easy as possible.

The symptoms of perimenopause can include:

  • Hot flushes – sudden bursts of heat often around the face and neck
  • Night sweats
  • Irregular periods
  • Mood changes – anxiety, sadness or anger are common
  • Sleeplessness (fatigue)
  • Difficulty sleeping
  • Lack of interest in sex (low libido)
  • Breast tenderness
  • Vaginal dryness
  • Intensified PMS
  • Hair loss
  • Urinary incontinence
  • Lack of concentration and memory difficulties

Symptoms of the menopause are similar to perimenopause but can be stronger in severity and longer in length. The main symptom is the changes to your period. This does make them unpredictable. Other menopausal symptoms include the following.

Physical changes of the menopause

  • Hot flushes – sudden bursts of heat often around the face and neck
  • Night sweats
  • Irregular periods
  • Sleeplessness (fatigue)
  • Difficulty sleeping
  • Pain during sex
  • Breast tenderness/pain
  • Vaginal dryness
  • Intensified PMS
  • Hair loss
  • Urinary incontinence
  • Urge to urinate more frequently
  • Headaches
  • Dizziness
  • Heart palpitations
  • Issues with joints – stiffness and aches
  • Brittle nails
  • Issues with bones (osteoporosis)
  • Weight gain
  • Recurrent UTIs (i.e. cystitis)

Psychological changes of the menopause

  • Mood changes – anxiety, sadness or anger are common
  • Lack of interest in sex (low libido)
  • Lack of concentration and memory difficulties
  • Mood swings and tantrums
  • Loss of memory
  • Panic disorder

These symptoms are very common with an estimated 8 out of 10 women experiencing additional signs other than the change in periods, according to the NHS. If you're not in the lucky 20% that remain nearly symptom-free during the menopause, there is help available from your doctor and treatment options.

Dr Hilary Jones Independent Medical Adviser

Still not sure? Take our free consultation to find the right treatment for you.

Start Free Consultation

The menopause and osteoporosis

Osteoporosis is a condition that causes the bones to become much more fragile, resulting in breaks and fractures as well as other discomforts. The most common fractures are in the wrist, hips and spine.

If the menopause begins early (classed as below 45 years), you have had your womb removed (hysterectomy) or you haven't experienced your period in a number of months, this increases the risk of osteoporosis.

The menopause and osteoporosis are linked because oestrogen is essential in keeping your bone strong and healthy. Once there's a dip in hormone levels, this will subsequently affect the bones.

Other long-term symptoms of menopause

The risk of heart disease and Alzheimer's disease is higher once going through the menopause. You may find your bladder and bowel takes longer to recover if that was a prominent symptom for you, skin can lose its elasticity causing more wrinkles and you find it more difficult to build muscle. The differences in vision can remain after the menopause; this includes cataracts and macular degeneration.

Causes of the menopause

The menopause is caused by the drop in oestrogen, the female hormone naturally produced by the body. This decline of oestrogen causes an imbalance, which is what we know more commonly as the menopause. This is a natural process of growing older that all women will go through, typically in their 50s.

The oestrogen drops because your ovaries aren't producing and releasing an egg every single month. This is why many women find that the first symptom of the menopause is infrequent and unpredictable menstrual bleeds.

As the menopause is a naturally occurring condition, a cause is often not determined unless there's anything unusual about the situation (for example, it is early).

If you would like an indication as to when you may start the menopause, genetics is the best option. Enquire with your mother and grandmothers about their transition, and gain first-hand knowledge on how to best manage the menopause yourself.

Causes of early menopause

It is much easier to establish a cause other than genetics if you're experiencing symptoms of early menopause. Early menopause happens to a surprising number of women in the UK and there may be an underlying reason. Here are some of the conditions that increase the likelihood of early menopause.

Genetics

If your mother experienced the menopause early, you may follow suit. A family history is a good predictor of menopause. In addition, if there are none of the following reasons below that attribute to you, it's likely that genetics have been the cause.

Defects to the chromosome

Turner syndrome causes the ovaries to malfunction. It is, therefore, more likely to experience the menopause earlier in life. Other chromosome conditions include trisomy 13 and trisomy 18, meaning there are extra chromosome than required, which can lead to early menopause as well as infertility.

Smoking

A study in the BMJ discovered that women who had smoked for over 10 years were more likely to have menopause 1-2 years earlier than if they had not smoked. This includes women who inhaled secondhand smoke.

Smoke damages body cells and contributes to unhealthy body issues such as high blood pressure and the risk of cancer. If you're a regular or occasional smoker it's best to quit for good.

Autoimmune diseases

Autoimmune disease is when the immune system attacks the body damaging its tissue, bones, organs and skin, so it's no surprise it can attack the ovaries and reproductive system too.

Rheumatoid arthritis is linked to early menopause, as is scleroderma and connective tissue disease. A study of 18,000 women from Sweden showed that women with early menopause were twice as likely to develop rheumatoid arthritis.

