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Alternative Names
change of life, climacteric

Menopause is the point in a woman's life when menstruation stops permanently. This means she is no longer able to have children. Menopause usually occurs between the ages of 35 and 58. It is a natural event in a woman's life. Surgical menopause occurs when a woman has both of her ovaries removed.

What is going on in the body?
By the time a woman is in her mid 30s, the level of the hormone oestrogen in her body begins to drop. Levels gradually decline until a woman stops menstruating. The period during which oestrogen levels are dropping but the woman is still menstruating is called perimenopause or premenopause. The point at which oestrogen has declined enough so that menstruation has ceased is called menopause. The period of time that begins after menstruation stops and continues for the rest of a woman's life is known as post-menopause.

What are the signs and symptoms of the condition?
Symptoms of menopause vary from woman to woman. Some women will have severe symptoms, while others will have mild or no symptoms. The symptoms may occur for a few weeks, a few months, or even several years. The symptoms may come and go. Physical symptoms can include:
  • irregular menstrual periods. This may include increased bleeding, decreased bleeding, longer or shorter periods, changes in the frequency of menstrual periods or absence of periods for 12 months.
  • hot flushes. This is a sudden sensation of heat in the whole or upper part of the body.
  • night sweats
  • disturbed sleep patterns, or other sleep disorders
  • vaginal dryness and shrinkage of genital tissues. This sometimes results in discomfort or pain during sexual intercourse, known as dyspareunia.
  • more frequent urination
  • leakage of urine when coughing, laughing, lifting, or during exercise, which is known as stress incontinence
  • more frequent minor vaginal infections and urinary tract infections
Women who are menopausal do not experience more depression or other mental illnesses than any other group. Psychological symptoms common during menopause include:
  • anxiety
  • depression
  • tearfulness
  • irritability
  • sleeplessness
  • less desire for sex
  • lack of concentration
  • difficulty remembering things
Menopause usually occurs during a time in life when other dramatic changes take place. Common changes during mid life include:
  • loss of parents
  • children growing up and leaving home
  • becoming a grandparent
  • retirement
  • career changes
These changes in addition to the changes going on in a woman's body during menopause may result in increased stress.

What are the causes and risks of the condition?
Menopause is a natural part of a woman's life. A woman's oestrogen level decreases eventually, causing her to stop menstruating. A woman who has her ovaries removed will also go through menopause.

What can be done to prevent the condition?
There is no prevention. All women will experience menopause. The risks that come from the loss of oestrogen may be preventable or treatable with early recognition, lifestyle change, and possible hormone replacement therapy.

How is the condition diagnosed?
Diagnosis is usually made by the woman's history and supporting symptoms. A blood test can be used to measure oestrogen levels. A pelvic examination and Pap smear may show effects of decreased oestrogen.

What are the long-term effects of the condition?
Certain diseases are associated with oestrogen loss in women. A woman who is past menopause is at higher risk for: Many women have an increased interest in sex following menopause. This may be because pregnancy is no longer a worry. However, women who are still menstruating, and women who have ceased menstruating within the past year, may still get pregnant. Barrier birth control methods, intrauterine devices (IUDs), or tubal ligation can prevent pregnancy.

What are the risks to others?
There are no risks to others.

What are the treatments for the condition?
Menopause itself is not treated. Certain health problems, such as Osteoporosis and heart disease are associated with loss of oestrogen. To help prevent such problems many women take oestrogen to replace what their body is no longer producing. This treatment is called oestrogen or hormone replacement therapy (HRT).

Symptoms associated with menopause may also be treated. During menopause, sexual intercourse may become painful, a condition known as dyspareunia. Some women may experience a decline in sexual interest. This may be due to more painful intercourse because of vaginal drying. Creams are available to help with lubrication.

Kegel exercises of the pelvic muscle can treat urinary leakage. Surgery or medication may also be used.

What are the side effects of the treatments?
Side effects to hormone replacement therapy can include headaches, bloating, vaginal bleeding, breast tenderness, and irritability. Numerous studies have been done on the effects of hormone replacement therapy and the results are conflicting. It may increase the chance of breast cancer, gallbladder disease, and endometrial cancer. A doctor can help a woman make a decision about HRT. He or she can point out risks, risk factors, and benefits of any proposed therapy.

What happens after treatment for the condition?
Most menopausal symptoms will go away after menstruation ceases. osteoporosis and increased cardiac risk factors will continue unless oestrogen is replaced.

How is the condition monitored?
A woman's progression through menopause is monitored through regular Pap smears and pelvic examinations.

Author: Terry Mason, MPH
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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