Menopause is sometimes referred to as 'the Change of Life'. We prefer the term ‘Second Spring’, coined by the Chinese to describe the new zest for life that many women experience now they are free from the hormonal highs and lows. 

The menopause can be a challenging and confusing time for some women and their loved ones but knowledge is power, and we have created this guide to help you better understand some of the core concerns many women have around the menopause. 

We will cover some of the various stages you may encounter, explore the common symptoms of menopause and answer some of the most common questions our customers ask in our Meaghers Pharmacy stores. 

Armed with the right knowledge and correct menopause care, our aim is to help give you the confidence to navigate the often stormy waters that the Second Spring brings.

What is Menopause?

Menopause is the cessation of the reproductive age in a woman. It is the time in a woman’s life marked by the end of menstruation and is usually a gradual process where your period becomes less frequent before stopping altogether. 

You may also notice your period becoming unusually light or heavier than normal. If a woman goes for a year without menstruation and can't conceive naturally, she is said to be in menopause. This occurs mainly in women aged 45 years and above.

During this phase, many women experience a variety of uncomfortable symptoms though the severity varies from one woman to another. 

The official menopause literature from the HSE (PDF) contains some useful information and links on understanding this crucial stage in a woman’s life.

What Causes Menopause?

When we are born, all our eggs are intact; these eggs are stored in the ovaries. Upon maturity, the ovaries are responsible for producing the hormones oestrogen and progesterone that are responsible for menstruation.

As women age, our bodies experience a fluctuation of sex hormone levels. The menopause comes about when the production of oestrogen and progesterone becomes imbalanced in later life.

It occurs when the ovaries cannot generate the right amount of the oestrogen hormone to support the release of an egg each month.

Most women will experience these body changes from the age of 40, while for others, it happens a bit earlier and is referred to as premature menopause.

When Does Menopause Begin?

The age of menopause is primarily determined by genetics. However every woman is unique and factors such as smoking and intensive medical treatments like chemotherapy may result in earlier menopause since they accelerate ovary decline.  

Most women will experience menopause symptoms four years before their last menstrual cycle, some of which may continue for four more years after their last period. As such, 51 is the median age for menopause (per the NHS), but not all women will undergo menopause at around this age.

Around one percent of women worldwide begin menopause before turning 40, a condition known as primary ovarian insufficiency or premature menopause.  

Another five percent of women have their last period aged 40 to 45. This is called early menopause.

The Three Stages of Menopause

In most cases, menopause is a slow, natural process that comes with age. 

However, in some instances, women don’t experience the natural process of menopause and may have to be assisted by medical interventions. This is called induced or medical menopause.

A natural menopause has three main stages which most women will go through at a certain point in their journey from youth to middle-age.

  1. Perimenopause

This is the period before the actual menopause. The duration of this phase varies from one woman to the other. For some, it lasts a few months, while for others, it could take years.

This period is characterised by a drop in oestrogen levels. You will also experience most of the symptoms of menopause up to the time you hit the actual menopause, where your ovaries can no longer produce eggs.

The very first tell-tale sign is that you will experience irregular periods. They may skip a month, or two then recur for several months before they disappear. During this perimenopause period, the cycles are shorter.

It is important to note that when experiencing irregular periods, you can still potentially conceive.

  1. Menopause

During this phase, your body will experience the menopause transition. Your ovaries will no longer produce eggs, meaning you won't experience menstrual periods and can't naturally conceive.

It is marked by the absence of your menstrual period for 12 consecutive months. At this stage, the ovaries are not releasing the oestrogen hormone. 

  1. Post menopause

This is the period after your menopause has passed; the years after the natural menopause symptoms have eased. The hot flashes have ceased or gone down significantly. 

Due to a reduction in oestrogen production, you may experience more health risks that come with age. 

Why Does Menopause Occur?

In most cases, menopause occurs naturally. As your ovaries age, they release less oestrogen, progesterone, follicle-stimulating hormone (FSH), testosterone, and luteinizing follicle hormone (LH). 

Your reproductive system will also have less active ovarian follicles, the structures responsible for producing and releasing eggs. Without these, a woman loses her ability to conceive and no longer menstruates. 

In other cases, menopause is triggered by;

  • Serious injuries to the pelvic area.
  • The surgical removal of the ovaries.
  • The shutdown of ovary function (ovarian ablation) through surgery, radiotherapy or hormone therapy. This is usually done in women with oestrogen receptor-positive tumours.
  • Pelvic radiation.