Premature ovarian failure

Ovaries and the female productive system is associated with oestrogen - as the female sex hormone – however, the ovaries do also contain progesterone. Any drastic changes in these levels can stop eggs from being produced, prompting premature menopause. If the issue is rectified, this can stop menopausal symptoms.

Low economic status

A study showed that women from poorer backgrounds were 80% more likely to experience early menopause. This was attributed to the connection between the immune system and stress, being overweight or diabetic, and a lack of good nutrition.

Being underweight

Women who are extremely underweight can experience an early menopause. Very underweight women, such as those suffering from anorexia, find their periods stop altogether. This is not strictly the menopause but the body's reaction to a low body mass. However, if you're consistently under 18.5 on the BMI scale your menopause may arrive earlier.

Epilepsy

It's not known why but women with epilepsy may experience premature menopause. A study of epileptics found 14% had early menopause compared to the general 1% of the population. It may be to do with lower oestrogen levels but studies continue to confirm this is the case.

Excessive alcohol

Drinking alcohol excessively can interfere with menstruation to the extent that periods stop. This is likely due to an inadequate diet and malnutrition issues because heavy drinkers often lack necessary vitamins, mineral and fibre to keep the body healthy.

Heavy drinking can affect reproductive hormones. Even women who think their drinking is not excessive may find their menopause arrives earlier. A study by the Harvard Medical School found early menopause occurred in social drinkers consuming 3 drinks per day.

Chemotherapy

Chemo is invasive and can damage ovarian follicles. If this happens it is known as medical menopause. 70-90% of women over 40 who undergo chemotherapy have menopause following their treatment and up to 40% of under 40s. Younger women may find their periods stop during treatment but may return afterwards, but you're at further risk of experiencing an early menopause.

Surgery

Another medical-related menopause cause is surgery that removes the ovaries. Endometriosis, cysts and cancer are reasons some women have their ovaries removed and the menopause will begin instantly in these cases.

Surgery of the uterus that does not remove the ovaries won't cause menopause. If a small amount of ovary can be saved, this may be enough to prevent menopause.

Fragile X Syndrome

Fragile X syndrome is a genetic disorder that causes learning and mental disabilities and it can lead to earlier menopause. Some women with no symptoms may carry the genes and it's thought 1 in 250 women carry the permutation. It raises the risk of early menopause by 20%.

The menopause due to cancer

It is not the type of cancer that causes early menopause but rather the treatment that was undertaken. Chemotherapy and other forms of radiation treatment for cancer can affect the ovaries. This includes surgery to remove the ovaries if cancer/tumour directly affects that area; radiotherapy to the pelvis; some hormone therapy; and as mentioned, chemotherapy.

If you're experiencing the menopause due to treatment related to cancer, it is possible that your symptoms will be more heightened than if it naturally occurred.

Severity of menopausal symptoms

Many of the symptoms of the menopause are well-known and dreaded by most women, however, over 50% don't find the symptoms to be troublesome at all. The list for menopausal symptoms is long but this doesn't mean you're going to experience every single one, and at a level that highly affects your day-to-day life.

How long will the menopause last for?

The average length for the menopause is approximately 4 years. Again, this is just an average figure and it's said that 1 in 10 women experience menopausal symptoms for up to 12 years.

Why am I getting these symptoms?

There is a complex balance of hormones in our bodies, for both men and women. For women, the menstrual cycle is due to the hormone oestrogen. The menopause causes a drop in oestrogen, which in turn is what causes the symptoms of the perimenopause and menopause.

When is the menopause diagnosed?

Menopause is medically diagnosed when a woman has gone a year without experiencing periods. When your periods' end, it means that your supply of egg-producing follicles has ceased and it's unlikely you'll be able to conceive. Menopause happens to all women, but that doesn't mean it's easy or you have to put up with the symptoms.

If you're experiencing periods but these are irregular and/or unpredictable or reducing in numbers, it's time to visit the GP. Based on this and other symptoms you may have will give your doctor a good indication if the menopause has begun. Sometimes a blood test may be required to confirm diagnosis.

Treating the menopause

Many women choose to use additional medication to help ease symptoms that are otherwise causing a detrimental effect on their day-to-day lives.

A familiar type of treatment is the prescription medication 'Hormone Replacement Therapy (HRT)'. This is available in tablets and patches that contain oestrogen (often synthetic versions) that help to replenish a lot of the hormone that has lost during the transition. Women who have a hysterectomy can also use certain types of HRT.

Whilst there are some risks to the treatment, the pros often outweigh the cons. When first considering hormone replacement therapy, it's important to visit your GP to discuss your options. The main types of HRT are combined (containing oestrogen and progestogen) and oestrogen-only HRT for women who have had a hysterectomy.

Dr Hilary Jones Independent Medical Adviser

Still not sure? Take our free consultation to find the right treatment for you.

