Managing menopause symptoms

Menopause and perimenopause

Menopause is when you haven't had a monthly period for 12 months. It usually happens when you're between 45 and 55. If it happens before you're 45 it's called early menopause. For some women it can happen as late as 60. The average age for menopause in Australia is 51.

Menopause happens when your body produces less oestrogen and progesterone. That eventually stops your ovaries from releasing eggs, which means your periods stop. Having your ovaries removed at any age will trigger menopause. It can also be triggered by medical treatments like some types of chemotherapy.

In the years leading up to menopause, your hormone levels, particularly oestrogen, go up and down. This transition time is called perimenopause. It usually starts when you're in your 40s. During this time, you'll start noticing menopause symptoms. The symptoms are your body's reaction to your changing hormones. Perimenopause can last up to 10 years.

Bone and muscle health

During perimenopause and menopause, your estrogen levels drop. This can affect many parts of your body, including your bones, muscles, tendons, cartilage and ligaments.

• During perimenopause, women lose up to about 10% of their bone density.
• After menopause, women also lose around 0.6% of their muscle mass each year.

These changes can result in:

• more inflammation
• lower bone density, which can lead to osteopenia or osteoporosis
• loss of muscle (sarcopenia)
• slower muscle repair and recovery.

Symptoms

Everyone experiences menopause symptoms differently. Your symptoms might be mild or severe. Some will develop gradually, and others might start suddenly. Some will be constant, and others will stop and start. Most women get symptoms for 4 to 6 years before they reach menopause.

The first sign of perimenopause is usually having periods that are:

• longer or shorter
• heavier or lighter
• closer together or further apart.

You might also get more intense pre-menstrual symptoms, like migraines, bloating and low mood.

It's very common to start:

• feeling very tired with low energy
• having trouble concentrating or remembering things
• having trouble sleeping
• getting mood swings
• feeling anxious, tense or nervous for no reason
• having less interest in sex.

These often begin very gradually and get worse over time.

You might also get physical symptoms like:

• hot flushes and night sweats
• muscle and joint pains
• bladder problems, like incontinence (leaking) and having to pee more often
• feeling your heart fluttering, pounding or beating faster (palpitations)
• ringing in your ears (tinnitus)
• dry, itchy skin or a feeling of crawling on your skin
• dry eyes
• vaginal dryness and painful sex
• less sensitivity in your clitoris
• tissue loss in your labia
• sore breasts
• changes with body shape and weight gain
• hair loss.

You might get some or all of these symptoms. Everyone is different. Talk to your GP if any symptoms begin to make your life difficult.

Read more about menopause symptoms on the Jean Hailes website. You can also listen to the Queensland Health podcast episodes on menopause symptoms.

Managing your symptoms

You can manage most symptoms with:

• hormone therapy
• lifestyle changes
• low impact exercise and resistance training
• non-hormonal medicines.

Find the combination that works well for you. It's likely to change over time as your symptoms develop and change.

Read more about menopause on the healthdirect website. You can also find videos in different languages on the Australasian Menopause Society website.

Menopausal hormone therapy

Menopausal hormone therapy (MHT) replaces hormones in your body lost through menopause. It was previously called hormone replacement therapy (HRT) and comes in different forms, including tablets, patches and gels.

If you have a womb you can have:

• combined oestrogen and progesterone
• oestrogen with a SERM (selective oestrogen receptor modulator)
• tibolone (a synthetic steroid that acts like a combination of hormones).

If you don't have a womb you can have:

• oestrogen only
• tibolone.

Hormone therapy works well for treating symptoms like hot flushes, vaginal dryness and joint aches. It can also help with your sleep and reduce your risk of osteoporosis, heart disease and type 2 diabetes. There can be risks and side effects, and not all women can use it. Your GP will talk to you about the benefits and risks and other options.

If you're not able to use other hormone therapies, most women can still use vaginal oestrogen. It comes in a cream or in tablet form. It can help bladder and vaginal symptoms like painful sex. You can often use it even if you've had breast cancer.

Read more about hormone therapy on the healthdirect website. You can also listen to the Queensland Health podcast episode on menopausal hormone therapy.

Lifestyle changes

Making changes to your routine, diet and activity levels can help with some menopause symptoms.

Try introducing:

• mindfulness and relaxation to help with anxiety
• a bedtime routine that helps you sleep better
• pelvic floor exercises to help with pee leaking
• regular low impact activities, like swimming and walking to help with muscle and joint pain
• a healthy, balanced diet with a lot of fibre to help with bloating.

For more advice read about:

• guided breathing and relaxation exercises on the Beyond Blue website
• good sleep habits on the Sleep Health Foundation website
• pelvic floor exercises on the Pelvic Floor First website
• getting started with exercise on the Health and Wellbeing Queensland website
• eating well on the Eat for Health website
• healthy bones on the Healthy Bones Australia website Osteoporosis Prevention - Healthy Bones for Life without Fracture.

You can reduce hot flushes by avoiding triggers like spicy foods, caffeine, alcohol and hot drinks. Managing your environment to avoid sudden body temperature changes can also help.

Non-hormonal medicines and other tools

Your doctor can prescribe non-hormonal medicines that help with menopause symptoms. These might include:

• antidepressants
• pain medicines
• blood pressure medicine
• medicine to treat hot flushes and sweats
• creams, gels or tablets to help with vaginal dryness and irritation.

You can also use things like:

• lubricants to make sex less painful
• hot and cold packs on muscle or joint pains
• cold packs and fans to help with hot flushes
• vitamins and supplements.

Talk to your GP or pharmacist for advice before taking any supplements.

When to get help

If your symptoms are affecting your life and relationships, talk to someone. There's information about accessing menopausal support in the Queensland Health podcast.

If you get any vaginal bleeding after your period has stopped permanently, talk to your GP straight away.

Information for First Nations women

Jean Hailes has information on menopause to support First Nations women.

Information in other languages

The Australian Menopause Society has videos in other languages about how menopause will affect your health and treatment options.

Jean Hailes has women’s health fact sheets in other languages and translated videos.