What is the menopause?

Technically, ‘menopause’ is when you’ve gone at least a year with no menstrual bleeding.¹ But the word ‘menopause’ is often used to describe what is – strictly speaking – the perimenopause. This is the period of time leading up to the menopause when levels of the main female hormones (oestrogen and progesterone) start to rise and fall erratically.¹

On average, perimenopause lasts for around four years, although it can go on for up to 12 years for some women.² You’ll likely begin to notice signs of perimenopause in your forties or even your thirties – only 10% of women report that their periods stop suddenly, with no noticeable changes in their cycles beforehand.³ The menopause usually happens between the ages of 45 and 55, while the average age that periods stop in the UK is 51.⁴

It’s because your ovaries’ supply of follicles – needed to make eggs – starts running out.

This starts a cascade of effects: your ovaries become less able to respond to reproductive hormones, like follicle-stimulating hormone (FSH), which means they then stop making oestrogen and progesterone. These are the hormones that regulate menstruation and are needed for fertility, and it’s the lack of these that causes those classic menopause symptoms.⁵ Sometimes, there can be other causes of menopause too, like certain cancer treatments.

Not every woman has significant signs and you may find you barely notice the transition.⁷

A persistent change of seven days or more in the length of your cycle – making it shorter or longer – can indicate you’re in early perimenopause. A stretch of 60 days or more between periods usually happens later in perimenopause. Menstrual changes are caused by ovulation becoming unpredictable as your supply of eggs dwindles.³ 

Hot flushes and night sweats are collectively known as ‘vasomotor symptoms’ and affect between 60 and 85% of women, varying in severity and frequency. They usually last around two years, but for 10% of women, hot flushes can last as long as 15 years.⁹ 

Anxiety and a low mood are more likely to affect women during perimenopause; if you have a history of low moods, you’re likely to experience it now. Changes in hormone levels may affect the neurotransmitters, such as serotonin, that control mood.³

What you can do: self-help measures can ease low moods and anxiety, including yoga, meditation, and regular exercise. Speak to your GP about a course in CBT too. HRT may be useful,⁹ but antidepressants are not recommended as there’s no evidence that they work for low mood associated with menopause. However, some women find herbal remedies, such as St John’s wort or valerian, as a natural menopause relief as they may help low moods or anxiety during the menopause.

Falling oestrogen levels can thin and dry vaginal walls, leaving you prone to infections and making sex feel uncomfortable. You may also experience irritation and soreness, even if you’re not sexually active. On top of this, you may find you have a reduced libido.¹ Stress and relationship problems can contribute to lower sex drive and loss of lubrication, too.¹

What you can do: vaginal dryness can be treated very simply with topical oestrogen, used either as a cream, pessary, or vaginal ring. It can be used on its own or with HRT. Or you could try over-the-counter vaginal moisturisers and lubricants.¹¹

After menopause, a lack of oestrogen means you’re more susceptible to developing osteoporosis and heart disease. You may also find you gain weight, and your skin starts to become dryer. You can support your bone health by upping your calcium and vitamin D intake – the government recommends all post-menopausal women take 10mcg a day – while omega-3 can contribute to the normal function of the cardiovascular system and vitamin C can support your skin.