Menopause is a natural process that every woman will experience at some point in their life. Learn about its causes, stages, hormonal changes, symptoms, and available management options.

Key takeaways

• Menopause is a natural part of the ageing process that occurs when the ovaries stop releasing eggs, leading to hormonal changes in the body.
• The menopause transition has three stages: perimenopause, menopause, and postmenopause.
• Fluctuations in oestrogen levels during this time can cause common symptoms like hot flushes, night sweats, vaginal dryness, mood changes, cognitive issues, and reduced libido.
• While every woman's experience of menopause is different, seeking help from a health care provider  can provide various management options to relieve symptoms and improve quality of life.

Menopause is often referred to as a transition, as there are many hormonal changes that occur in the years leading up to menopause, as well as afterwards and is a natural transition.

The menopause transition typically begins between 45-55 years of age and tends to last between 7-14 years. The duration varies depending on factors such as age, lifestyle factors, underlying health, alcohol consumption, attitudes, weight, genetics, stress and ethnicity. When menopause occurs prior to the age of 45, it’s called early menopause. When it occurs prior to 40, it is considered premature menopause.

What causes menopause?

Menopause happens naturally as part of the normal ageing process. Researchers hypothesise this is due to the ovaries running out of eggs, leading to changes in the hormones produced by both the ovaries and the brain.

It can also be influenced or triggered by circumstances such as surgery that influences the ovarian blood supply, hysterectomy or removal of the ovaries, smoking, radiation to the pelvis or chemotherapy drugs.

What are the three stages of menopause?

The menopause definition is when your menstruation ends. The menopause transition is gradual and is often described in three stages:

• Perimenopause: the years leading up to menopause where hormonal changes start to occur.
• Menopause: the end of menstruation, marked by 12 months after a woman’s final menstrual period
• Post-menopause: begins one year after your final period, and lasts the rest of a woman’s life

What happens to hormones during menopause?

The major change that occurs during menopause is fluctuations in the three sex hormones: progesterone, testosterone and oestrogen. During the menstrual cycle, your hormone changes are generally predictable:

• Oestrogen levels are controlled by two hormones: follicle-stimulating hormone (FSH) and luteinising hormone (LH)
• FSH tells the follicles in the ovaries (fluid-filled sacs that house the eggs) to produce oestrogen
• When oestrogen is high enough, the brain tells the pituitary gland to release LH, which stimulates ovulation (when the ovary releases an egg)
• The follicle then prepares for possible pregnancy by producing progesterone and oestrogen, which is accompanied by a drop in FSH and LH
• If there is no pregnancy, progesterone drops and menstruation occurs

During menopause, the number of follicles declines and the function of the ovaries decreases, reducing their responsiveness to FSH and LH. During the peri-menopause these hormones tend to fluctuate, whereas after menopause the levels remain consistently lower.

What are the symptoms of menopause?

Women undergo a progressive reduction in eggs throughout their lifespan. During the menopause transition, ovulation becomes less frequent until it eventually stops completely.

The reduction in the egg supply is accompanied by a decrease in the hormones oestrogen and progesterone. Both the drop in oestrogen and progesterone are major sources of the common menopause symptoms, but new research is showing that testosterone may play a role too. Many women find that once their hormone levels begin to stabilise and remain low, their symptoms may diminish.

Every woman’s menopause experience is different. Statistics show that 20% of women have severe symptoms, 60% have mild to moderate symptoms and 20% have no symptoms.

Common menopause symptoms include:

• Changes in your menstrual cycle such as irregularity and changes in flow (may become heavy or light or both)
• Menopause weight gain and difficulty losing weight
• Changes in body image and shape
• Vasomotor symptoms including hot flushes and night sweats
• Vaginal dryness and atrophy
• Mood changes including anxiety, depression and irritability
• Cognitive issues such as memory problems, brain fog and poor concentration
• Insomnia
• Reduced libido and painful sex
• Joint aches, muscle aches and fatigue are also common symptoms.

Common menopause treatment options

In Australia, there are many treatment options available for menopause, meaning it's important to talk to your doctor or health care provider to understand what is suitable for you.

Common options include:

• Hormone replacement therapy (HRT) or Menopausal hormonal treatment (MHT)
• Non-hormonal medical treatments
• Lifestyle modification
• Complementary therapies

HRT or MHT involves taking oestrogen, progesterone and/or testosterone to replace the hormones that are lost during menopause. It may be helpful in relieving many of the symptoms associated with decreasing amounts of these key hormones. Women may get relief from things like the hot flushes, night sweats, insomnia and vaginal dryness. MHT/HRT is also used to help strengthen bone and prevent bone loss. However, HRT/MHT may increase the risk of some conditions, so a full assessment of your health and your risk factors is advised.

Non hormonal medications are becoming increasingly popular. Some anti-depressants have research to support their use in hot flushes and insomnia associated with menopause. These can be a good option for the women who cannot take MHT for medical or other reasons.

Complementary therapies such as nutrients, acupuncture, yoga, and herbal supplements have also been used to manage menopause symptoms, and many women find these very helpful.  Taking the initiative to adopt a healthy lifestyle during this time can be rewarding too. Making sure alcohol, caffeine and sugar are minimised, maintaining regular physical activity, optimising your nutrition,  working on stress management techniques, and maintaining a healthy weight can also help alleviate symptoms, promote overall health and wellbeing, and reduce the risk of related health issues.

It is useful to consult with a healthcare provider before starting any treatment, especially if you have underlying health conditions or are taking other medications.

Continuous glucose monitors for menopause

Continuous glucose monitors (CGMs) are typically used to monitor blood sugar levels in people with diabetes. However, recent studies have shown that women experience significant changes to their metabolism during this time that can significantly impact their long-term metabolic and cardiovascular risk factors.

Optimising one’s metabolism by improving lifestyle choices may also be useful in lowering menopause symptoms. Fluctuations in blood sugar levels can trigger hot flushes, and if frequent can act like a physiological stress on the body.

Using a CGM can help women monitor their glucose levels, identify any triggers, and help them change their lifestyle to suit their changing metabolic needs. Additionally, some women with menopause-related insulin resistance may benefit from using a CGM to track their glucose levels and adjust their diet and exercise accordingly.

While more research is needed to confirm the effectiveness of CGMs for menopause management, they may offer a promising new tool for women seeking relief from menopause symptoms and to help them optimise their metabolism, support weight loss and manage belly fat

If you’re experiencing menopause symptoms or think you may be entering perimenopause, consider seeking help from your healthcare provider. There are many options available to help manage symptoms. If you'd like to try a CGM, consider the Vively app. Vively is a metabolic health app that can help women in the menopause transition improve their lifestyle and track their blood sugar levels.