Symptoms of Menopause

There are many indicators that a woman is nearing or has undergone menopause. Naturally, these vary for each woman, but are generally the same through perimenopause, menopause, and post menopause.

Some of the most common symptoms of menopause include; 

Hot flashes

Up to 70% of women undergoing menopause will experience hot flashes, making them the most common symptom. The flashes are characterised by a sudden rise in temperature that usually affects the upper part of your body. 

During a flash, you may experience profuse sweating and blushing, heart palpitations, increased blood pressure or a feeling of dizziness. 

On average, menopausal women will experience one hot flash a day over the course of one or several years. The intensity varies from woman to woman, but excess body weight and smoking can contribute to the severity of the flash. 

Consuming spicy food, alcohol, and caffeine, being in hot surroundings and feeling stressed are known triggers of hot flashes. If possible it is recommended to avoid these triggers to reduce the frequency of hot flashes. 

Other techniques you can use to manage this symptom include using a fan to regulate the room temperature and dressing in light layers.

Insomnia

Insomnia is a disorder in which sufferers have a difficult time falling or staying asleep. Around 61% of postmenopausal women experience bouts of insomnia due to the following reasons; 

  • Falling levels of progesterone, which is also a sleep-producing hormone. 
  • Hot flashes accompanied by night sweats make it difficult for some women to fall back to sleep.

Vaginal dryness

In most women, vaginal walls are coated by a thin layer of moisture that helps lubricate the walls to reduce friction during sex. The secretions also provide the alkaline environment needed by sperm cells to survive and travel during sexual reproduction. 

Changes in hormone production (falling oestrogen levels) also cause the vaginal walls to be thin, which reduces the number of cells that secrete moisture. This adds to vaginal dryness in some women. A number of factors that may make symptoms worse are cigarette smoking and experiencing depression.

Weight gain    

Research shows that women gain an average of 5 pounds around the time menopause occurs. 

Regular exercise, in conjunction with a healthy, balanced diet is critical to help keep weight at a stable level throughout the period of menopause. Exercise and a balanced diet will greatly contribute to your overall health and wellbeing.

Lower libido or sex drive

Changes that accompany menopause mean that some menopausal women may experience a reduced sex drive or sexual desire.

Some of the reasons for this include; 

  • Reduced oestrogen and testosterone levels, which may make it difficult for one to get aroused.
  • Reduced oestrogen levels can lead to vaginal dryness due to reduced blood supply to the vagina. It can also cause the thinning of vaginal walls in what is known as vaginal atrophy. Both of these situations result in increased discomfort during sex, which reduces one's urge to engage in intercourse. 
  • Other side effects of menopause may also negatively affect a woman’s libido. You may not feel like yourself if you are suffering from symptoms such as weight gain, hot flashes and irritability. It is important to take care of yourself and prioritise self-care to improve overall wellbeing.

Skin changes 

Hormonal changes during menopause may trigger changes to the skin of menopausal women. For instance, oestrogen plays a significant role in the production of collagen; a protein that gives the skin elasticity and strength. The level of hormones play another role in the production of natural oils responsible for moisturising the skin and for maintaining the water retention in the skin.

When oestrogen levels drop during menopause, the production of collagen and natural oils is hampered as well as the skin's ability to hold onto water. This may result in dry, dehydrated and itchy skin, acne breakouts, rashes, dark spots, sagging, a lack of density and deepened wrinkles which products such as those in Vichy’s Neovadiol range can help with.

Some menopausal women experience paraesthesia in rare cases, better described as a tingling or numbness sensation on the skin. 

A more extreme case of paraesthesia involves formication, where one experiences a sensation of insects crawling on their skin. If this occurs, speak to your GP or pharmacist to get the best advice on how to manage the symptoms.

Sore or tender breasts

Breast tenderness and pain is known as mastalgia, and the symptom can be a little confusing as it can be an indicator of many other things. Sore breasts may be a signal of pregnancy or a menstrual period that is about to start. However, women experiencing menopause can also suffer from tenderness in the breasts.

Menopausal breast pains are a bit different from menstrual ones. Whereas menstrual breast pain occurs right before one’s period and feels like a dull ache in both breasts, premenopausal and menopausal feel more like a burning sensation in one or both breasts.

