Reaching menopause: What age it happens and how to prepare

Ageing is a natural part of life, but it does come too often on its own, unique timeline. You can never know for sure when that first grey hair might pop up, when you might need to increase that glasses prescription, or when you may start having to take an extra day or two off to recover from a hike or a holiday.

For many women, menopause sits alongside all of those new milestones as an unpredictable part of ageing that sees your body's needs change.

While we can't tell you exactly what age you might experience menopause, we can tell you what we do know to help you prepare to approach menopause, namely what menopause is, what menopause symptoms you may experience, how to manage those symptoms, and when you may expect your menstrual periods to stop and this new chapter of your life to begin.

What is menopause?

The Australasian Menopause Society defines menopause as the final menstrual period a woman experiences. This natural event happens due to a loss of ovarian follicles, follicular development and ovulation, which in turn causes a woman’s ovaries to stop producing estrogen and progesterone, marking the end of a woman’s reproductive years [1].

How it differs from perimenopause

While we tend to think of menopause as an all-encompassing term, the process of menopause itself is actually made up of three distinct phases called perimenopause, natural menopause, and post-menopause.

Perimenopause, also known as the menopause transition, is the first phase of this new life stage, and can take up to ten years. In it, your body starts to slow down its estrogen production, resulting in the symptoms many women associate with menopause more broadly. Hot flashes, night sweats, irregular periods, disturbed sleep and mood changes are all common during perimenopause, but as your body hits menopause, significantly reducing ovarian estrogen levels until your menstrual periods stop permanently, these symptoms of menopause should hopefully start to ease [2].

What causes menopause?

Unfortunately, as with many issues regarding women's health, we don’t know exactly why menopause occurs, just simply that it does. That said, some theories and ongoing studies are investigating this phase of a woman's life, with the most popular one among medical professionals currently being that the ovaries run out of eggs as women age. It’s believed that this is what causes hormone levels to fluctuate in perimenopause, and the body to eventually stop producing ovarian estrogen and progesterone in a process known as primary ovarian insufficiency until the menstrual cycle stops [2].   

The role of hormones and natural ageing

Many parts of the body change as we age, but our endocrine system, otherwise known as the hormonal system, is perhaps where ageing can be seen the most, in no small part because hormonal changes are at the root of menopause and its male counterpart, late-onset hypogonadism.

For women, estrogen and progesterone are vital not just in maintaining women’s reproductive health, but in cardiovascular health, bone health, urinary health, metabolic health and vaginal health, and the reduction of these hormones during menopause and postmenopause can carry with it implications for your broader health.

It’s worth noting, too, that the ovaries aren’t the only hormonal organ that is affected by age. Research has shown that the thyroid, adrenal and pituitary glands are all impacted, and even if hormone production stays steady, receptor sensitivity can decrease, impacting how the hormones are able to be used. In other words, hormonal factors can impact ageing, just as ageing can impact your hormonal status, which can have a big effect on important organs' functioning and how your body works [3].

What is the average age of menopause?

Most women enter the menopausal transition between the ages of 45 and 55, with the average age of menopause being about 51 years of age [1]. That said, some women reach menopause earlier or later than others.

Early and late menopause explained

While most women will experience menopause in their mid-40s to mid-50s, some may experience it at an older or younger age, with early menopause being considered before the age of 40. There are several reasons why you might experience early or premature menopause, but it generally occurs when the ovary has been through trauma. This can be caused by the surgical removal of your ovaries, surgery near your ovaries, or as a result of chemotherapy or radiation therapy, although sometimes genetic factors can come into play. If you have any concerns about early or late menopause, you should speak to a medical professional [1].

What happens in the lead-up to menopause?

As your body moves towards natural menopause, your hormones will start to fluctuate in a process known as perimenopause. This phase is really defined by irregular menstrual cycles and irregular bleeding, so you may find yourself with a really heavy period one month, and only spotting six or eight weeks later, as well as the symptoms many associate with this phase in a woman’s life. So, in answering the question of how menopause affects you, there is an answer.

Common symptoms and signs of transition

Just as with a woman’s menstrual cycle, menopause does tend to be different for everyone depending on genetics, lifestyle and family history, but there are common symptoms that many women share to varying degrees of severity that can help you to identify if you’ve begun your menopausal transition.

These common menopause symptoms include:

• Hot flushes and night sweats
• Sleep disturbances, such as trouble getting to sleep or conditions that disrupt sleep, such as insomnia
• Headaches
• Sudden feeling of muscle and joint aches
• Vaginal dryness leading to painful sexual intercourse
• Sore breasts
• Skin changes
• Weight gain or bloating
• Mood changes
• Tiredness
• Forgetfulness
• Brain fog or difficulty concentrating [1, 4]

It's important to note that if you're still taking birth control or taking hormones, these can mask these and other symptoms of menopause. If you are of a menopausal age, talking to your doctor about precautions is recommended.

How is menopause diagnosed?

Menopause is a clinical diagnosis. In other words, it’ll be diagnosed by your doctor based on your symptoms and changes in your menstrual cycle, with some doctors using a symptom score card to determine which ones you might have, and whether treatment might be helpful to ease any common physical symptoms or address your emotional health [1].

How is menopause treated?

There are many ways menopause and menopausal symptoms can be treated that range from simple healthy lifestyle changes, such as eating a balanced diet and drinking more water, doing more physical activity and keeping a hand fan on you for any hot flushes, to medical treatments and natural therapies designed to support you through this life transition [4].  

Hormonal and non-hormonal treatment options

If you’re experiencing severe menopausal symptoms, your doctor may recommend a treatment such as menopausal hormone therapy. This is a medication that contains estrogen, progesterone and sometimes testosterone, and has been found to help decrease the symptoms of menopause that may be causing you pain or discomfort. It’s often recommended in particular for women who are experiencing early or premature menopause, as they are at an increased risk of long-term health conditions [5].

Hormone replacement therapy has been found to have risks, though, which is important to consider when weighing treatment options [6]. If you have any genetic predispositions, you may want to consider other, non-hormonal treatments such as:

• Non-hormonal prescription medications to reduce hot flushes, sweating or manage any emotional symptoms
• Cognitive behavioural therapy
• Acupuncture
• Yoga and exercise
• Over-the-counter medication, such as anti-nausea medication or melatonin
• Herbal therapies [5]

Can menopause be prevented or delayed?

As menopause is a natural life stage reached at the typical age of 51, it cannot be prevented or delayed. As an older woman, your last menstrual period will at some point occur, and understanding it to manage any emotional or physical symptoms is the best way to ensure minimal impact on your life.

What are the possible complications of menopause?

The hormonal fluctuations and eventual loss of ovarian estrogen can lead to both physical and cognitive complications, particularly if you are younger than 40 years of age at menopause. In particular, early menopause has been linked to several health risk factors, making it vital to monitor with a healthcare professional [7].

Health risks linked to low oestrogen

Regardless of whether you’re experiencing menopause early, late or right on-time though, certain health risks have been linked to low oestrogen levels that every post-menopausal woman faces. In particular, low estrogen has been found to impact:

• The cardiovascular system. Some studies have shown that estrogen supports heart health and cardiovascular function, making the loss of it during menopause risky business when it comes to heart health.
• The urinary system. In some cases, low levels of estrogen have been found to cause a thinning of the urethral lining, which, paired with weaker pelvic muscles, can lead to poor bladder control, urinary tract infections, and other urogynecological health issues in menopausal women.
• The metabolic system. Lower levels of estrogen have also been found to lower your metabolic rate, which causes your body to store fat instead of burning it. This can lead to weight gain that’s hard to lose.
• The skeletal system. There is a direct relationship between the lack of estrogen after menopause and bone density loss, with postmenopausal women as a result having a higher risk of developing osteoporosis.
• The vagina. As estrogen is what helps keep your vagina lubricated, losing it during menopause can cause you to dry out, resulting in pain during sexual activity. It can also lead to an increase in urinary tract infections or atrophic vaginitis [8].

When to see a doctor

You should see your doctor if your menopausal symptoms are causing you pain or distress, impacting your emotions, affecting your sleep, if you have any underlying health condition or medical history that may put you at risk for further complications, or if you're a younger woman under the age of 40 who thinks they may be experiencing menopause at an early age.

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