Menopause Symptoms: What to Expect and What Helps

What is menopause?

Menopause is your final menstrual period. Because periods can be irregular in the lead-up, it is only confirmed once you have gone 12 months without one. The years before it are called perimenopause, and the years after are postmenopause.¹

When does menopause start?

The average age in Australia is 51, and most women reach menopause between 45 and 55. Menopause between 40 and 45 is called early menopause. Before 40 it is called premature menopause, or premature ovarian insufficiency.^7,8

Menopause can also happen suddenly after surgery to remove the ovaries, or after some cancer treatments.

Menopause symptoms

Symptoms come from falling and fluctuating oestrogen, and they differ from woman to woman. About eight in ten women have some symptoms, and around one in four have symptoms severe enough to interrupt daily life.^7,8

• Hot flushes and night sweats. The most common symptoms. See hot flushes
• Sleep problems. Night sweats wake many women, and sleep can become lighter even without them. See insomnia
• Mood changes. Irritability, anxiety and low mood
• Aches and pains. Sore joints and muscles are common around menopause
• Vaginal and bladder changes. Dryness, discomfort with sex, needing to pass urine more often and more urinary infections. Doctors call this the genitourinary syndrome of menopause⁴
• Other changes. Trouble concentrating, lower libido, headaches, dry skin and weight shifting to the waist

How long does menopause last?

Menopause itself is one day. The symptoms around it last much longer than most people expect. In a study that followed more than 1,400 women with frequent hot flushes or night sweats, the symptoms lasted more than seven years for over half of them, and continued for about four and a half years after the final period.²

Vaginal and bladder symptoms behave differently. They tend to appear later and usually don’t improve without treatment.⁴

Health after menopause

Lower oestrogen affects more than symptoms. Bone density falls faster in the first years after menopause, and the risk of heart disease rises. Women who reach menopause early have a higher risk of heart disease and stroke before age 60 than women who reach it at 50 or 51, which is one reason early menopause should be assessed and not just put up with.³

Treatments for menopause symptoms

• Menopausal hormone therapy (MHT). The most effective treatment for hot flushes and night sweats, and it also protects bone. For most healthy women under 60, or within ten years of menopause, the benefits are considered to outweigh the risks. The type, dose and whether it suits you depend on your health history^5,6
• Non-hormonal prescription medicines. Several reduce hot flushes for women who can’t use hormones or prefer not to⁶
• Vaginal treatments. Moisturisers, lubricants and low-dose hormonal treatments used in the vagina help dryness and bladder symptoms⁴
• Cognitive behavioural therapy. Reduces how much hot flushes and night sweats interfere with life, and helps sleep and mood⁹
• Exercise. Trials haven’t shown that exercise reduces hot flushes, but it protects bones, heart, mood and sleep, which all matter more after menopause¹⁰

Supplements and herbal products are heavily marketed for menopause. Most have little good evidence behind them, and an expert review advised against relying on them for hot flushes.⁶

Your GP can do a Medicare-funded menopause health assessment once every 12 months.¹¹

When to see a doctor

• Any vaginal bleeding after menopause. It is usually caused by something minor, but it always needs to be checked
• Menopause symptoms before 45
• Symptoms that are disrupting sleep, work or relationships
• Low mood or anxiety that isn’t lifting

References

1. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-68.
2. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.
3. Zhu D, Chung HF, Dobson AJ, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health. 2019;4(11):e553-e564.
4. Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-8.
5. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
6. New Collective Author. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
7. healthdirect. Menopause.
8. Jean Hailes for Women’s Health. Menopause.
9. Ayers B, Smith M, Hellier J, et al. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012;19(7):749-59.
10. Daley A, Stokes-Lampard H, Thomas A, et al. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2014;2014(11):CD006108.
11. Australian Government, MBS Online. Item 695: Menopause and perimenopause health assessment.