Hair thinning or loss

Hair loss is another common symptom that accompanies fluctuating hormone levels during menopause. Fortunately, hair loss in women is mostly subtler than in men and will manifest as hair thinning in most women, instead of developing bald spots. 

Hair thinning is due to changes in the amounts of progesterone and oestrogen in the body. These hormones affect how fast your hair grows and how long it stays on the head. When oestrogen and progesterone levels diminish, two things happen;

  • Your hair grows more slowly and becomes thinner.
  • This decrease in female hormones triggers an increase in the production of androgens. These male hormones then shrink hair follicles, causing hair loss.

Menopausal hair thinning and loss can also be accelerated by factors other than hormonal changes, most notably stress and lack of certain nutrients. If you suffer from hair loss seek advice from your GP or Meaghers pharmacist.

Headaches

Many women experience hormonal headaches around the time their period is due. When these women approach menopause, their headaches become less severe because their hormone levels stay low. 

On the other hand, some perimenopausal women will experience more frequent and intense headaches. The spike may be a result of oestrogen and progesterone levels falling. This is especially the case in women who have a history of migraines, many of whom report significantly worse headaches.

Depression and mood changes 

There are many factors affecting women approaching the ‘Second Spring’, especially if you are experiencing the symptoms of menopause. The physical symptoms often directly affect one's emotions and mental health. 

For a lot of women, experiencing symptoms such as hot flashes, insomnia and changes to their physical appearance and sex life are incredibly frustrating. 

This frustration coupled with any other life circumstances such as family or work life can have a real impact on anxiety, stress and levels of depression among menopausal women. 

It is critical that you feel supported during this time so please seek help from healthcare professionals and from loved ones to give you the help you deserve through this time. 

The HSE’s menopause support infrastructure and talking therapies are a highly recommended outlet.

Common Menopause Complications

Some women can unfortunately experience complications that result from the menopause. We cover the common complications below:

Postmenopausal Atrophic Vaginitis 

Also known as vaginal atrophy, this menopause symptom is the thinning of vaginal walls caused by decreased oestrogen levels. The tissue around the vaginal walls become dry, less elastic, and more fragile. 

Symptoms of postmenopausal atrophic vaginitis include a burning sensation during urination, vaginal burning, shortening and tightening of the vaginal canal, and vaginal dryness. For more information on this symptom, please see the following NHS resource on vaginitis (PDF). 

Dyspareunia

Dyspareunia refers to recurring pain during intercourse. In menopausal women, it is often in response to vaginal atrophy, although stress can play a significant role. 

Osteoporosis

Osteoporosis is a condition that causes bones to thin and become less dense and may develop in menopausal women due to hormonal changes. 

Since oestrogen plays a significant role in maintaining bone health and strength, falling levels of oestrogen may result in osteoporosis. 

In most cases, oestrogen isn’t the sole cause of reduced bone density but rather acts as an accelerant.

Urinary Tract Infections (UTIs)

Vaginal atrophy puts menopausal women at a greater risk of contracting urinary tract infections. 

Other complications including periodontal disease, cataracts, sudden mood or emotional changes, and a slower metabolism may occur in different individuals. 

If you experience any form of bleeding after menopause, be sure to contact your GP immediately.

Tests to Diagnose Menopause

To verify that you are in any of the menopause stages, your doctor may require to carry out some tests on your blood, including:

Thyroid Hormones

Evaluating the thyroid gland will help establish whether any irregularities of the menstrual periods result from the menopause transition phase or general thyroid problems.

Follicle Stimulating Hormone

Healthcare professionals will test your blood to evaluate the levels of the FSH hormone. Menopausal women have a higher level of the follicle-stimulating hormone. 

A woman with an elevated FSH of 30 MIU/ML coupled with her monthly cycle of menstrual periods ceasing for a year can be confirmed to have hit menopause.

Oestradiol

This test will guide your doctor on the oestrogen levels your ovaries can produce. With this information, the doctor can tell whether there is a drop in oestrogen levels due to menopause.

Anti-Mullerian Hormone

AMH, as it’s commonly referred to, will guide the doctor on the eggs in your ovaries. The hormone is produced in the reproductive organs and can be vital in evaluating the status of your reserve eggs.

How to Treat Menopause Symptoms

Women experience different changes in their bodies during their menopausal transition. Some of the symptoms will go away naturally, while others will require the intervention of your GP or healthcare professional.

