Menopause: Symptoms, Stages and Ways to Find Relief

Menopause is a natural stage of life when periods stop permanently because the ovaries stop releasing eggs and produce much less oestrogen. Many women go through it in their late 40s or early 50s, and studies suggest Indian women often reach menopause a few years earlier than women in Western countries.

The stages

• Perimenopause: the transition, usually lasting several years. Periods become irregular and symptoms begin.
• Menopause: confirmed after 12 months in a row without a period (with no other cause).
• Postmenopause: the years after menopause.

Menopause before 40 is called premature ovarian insufficiency, and before 45 is early menopause: both need medical review, because of longer term effects on bones and heart.

Common symptoms

• changes in periods: shorter or longer cycles, heavier or lighter bleeding
• hot flushes: sudden waves of heat in the face, neck and chest, often with sweating and redness
• night sweats and disturbed sleep
• mood swings, irritability, anxiety or low mood
• difficulty concentrating ("brain fog")
• vaginal dryness and discomfort during sex
• needing to pass urine more often, or more urinary infections
• joint aches
• reduced sex drive
• weight gain around the middle

Symptoms vary greatly: some women barely notice them, while others find them disruptive for years.

Finding relief

Lifestyle

• Keep cool: dress in layers, use a fan, and keep your bedroom cool.
• Identify triggers: spicy food, hot drinks, caffeine, alcohol and stress can set off hot flushes.
• Exercise regularly, including strength and balance training.
• Practise relaxation: yoga, slow breathing and mindfulness may reduce how bothersome symptoms feel.
• Prioritise sleep: see our sleep guide.
• Stop smoking.

Treatment options

• Menopausal hormone therapy (MHT/HRT): the most effective treatment for hot flushes and night sweats. For most healthy women under 60 or within 10 years of menopause, benefits generally outweigh risks. Your doctor will assess your personal and family history.
• Vaginal oestrogen in low doses treats dryness and urinary symptoms with minimal absorption.
• Nonhormonal medicines, such as certain antidepressants, gabapentin and newer targeted treatments, can reduce hot flushes for those who can't or prefer not to take hormones.
• Vaginal moisturisers and lubricants help with dryness.

Herbal and "natural" supplements are widely sold, but evidence is limited and some interact with medicines.

Protecting your long term health

Lower oestrogen after menopause:

• speeds up bone loss, raising the risk of osteoporosis: get enough calcium and vitamin D, and do weight bearing exercise
• raises heart disease risk: check your blood pressure, cholesterol and blood sugar regularly

When to see a doctor

• Symptoms are affecting your daily life or relationships.
• You have any bleeding after menopause: this always needs checking.
• You have symptoms of menopause before age 45.
• You'd like to discuss hormone therapy or other treatments.