Menopause and your menstrual cycle

From puberty to the menopause, most of our lives will be governed by our monthly cycles of periods, ovulation and often premenstrual tension. After the menopause we are free of our menstrual cycle and fluctuating hormones and can enjoy a new phase in our life. Going through the menopause can take several years, often with hurdles along the way but I want to stress that once it is over, most women I know feel the best they have ever felt.

The menopause is defined as the “last period” and typically happens between a woman’s mid-40s to mid-50s, with an average age of 51 years. 1% of women go through the menopause before the age of 40 (premature menopause) and 10% before the age of 45. The menopause happens as the hormones involved in the menstrual cycle, mainly progesterone and oestrogen, stop being produced and the ovaries run out of eggs.

The menopause has three stages: the perimenopause, the menopause and post menopause. Perimenopause is the time when a woman may start to experience menopausal symptoms because of fluctuations in the level of oestrogen, such as hot flushes, mood swings, vaginal dryness and a change in her periods.

The menopause is complete in a woman under 50 years if she goes for 24 months without a period and for a woman over 50 if she goes for 12 months without a period. The woman is then postmenopausal.

The first change that a woman normally notices in the perimenopausal period is a change in her menstrual cycle. It might be useful to keep a note of your periods so you can track the changes and be sure how long it is since your last one.

Usually from age 40 onwards, there will be a change in the length of the menstrual cycle, often initially becoming shorter but then further apart until the periods totally stop.

The period may become lighter, heavier, more painful or less painful and there may be bleeding mid cycle. These changes occur as the levels of oestrogen and progesterone fluctuate. There may be an increase in premenstrual syndrome, which may correspond with other mood changes.

It is totally normal for these changes to occur and women need to be prepared and not get stressed about them. It would be advisable to always carry some sanitary protection, as the cycle will be unpredictable.

Problems may arise if the period becomes really heavy and more painful. They can make you tired and stressed.

Sanitary protection may have to be increased and sometimes flooding may occur and very regular changes in sanitary pads or tampons will be required. The use of a menstrual cup might help.

Non-steroidal anti-inflammatories such as ibuprofen every 4–6 hours during heavy flow will decrease the blood loss by 25–45% and can help with pain relief.

If heavy periods persist, women should see their doctor as there is a chance they could become anaemic. Progesterone therapy or the Mirena intrauterine device may help reduce heavy periods. Endometrial ablation (removing or destroying the endometrial lining of the womb) is also an effective treatment for heavy periods, especially when the uterus is normal. It is also useful to check for fibroids as this can increase bleeding. The very last resort would be a hysterectomy.

HRT may help. But if women are still having periods, HRT is usually prescribed cyclical or sequential as this allows a bleed, so that a natural end to her periods can be determined. For women who have not had a period for at least a year, progesterone and oestrogen can be given continuously.

Hormonal contraceptives, such as the implant or the pill, can be used so that you do not have periods.

Women should not suffer in silence. If these changes are affecting your life, you need to see your doctor to discuss the options and ask to be referred to a gynaecologist.

I have heard three men recently propose that women might want to freeze some of their ovarian tissue with the aim of delaying the onset of the menopause. They are suggesting that the ovarian tissue can be transplanted back around the time of the menopause. But this would mean that we would have menstrual cycles. They are proposing this to reduce the effects of cardiovascular disease and osteoporosis. I personally think that having periods forever is a really bad idea. The end of my menstrual cycles was one of the best things about being postmenopause. I would not undergo several rounds of surgery to freeze and retransplant my ovarian tissue so I could continue having periods! There are other ways to reduce the risks of cardiovascular disease and osteoporosis.

Hear my talk on YouTube which summarises most of this post.

Read more – global women – dealing with periods; tampons, sanitary towels or the menstrual cup?

Image credit – The Independent