Failure to address vasomotor symptoms (those that occur due to the constriction or dilation of blood vessels) such as increased heart rates could lead to further complications like heart disease if left unchecked.

To assist your doctor in accurately diagnosing your menopausal transition, it's advisable to keep track of your menstrual period chart for the preceding 6 to 12 months.

Common treatments for menopause include:

Hormone Replacement Therapy (HRT)

Hormone therapy is the most effective way to manage menopausal symptoms. It involves replacing the hormones that are in short supply as a result of menopause. Since low oestrogen levels cause most symptoms, hormone therapy mostly involves oestrogen replacement. Women looking to protect the lining of their wombs will also need progesterone replacement therapy. 

Hormone therapy can be administered as tablets, implants, skin patches, or a gel to rub into the skin. 

Benefits of HRT

The biggest benefit of HRT is that it relieves most menopausal symptoms. It effectively manages joint pains, vaginal dryness, reduced libido, mood swings, brain fog, and hot flashes. Hormone therapy also reduces the risk of developing osteoporosis (thinning of bones). 

Risks attached to HRT

Hormone therapy increases the risk of developing blood clots and breast cancer in some women. Therefore, you need to consult with your GP or specialist to determine whether you have any risk factors. 

Treatment for Hot Flashes and Night Sweats

Some measures to help reduce hot flashes and night sweats include; 

  • Wearing light clothing.
  • Avoid smoking and triggers like caffeine, spicy food, and alcohol.
  • Take cool showers regularly.
  • Have a cold drink.
  • Use a fan to keep your bedroom cool at night. 
  • Lots of women find Sage drops to be effective and they can work faster than tablets and are handy to keep on your bedside locker in case you have night sweats, which can really disturb your sleep.

Exercise

Exercise is the go-to hack for a lot of health issues. For menopausal women, exercise is great to improve mood, battle insomnia, and increase energy levels. Therefore, try to exercise for at least 30 minutes a day if possible. 

Incorporating a healthy diet with exercise will help overall health and wellbeing, as will improving your microbiome health

Supplements

Taking Vitamin D, calcium, and magnesium supplements lowers the risk of osteoporosis. A. Vogel Menopause Support is a product we highly recommend to anyone going through menopause. 

It is an incredibly effective blend of fermented soybeans which means that the important phyto-oestrogenic soy compounds (genistein, daidzein and glycitein) are more easily absorbed by the body. 

A Vogel’s unique formulation also contains magnesium (known to help with symptoms such as tiredness and fatigue), hibiscus and vervain. It also improves your energy levels and helps you sleep better.

Therapy and antidepressants 

For menopausal women experiencing anxiety, stress, and depression, talking to someone helps. Communicating your needs, feelings, and fears will help you cope with the emotions and seeking support is vital at this time of life. You can enlist the services of a professional therapist to go along with the support you’re receiving from trusted friends and family. 

Some healthcare professionals and therapists prescribe mild antidepressants to help if necessary.

Relaxation techniques

Yoga, meditation, and breathing exercises are another way to manage stress and anxiety caused by menopause. 

Taking time for yourself and prioritising your self-care is of utmost importance during the menopause. It’s important that you feel supported, connected and cared for by others but also by yourself. 

Additional medication  

A wide range of medication can be used to treat menopausal symptoms like hair thinning, vaginal atrophy, UTIs, insomnia, postmenstrual osteoporosis, and unwanted hair growth. 

As with any new course of medication, we strongly advise that you consult with your physician or pharmacist to find the best medication for you 

Conclusion / 'The Meaghers Verdict on Menopause'

Menopause is said to occur 12 months after a woman has her last menstrual cycle. It usually occurs naturally, and the age of occurrence is often determined by genetics. However, it can be induced medically or triggered by injuries to the pelvic area.

Menopause is accompanied by symptoms a few years before and after its onset. These include hot flashes, vaginal dryness, night sweats, dry skin, and hair loss, to name a few. Fortunately, these symptoms can be managed by medical intervention, by consulting your doctor or a qualified menopause specialist, through hormone therapy and lifestyle changes.

Contact Us to Discuss Your Change of Life Challenges

We’re hopeful this guide has equipped you with the knowledge to understand that the management of menopause isn't as daunting as it seems and that you're not alone on this journey. 

We're on hand to assist you and are here to talk you through the various menopause support options available to Irish consumers for improving your quality of life.