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What is menopause?

Menopause (your final period) happens to most women. In Australia, the average age of menopause is 51 years, but it’s normal to have menopause anywhere between 45 and 55 years – although some women have it at an earlier or later age. Perimenopause is the time leading up to menopause, and postmenopause is the time after your final period.

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How do you know if you’ve reached menopause?

It can be hard to know if you’ve reached menopause, because your periods can be irregular during this time. It’s likely you’ve reached menopause if you haven’t had a period for 12 months.

What happens at menopause?

From about 35–40 years of age, you have fewer eggs left in your ovaries and don’t ovulate (release an egg from your ovary) as often. Menopause means your ovulation and periods stop.

Hormones and menopause

Hormones are chemicals made in your body that relay messages through your bloodstream. For example, your hormones tell your body to eat and sleep.

The three main hormones that change as you approach menopause are:

  • oestrogen
  • progesterone
  • testosterone.

The change in hormone levels can lead to different menopausal symptoms.

Oestrogen

Oestrogen is produced from the cells around the eggs in your ovaries. It helps to maintain parts of your body. For example, your endometrium (uterus lining), cervix (where your uterus joins your vagina), breast ducts and bones.
Your oestrogen production increases and decreases in the lead-up to menopause. As you approach your final period, your number of eggs decreases and oestrogen levels drop by up to 90%.

Progesterone

Progesterone is responsible for things like mucus levels in your cervix, acidity levels in your vagina and milk cells in your breasts. It can also make you moody.
Progesterone is produced when an egg is released. It prepares your uterus for a fertilised egg and pregnancy. As you approach your final period, your progesterone levels decrease.

Testosterone

Testosterone is produced by your ovaries and other parts of your body.
You might think testosterone is a male hormone but it also plays an important role in women’s sexual desire, emotional wellbeing and bone and muscle strength.
Testosterone decreases gradually with age. In some women, levels fall by half between the ages of 20 and 40 years.

Watch a video and find out what happens to your body during menopause.

The menopause transition

Most women reach menopause between the ages of 45 and 55 years. In Australia, the average age for women to reach menopause is 51 to 52. Some women reach menopause as late as 60.

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Perimenopause

Perimenopause is the stage before your final period (menopause). It’s when your body reaches the end of its reproductive years. Perimenopause is a natural part of a woman’s life.

Perimenopause usually happens sometime in your 40s. On average, it lasts four to six years, but it can last from one to 10 years.

During this time, your ovaries begin to run out of eggs. This causes hormone levels, particularly oestrogen, to fluctuate, causing different symptoms, like hot flushes and mood swings.

Changing hormones can also affect your menstrual cycle. For example, your periods may be irregular, shorter (or longer), lighter (or heavier), or they may not come for a few months.

Some months you may ovulate and other months you may not. You may even ovulate twice in a cycle.

Contraception in perimenopause

Even though fertility is lower in your 40s and 50s, it is possible to become pregnant. This is because you still ovulate during perimenopause.

The chance of pregnancy in women aged 45–49 years is around 2–3% per year. After the age of 50, it is less than 1%. While this is low, every woman’s fertility is different.

If you don’t want to become pregnant, you should continue to use contraception until you’ve had:

  • one year without a natural period if you’re older than 50
  • two years without a natural period if you’re younger than 50.

Menopausal hormone therapy (MHT) is not a contraceptive. You shouldn’t rely on MHT to prevent pregnancy.

Learn more about perimenopause

Menopause

Menopause is your final menstrual period. If you haven’t had a period for 12 months, you’ve reached menopause.

Postmenopause

Postmenopause is the time after menopause.

As your body adjusts to lower hormone levels, you may have less menopausal symptoms – or they may even disappear – but some women still experience menopausal symptoms for years after their final period.

It’s important to look after your health after menopause, as changes due to ageing and lower levels of oestrogen can increase your risk of developing certain health conditions.

Heart health

Before menopause, women have a lower risk of heart disease than men. However, as women age and their oestrogen levels fall, their risk of cardiovascular disease increases. Heart disease is one of the leading cause of death for Australian women. Heart disease also claims three times as many lives as breast cancer.

After menopause, risk factors for heart disease increase. These include:

  • high blood pressure
  • an increase in total cholesterol
  • an increase in LDL (‘bad’ cholesterol)
  • a decrease in HDL (‘good’ cholesterol)
  • an increase in blood fats, such as triglycerides.

You can reduce the risk of heart disease by having a healthy lifestyle.

For example:

  • eat a healthy and nutritious diet
  • do regular exercise
  • maintain a healthy weight
  • don’t smoke
  • limit alcohol intake.

You can also see your doctor for a heart check. They will take your blood pressure and test your blood to determine your risk factors. If you have a high risk of heart disease, your doctor may prescribe medication for high blood pressure and cholesterol.

Bone health and osteoporosis

Osteoporosis is a condition where bones become weakened. This can cause bones to break (fracture) easily. About half of all women over 60 years of age will have at least one fracture due to osteoporosis.

