What are the possible symptoms and problems of the menopause?

Short-term symptoms

These short-term
symptoms only last for a few months for most women. However, for some
women they can continue for a few years after their last period:

• Hot flushes
  occur in about 3 in 4 women. A typical hot flush lasts a few minutes
  and causes flushing of your face, neck and chest. You may also perspire
  (sweat) during a hot flush. Some women become giddy, weak, or feel sick
  during a hot flush. Some women also develop palpitations and feelings
  of anxiety during a hot flush. The number of hot flushes can vary from
  every now and then, to fifteen or more a day. Hot flushes tend to start
  just before the menopause, and typically persist for 2-3 years.
• Sweats commonly occur when in bed at night. In some cases
  they are so severe that sleep is disturbed and you need to change your
  bedding and night clothes.
• Other symptoms may develop such as headaches, tiredness,
  being irritable, difficulty sleeping, depression, anxiety, aches and
  pains, loss of libido (sex drive), and feelings of not coping as well
  as before. It can be difficult to say whether these symptoms are due to
  the hormone changes of the menopause. For example, you may not sleep
  well or become irritable because you have frequent hot flushes,
  and not directly because of a low oestrogen level. Also, there may be
  other reasons why these other symptoms develop. For example, depression
  is common in women in their 'middle years' for various reasons.
• Changes to your periods. The time between periods may
  shorten in some women around the menopause; in others, periods may
  become further apart, perhaps many months apart. It is also common for
  your periods to become a little heavier around the time of the
  menopause.

Longer term changes and problems

• Skin and hair. You tend to lose some skin protein (collagen) after the menopause. This makes the skin drier, thinner and more likely to itch.
• Genital area. Lack of oestrogen tends to cause the tissues
  in and around the vagina to become thinner and drier. These changes can
  take months or years to develop.
  • The vagina may shrink a little, and expand less easily during sex. You may experience some pain when you have sex.
  • Your vulva (the skin next to your vagina) may become thin, dry, and itchy.
  • Some women develop problems with recurrent urine infections.

Osteoporosis after the menopause

As you
become older, you gradually lose bone tissue. The bones become less
dense and less strong. The amount of bone loss can vary. If you have a
lot of bone loss, then you have osteoporosis. If you have osteoporosis
you have bones that will break more easily than normal, especially if
you have an injury such as a fall.

Women lose bone tissue more
rapidly than men especially after the menopause when the level of
oestrogen falls. Oestrogen helps to protect against bone loss. By the
age of 70 some women have lost 30% of their bone material. In the UK,
about half of women over the age of 50 will fracture a bone, many as a
result of osteoporosis.

However, not all women develop
osteoporosis after the menopause. Osteoporosis is more likely to
develop if you have, or have had, one or more 'risk factors'. The
following situations are risk factors for developing bone loss and
osteoporosis. If you:

• Had your menopause before the age of 45.
• Have already had a bone fracture after a minor fall or bump.
• Have a strong family history of osteoporosis.
• Have a body mass index (BMI) of 19 or less. (That is, you are very
  underweight.) For example, if you have anorexia nervosa. In this
  situation the level of oestrogen is often low for long periods of time
  and, combined with a poor diet, can affect the bones.
• Have a time when your periods stop for a year or more before the time of your menopause. This can happen for various reasons.
• Have taken, or are taking, a steroid medicine (such as
  prednisolone) for three months or more. A side-effect of steroids is to
  cause bone loss.
• Smoke.
• Lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight).
• Have never taken regular exercise, or have led a sedentary lifestyle (particularly during your teenage years).
• Have, or had, certain medical conditions that can affect the bones.
  For example, an overactive thyroid gland, Cushing's disease, or
  anything that causes poor mobility.

Cardiovascular disease after the menopause

Your
risk of cardiovascular disease (disease of the heart and blood
vessels), including heart disease and stroke, increases after the
menopause. Again, this is because the protective effect of oestrogen is
lost. Oestrogen is thought to help protect your blood vessels against
atheroma (small fatty lumps that develop within the inside lining of
blood vessels). Atheroma is involved in the development of heart
disease and stroke. After the menopause, your oestrogen levels drop and
part of this protective effect is lost.

Do I need any tests to see if I am going through the menopause?

Your
doctor can usually diagnose the menopause by your typical symptoms.
Hormone blood tests are not usually needed to confirm that you are
going through the menopause. However, they may be helpful in some
cases. For example, if your doctor suspects that you are going through
an early menopause, or if you have had a previous hysterectomy (and so
are no longer having periods).

Do I need treatment for the menopause?

Many
women do not have symptoms severe enough to require treatment. Only
about 1 in 10 women sees a doctor because of her symptoms. Without
treatment, the short-term symptoms discussed above last for 2-5 years
in most women. In some women they may last longer. Hormone replacement
therapy (HRT) is available to ease the symptoms of the menopause. It
has benefits and risks, which are discussed below.

There are
treatments other than HRT for menopausal symptoms. As a rule, they are
not as effective as HRT, but may help relieve some symptoms. (See
separate leaflet called 'Menopause - Alternatives to HRT' for details of menopausal symptom treatments other than HRT, which are not mentioned further here.)