The menopause is not a disease. It is the natural milestone that marks the end of a woman’s reproductive years. Officially, we only say a woman has reached the menopause when she has gone 12 consecutive months without a period.
The body’s orchestra
Picture the body as an orchestra. The brain is the conductor and the ovaries are the musicians. With age, the ovaries stop responding and stop producing hormones, mainly oestrogen. Noticing the silence, the conductor starts to “shout”: that is why FSH, the hormone that stimulates the ovaries, rises sharply at this stage.
Why hot flushes happen
The lack of oestrogen affects the whole body. The brain’s “thermostat” goes off balance, partly because a substance called neurokinin B goes unchecked, and creates a false sensation of heat: these are hot flushes and night sweats. Other symptoms can include:
- vaginal dryness;
- insomnia;
- joint pain;
- mood changes and anxiety.
When it happens
The menopause happens naturally at around 51. It can also be induced, for example by surgery or treatments such as chemotherapy, or come early, before the age of 40, which should be assessed by a doctor.
Do you need blood tests?
Most of the time, the diagnosis is clinical. If you are over 45 and have typical symptoms, your doctor can diagnose the menopause without blood tests. Measuring FSH or oestrogen in the blood is rarely needed, because these hormones fluctuate a great deal at this stage.
What treatments are there?
Hormone therapy (HRT) is the most effective treatment for hot flushes. It replaces the missing oestrogen, combined with a progestogen in women who still have a womb, to protect the lining of the womb. It also helps to prevent bone loss. The decision is individual and weighs up the benefits and risks in each case; in general, the balance of benefits and risks is more favourable when it is started before the age of 60 or within 10 years of the menopause. Among other situations, it should not be used by women with a history of breast cancer, blood clots, uncontrolled high blood pressure or unexplained vaginal bleeding.
For women who cannot or do not wish to take hormone therapy, there are alternatives:
- NK3 receptor antagonists, which act directly on the temperature control centre in the brain;
- some antidepressants at low doses;
- local treatments for vaginal dryness.
The key message
The menopause is natural, but you do not have to live with the symptoms in silence. Don’t accept a poor quality of life as normal: talk to your doctor about the options that make sense for you.
This article is for information only and does not replace a medical appointment.
References
- Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. doi:10.1210/jc.2015-2236
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200
- National Institute for Health and Care Excellence (NICE). Menopause: identification and management. NICE guideline NG23. nice.org.uk/guidance/ng23