Start Free Consultation

For a small number of women, HRT is not suitable but there are other options you may be recommended such as antidepressants and some high blood pressure medications. In terms of HealthExpress, we only offer a range of HRT and this must have been recommended by a doctor in-person before you can repeatedly order online.

Another form of medication is the combined contraceptive pill for women with early menopause. Again, your doctor will need to advise which form of treatment is best suited for you.

Another form of treatment specifically use for symptoms of a dry vagina and discomfort during sex is vaginal lubricants and moisturisers. You may want to research types of lube designed for menopausal women, or an over-the-counter method may work for you.

How to relieve the symptoms of menopause

Stopping the process of the menopause is impossible, but that doesn't mean you need to put up with the symptoms, especially if they're causing you distress. As well as HRT and vaginal lubricants, there are self-help techniques and other therapies that can help you transition smoothly. This includes keeping yourself cool and relaxed.

Lifestyle changes

  • Keep cool with light cotton clothing and cold water to hand. Running your wrists underneath a cool tap can also help.
  • Minimise night sweats by keeping a fan on in your room, thin cotton bed sheets and placing your pillows in the fridge.
  • Avoid triggers that make you warm like spicy food and hot drinks, warm environments and alcohol.
  • Avoiding triggers that cause emotional discomfort also apply. Altering your work commute, job, group of friends or anything else causing additional stress is advised, whether you're going through the menopause or not.
  • Alter negative lifestyle choices such as quitting smoking, getting a regular exercise regimen, limiting alcohol and adhering to a healthy diet. You may also wish to limit caffeine.

Menopausal Therapies

If you're experiencing many changes in your mood, including depression, anxiety and anger, discovering meditative practices can be beneficial. This includes meditation itself but can also stem to general relaxation techniques, yoga and Pilates. Of course, getting plenty of rest is a simple but effective method as well.

  • Self-mediating – Meditation doesn't need to require specialised help and resources. There are free phone apps and practises you can try yourself.
  • Deep breathing – Leading on from meditation, focusing purely on our breathing can help you relax. Both meditation and deep breathing only requires 5-10 minutes per day.
  • Smile and laugh – Positive thoughts and feelings boosts endorphins (the feel-good hormone) and lowers cortisol (stress hormone).
  • Listening to music – Ambient forms of music including electronic, classical or sound effects can lower stress levels, but you can also have a time out with your favourite album, whatever the genre.
  • Creating a calm atmosphere – Your bedroom is the perfect place to create your personal sanctuary. This should always be the place for relaxing. Include candles, scents to promote relaxation (i.e. lavender), soft lighting and comfortable bed sheets.
  • Exercise – Yoga and Pilates are the obvious exercise choice to relieve stress and anxiety, however, all forms of exercise can lower stress levels and promote feel-good endorphins.
  • Hobbies - Craft-related hobbies help concentration, distract your mind and keep you calm. If you're not particularly arty, cooking, sports and any other hobby will help to reduce stress.
  • Visualisation – Along the same line as meditation, visualisation is imagining a peaceful scenario and placing yourself within in. Take it one step further and incorporate aspects of the visualisation into your surroundings such as wall hangings, sound effect CDs and scented candles.
  • Do something you love – Taking time out to read your favourite book, have a bath, organise a trip or continue with a hobby can be the perfect way to unwind.

Some women find acupuncture to be a suitable release for menopausal symptoms. In terms of physical symptoms of the menopause, pelvic floor exercises can help to strengthen the vaginal area to ease urinary incontinence and the urge to urinate frequently.

Self-help for osteoporosis

HRT can give you an influx of oestrogen to help the condition, and there are some things you can alter in your lifestyle that may help too.

  • Healthier Lifestyle – Increasing or partaking in an exercise regime, improving your diet, quitting smoking and cutting down on alcohol. The NHS recommends resistance style exercises to help strengthen bones. Changes to diet includes the usual fruits and vegetables, but including more calcium-filled items can help too.
  • Vitamin D - Calcium supplements are also available, and vitamin D supplements may also help. For vitamin D, extra sunlight is recommended.

Monitoring your menopause

Once your treatment plan has been agreed, you can continue taking treatment unless symptoms subside. Rather than visiting the doctor every time, you can order this online. However, it is imperative that you do visit your doctor in-person periodically to check the HRT is still working for you. When first using HRT, your doctor will advise a catch-up within a first 3-4 months. If everything is fine from here, you often will not need to see your doctor in-person for another 12 months.

HRT medication needs to be monitored to ensure it's working (symptoms are minimising and/or disappearing), if there are any side effects, the status of your periods (Are you still bleeding? What is the frequency?), to change treatment if necessary and stopping treatment when the menopause ends.

Dr Hilary Jones Independent Medical Adviser

Still not sure? Take our free consultation to find the right treatment for you.

Start Free Consultation
Sources: