What is menopause?
Menopause marks the end of a woman's menstrual cycles, and is diagnosed after 12 months without a period. Typically occurring between 45 and 55 years of age, it can bring on various symptoms due to hormonal changes, like hot flushes, mood swings, and sleep disturbances.
1 in 100 women under the age of 40 and 1 in 1000 woman under the age of 30 will go into menopause. This is known as premature menopause or POI.
Perimenopause is the transition phase leading up to menopause, with large surges and dips of oestrogen, resulting in a wide variety of symptoms. It can start up to 10 years before menopause, so often in our early 40's. A significant proportion of women present with mental health issues first i.e. increased anxiety, irritability, low mood, brain fog, memory problems, reduced self-esteem and even increased ADHD symptoms.
In the most straightforward terms, menopause is the result of our ovaries gradually shutting down and shrinking, leading to a lifelong hormonal deficiency of three important hormones: oestrogen, progesterone, and testosterone.
This hormonal deficiency carries significant long-term health implications. It's important to remember that menopause is something we enter into, not a phase we go through. Once we are menopausal, we will be in menopause for the rest of our lives.
Isn't menopause natural?
Although Homo sapiens have lived on Earth for approximately 200,000 years, up until a century ago, only 5% of women lived beyond their 50th birthday. With such a brief lifespan, menopause wasn't even a consideration for most women.
In today's era of modern medicine and improved living conditions, our lifespan has markedly improved. In Australia today, the average life expectancy of women is 83 years. That means that the majority of women will spend about 40% of their lives in menopause.
Living longer comes with its own set of challenges, including the natural process of ageing and an increased risk of chronic diseases, such as cardiovascular disease, osteoporosis, diabetes, dementia and arthritis. For women, the cessation of ovarian hormone production after menopause plays a pivotal role in these processes.
So, while menopause is a natural phase, it's important to note that natural doesn't always equate to beneficial when it comes to our health.
There is a concern that we might 'overmedicalise' menopause. However, only 13% of postmenopausal Australian women are on HRT, despite 80% of women experiencing symptoms, 50% of those describing them as significant.
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Women are more likely to be referred to a cardiologist for their palpitations, a urologist for recurrent UTIs, a psychiatrist for anxiety and depression, a rheumatologist for joint pains and a gastroenterologist for heartburn than started on HRT- a treatment that may have resolved all of these symptoms.
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So in reality, we are overmedicalising menopause already, but the reason is the inability for health practitioners to consider menopause as the cause, and this is where the change really needs to happen.
Does menopause need to be treated?
The decision to treat menopause is a very individual one.
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Some women will sail through the transition without so much as a hot flush. Others might suffer for years, or even decades, with symptoms such as debilitating anxiety, night sweats, vaginal dryness, loss of confidence, loss of libido and a significant decrease in their quality of life. As a result, some women decide to reduce their working hours, or have to give up work altogether. Every year in Australia alone, menopause costs women $17 billion in lost income and superannuation.
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Apart from symptom control, the long term effects of menopause and future health also need to be considered. The lack of oestrogen, progesterone and testosterone after menopause increase a woman's risk of many chronic conditions such as osteoporosis, cardiovascular disease, dementia, osteoarthritis and type 2 diabetes.
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Women with premature ovarian insufficiency should be offered HRT until at least the age of 52 as they are at increased risk of osteoporosis and heart conditions.
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I encourage all women to do their own research in regards to whether treatment of menopause, particularly with HRT, is right for them. Studies have shown, (even the Women's Health Initiative), that for the majority of women, HRT is safe and effective, and any small risk is far outweighed by the benefits.
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Regardless of the decision to take HRT or not, all women can benefit from a healthy lifestyle, high fibre diet and regular exercise.
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Where to start...
I understand that this journey can be overwhelming, and sometimes it's hard to know where to start or go for the right information.
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I recommend the following podcast episode to all my patients for a great overview:
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The Imperfects: Dr Louise Newson- Maybe it's Menopause
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Download the free balance app and track your symptoms.
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Go to FAQs for answers to the most commonly asked questions and visit the Resources page for recommended books, podcasts, videos and more.
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Knowledge is power and the more we educate ourselves, the more we can advocate for ourselves. Find a doctor who will listen and discuss the choices that are right for you.
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Disclaimer: The information provided here is for general informational purposes only and is not intended as a substitute for professional medical advice. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition.