World Menopause Day is held every year on the 18th October. The day is important for raising awareness of the menopause and the support available for boosting health and wellbeing.
Menopause usually occurs between the ages of 45 and 55, and affects anyone who menstruates.¹ Women, some transgender men, non-binary people and intersex people may all experience menopause.
In physiological terms, menopause happens because of a decrease in the ovaries’ production of oestrogen and progesterone.
Because oestrogen and progesterone are responsible for regulating bone production and absorption, a drop in these hormones can predispose postmenopausal women to an increased risk of osteoporosis.
You can get a good idea of when you might go through the menopause by looking at your family history. You’ll likely experience it at a similar age to when your mother or older sisters did.
Some factors will influence the start of the menopause, such as pregnancy history, BMI and whether or not you smoke.
Premenopause is the time between a person’s first period and the onset of perimenopause. A person who is premenopausal will be experiencing no symptoms of the menopause.
Although there are no noticeable changes in the body during premenopause, hormones will be starting to shift.
Perimenopause literally means ‘around menopause’. It’s marked by the onset of menopausal symptoms, such as changes to menstrual pattern, mood swings and hot flushes. On average, this stage starts in the late 40s and lasts around four years.
Perimenopause ends and the menopause begins when menstruation has not occurred for 12 consecutive months. The average age for this in the UK is 51.²
The menopause often lasts between seven and 14 years, with symptoms persisting throughout this stage.³
At the end of the menopause symptoms begin to ease, marking the beginning of postmenopause.
Once you reach postmenopause you will remain at this stage for the rest of your life.
Menopause can occur before the age of 45 – known as early menopause. Menopause before the age of 40 is called premature menopause, or premature ovarian insufficiency (POI).
There are many different reasons for experiencing early menopause, including certain surgeries, such as a hysterectomy,⁴ or undergoing cancer treatment.⁵
Rates of premature menopause have been found to be significantly higher in both identical and fraternal twins, with about 5% of twins reaching menopause before the age of 40, although the reason for this is unknown.⁶
The hormonal fluctuations that occur prior to and during the menopause can cause a number of unpleasant symptoms. These include:
Irregular periods. Changes to your menstrual pattern are one of the most noticeable signs of perimenopause. You may experience changes to your bleeding pattern or changes in the symptoms leading up to your period.
Hot flushes. Oestrogen has a regulating effect on body temperature. With loss of regulation, which occurs when oestrogen levels drop, hot flushes occur.
Sleep disturbances. When oestrogen is low, the time it takes to fall asleep and the number of times you wake up during the night increases, decreasing total time asleep.⁷ Failure to regulate body temperature can also cause night sweats, having a further effect on quality of sleep.
Change in emotions. Drops in both oestrogen and progesterone can lead to irritability and mood swings.
Weight gain. Hormonal shifts trigger metabolic changes in the body. It’s common for muscle mass to decrease, so fewer calories are burned throughout the day. In this case, more fat is stored, often around the midsection.⁸
Life doesn’t have to be put on hold because of the menopause. There are a lot of things you can do to manage symptoms, including adopting a healthy lifestyle, and trying out treatments that can rebalance your hormones.
Hormone replacement therapy (HRT) treats symptoms of the menopause by replacing oestrogen and progesterone. This can also keep your bones healthy, reducing the risk of osteoporosis and preventing fractures.⁹
There are a few different options available when it comes to HRT.
HRT can contain oestrogen, progesterone, or both, and can be taken or used in different ways – tablets, patches, gel, spray or vaginal rings, pessaries or creams.¹⁰
The HRT option that’s best for you will depend on different factors, such as what stage of the menopause you are at, whether you have had a hysterectomy and ultimately, your personal preference.
If you have had a hysterectomy to remove your womb, you can take oestrogen-only HRT; those with a womb still intact will be offered HRT with both oestrogen and progesterone.
It’s important to be well-informed to make the best choice for you and understand that, in most cases, HRT is very safe and using it to treat menopausal symptoms greatly outweighs any risks.
HRT causes breast cancer
Taking oestrogen-only HRT is associated with no change to breast cancer risk; in some cases, oestrogen-only HRT can actually reduce the risk of developing breast cancer.¹¹
Combined HRT is associated with an increased risk, but this is extremely low in both medical and statistical terms, at only one extra case of breast cancer in every 1,000 women per year. This risk is so low that other modifiable factors such as whether you smoke, drink alcohol or are overweight are likely to have more of any effect.¹²
After you stop taking HRT, the risk of breast cancer returns to the level before you started treatment.¹³ If you are under 51, there is no increased risk from taking any type of HRT.
HRT causes weight gain
Women have a tendency to gain weight as they age, but there is no evidence to suggest that HRT is at blame for this. Weight gain is likely to occur due to other factors such as a reduction in physical activity and the menopause itself.¹⁴
HRT causes heart attack and stroke
Under the age of 60, the benefits of HRT usually outweigh any risks in most women.
There is a slight increased risk of heart disease if you start taking HRT over the age of 60, which is why it is best to start HRT as soon as you experience symptoms of the menopause.¹⁵ Overall risk will also be influenced by other factors, such as whether you smoke or if you are overweight.
Oestrogen-only HRT is associated with a lower heart disease risk when compared to not taking any HRT at all, displaying a protective effect.
HRT causes blood clots
HRT tablets can increase the risk of blood clots, but the risk is still very low.
HRT in the form of patches, sprays and gels do not increase the risk of blood clots, as oestrogen is safer when absorbed into your body through the skin.¹⁶
If you are at risk of blood clots, you will usually be offered patches, spray or gels rather than tablets.
You should wait until your menopause symptoms are unbearable before starting HRT
When it comes to deciding when to start taking HRT, the choice is entirely yours. It is not necessary to wait until your symptoms are severe, or until your periods stop entirely.
If you have any symptoms of menopause that are impacting you, talk to your GP.
HRT only delays the menopause
Some believe that HRT just presses pause on their symptoms, and worry that once they stop taking it the symptoms will come back with a bite. But this isn’t true.
HRT simply treats the symptoms of the menopause, rather than stopping it all together.
If your body was going to experience menopause symptoms for 8 years, and you take HRT for 6, you will probably experience 2 more years of symptoms if you stop taking HRT. So instead of delaying symptoms, you’ve avoided them all together.¹⁷
You no longer need contraception if you’re taking HRT
HRT is not a contraceptive and there is still a possibility of conception while taking it.
Most guidelines recommend that women continue to use some form of contraception until the age of 55, when it can be assumed they are naturally infertile.¹⁸
Calcium supplements are more effective than HRT at protecting against fractures
Many studies have found that HRT is extremely effective in combating osteoporosis and repairing bone loss, reducing risk of fracture by 50%.¹⁹ The oestrogen in HRT promotes new bone growth, which helps keep bones stronger for longer.
While it is important to have a balanced diet, evidence for calcium supplements preventing fracture is not as strong as that for HRT.²⁰
If you have any questions or are interested in HRT, make sure to talk to your doctor or GP to see whether HRT is right for you.
Do you have experience of taking HRT, or have you opted for a different remedy for your symptoms? We’d love to hear from you.
Sharing real life stories is a great way of raising awareness this World Menopause Day.
Get in touch.
Learn more about the links between menopause and osteoporosis in our guide.