After menopause, lower levels of oestrogen affect women’s bone health, which puts them at greater risk of developing osteoporosis.

On average, women lose up to 10% of their bone mass in the first five years after menopause. After this, the rate of bone loss slows.

You can reduce your risk of osteoporosis by eating the right amount of calcium per day. Women over 50 should eat 1300mg of calcium per day, which is equal to 3–4 serves of dairy per day. Other good sources of calcium include:

  • canned fish with bones (e.g. sardines)
  • almonds
  • tofu
  • leafy green vegetables
  • legumes (e.g. chickpeas or kidney beans).

You can also:

  • get the right amount of vitamin D through sunlight or supplements
  • do regular weight-bearing exercise
  • not drink coffee
  • not smoke.

It’s important to have regular bone health checks. Your doctor might ask about your medical history, check risk factors for osteoporosis and do a bone density test.

Note that Medicare rebates for bone density tests are only available for women with particular risk factors or those over 70 years of age.

Healthy weight

After menopause, you may notice extra body fat around your stomach. This can increase your risk of health conditions such as high blood pressure, diabetes, cardiovascular disease, dementia and some cancers.

It’s very important to maintain a healthy weight at this stage of life. You can do this by:

  • eating a healthy diet rich in fruits, vegetables, lean protein and whole grains
  • limiting your intake of processed foods, especially those high in fat and sugar
  • getting regular exercise
  • limiting alcohol intake
  • drinking more water.

Learn more about healthy weight or open the menopause and weight fact sheet.

Bladder health

Lower levels of oestrogen after menopause can affect your bladder health, including:

  • weak pelvic floor muscles
  • loss of elasticity of the bladder
  • thinning of the urethral and bladder lining, which could lead to urinary tract infections (UTIs)
  • loss of elasticity in the pelvic tissues.

These factors can lead to incontinence (i.e. you might wee when you don’t want to). While this can be embarrassing, it is very common.

You don’t have to put up with incontinence. You can ask your doctor for a referral to a continence nurse or pelvic floor physiotherapist to help strengthen your pelvic floor muscles.

Vaginal and vulval health

Some vaginal and vulval symptoms continue into postmenopause.

Cervical screening (pap smear)

After reaching menopause, you still need a cervical screening test every five years until you’re 74 years old. You will usually be sent a reminder every five years if your results are normal. If your results are abnormal, you will need more frequent tests.

Postmenopausal bleeding

Bleeding from your vagina after menopause is not normal. If you have any bleeding, spotting or staining after you reach menopause, talk to your doctor. They may recommend tests, including:

  • cervical screening
  • vaginal (internal) ultrasound
  • biopsy
  • curette (a procedure to gently remove the lining of your uterus).
Contraception

If you don’t want to get pregnant and you’re younger than 50 years of age, you should use contraception for at least two years after your final period.

If you don’t want to get pregnant and you’re 50 or older, you should use contraception for at least one year after your final period.

Please note that MHT is not a contraceptive.

There are many types of contraception available. Speak to your doctor to work out what option is best for you.

Breast health

The risk of breast cancer increases as you get older and is most common in postmenopausal women. About 79% of all new cases of breast cancer occur in women over the age of 50 years.

It’s important to know the normal look and feel of your own breasts. This will help you notice any changes. Check your breasts and armpits while showering. Look for changes in your breasts, nipples or skin, such as a rash or dimpling, a lump or discharge. Also note any new pain you might feel in the area. If you are concerned about any changes, see your doctor.

If you are 50 years or older and have no breast changes, you should have a breast screen, or mammogram, every two years. A mammogram is the best way to find breast cancer early. Contact your doctor for more information.

Learn more about breast health and breast checks.

Diagnosing perimenopause and menopause

You can ask your doctor to check if you are perimenopausal or have reached menopause. If you are at the expected age, have experienced some symptoms and have irregular periods, it’s likely you are perimenopausal. If you haven’t had a period for 12 months, you have probably reached menopause.

The best way to predict menopause is to keep track of your symptoms. If your periods are irregular and your symptoms are getting worse, it’s likely you are approaching menopause.

Blood tests

Blood tests to measure hormone levels won't tell you if you are perimenopausal or when your final period is going to happen, because hormone levels vary widely at this time.

If you are younger than 45 years and your periods are irregular or have stopped, your doctor might measure your hormone levels to understand your situation.

A blood test to measure a hormone called anti-Müllerian hormone (AMH) is being studied to see if measuring egg or follicle activity can predict menopause. It is not standard practice to use this test, or other hormone level tests, in the diagnosis of normal perimenopause or menopause.

Saliva tests

Saliva tests are not an accurate way of predicting menopause, due to fluctuating hormone levels at this time.

When to see your doctor

Talk to your doctor if you are worried about:

  • irregular periods
  • heavy bleeding
  • bleeding after menopause
  • increased premenstrual syndrome (PMS) symptoms
  • menopausal symptoms, such as hot flushes, that interfere with your daily life.
Learn more about menopause
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This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2022.

References

Last updated: 11 November 2022 | Last reviewed: 19 August 2022

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