Menopause is a natural stage of life that marks the end of a person’s reproductive years. It occurs when the ovaries gradually stop releasing eggs and produce lower levels of the hormones oestrogen and progesterone. As a result, menstrual periods stop permanently.
Before menopause, many people experience perimenopause, a transitional stage during which hormone levels begin to change. During this time, periods may become irregular and a range of physical and emotional symptoms may occur.
Menopause is not an illness or disease. It is a normal biological process. Understanding what to expect can help people recognise normal changes, manage symptoms and know when medical advice may be needed.
What is Perimenopause?
Perimenopause is the transition leading up to menopause.
During this stage, hormone levels fluctuate, causing changes in the menstrual cycle and other symptoms.
Perimenopause often begins in a person’s 40s, although it may start earlier or later. It can last for several months or several years before menopause occurs.
What is Menopause?
Menopause is reached when a person has gone 12 consecutive months without a menstrual period, and there is no other medical explanation for the absence of periods.
The average age of menopause is around 51 years, but it can occur earlier or later.
Menopause is a normal part of ageing.
What is Postmenopause?
Postmenopause is the stage after menopause.
Once menopause has occurred, menstrual periods do not return. Hormone levels remain lower than during the reproductive years.
Although menopausal symptoms often improve over time, lower oestrogen levels may increase the risk of conditions such as osteoporosis and cardiovascular disease. Regular healthcare check-ups remain important.
What Happens During Menopause?
As the ovaries produce less oestrogen and progesterone:
• ovulation becomes less regular;
• menstrual periods become irregular;
• fertility declines;
• menstruation eventually stops permanently; and
• hormone changes may cause physical and emotional symptoms.Signs and Symptoms
Symptoms vary from person to person.
Common symptoms include:
• irregular periods;
• hot flushes;
• night sweats;
• difficulty sleeping;
• mood changes;
• irritability;
• anxiety;
• vaginal dryness;
• discomfort during sexual intercourse;
• reduced sexual desire;
• difficulty concentrating or memory changes (“brain fog”);
• headaches;
• joint or muscle aches; and
• changes in bladder control, such as needing to urinate more often.Some people experience only a few mild symptoms, while others find symptoms more disruptive.
Changes in Menstrual Periods
One of the earliest signs of perimenopause is a change in menstrual periods.
Your periods may become:
• closer together;
• further apart;
• lighter than usual;
• heavier than usual;
• shorter; or
• longer.Some months you may skip a period altogether before it returns.
These changes are common during perimenopause.
However, very heavy bleeding, bleeding after sexual intercourse or bleeding after menopause is not considered normal and should always be assessed by a healthcare professional.
Can You Become Pregnant During Perimenopause?
Yes.
Although fertility declines with age, pregnancy is still possible until menopause has occurred.
If you do not wish to become pregnant, continue using contraception until advised by a healthcare professional that it is no longer needed.
Early Menopause and Premature Menopause
Some people experience menopause before the age of 45.
Menopause before the age of 40 years is sometimes called premature menopause or may occur because of Primary Ovarian Insufficiency (POI).
Possible causes include:
• certain medical conditions;
• genetic factors;
• surgery to remove the ovaries;
• cancer treatments such as chemotherapy or radiotherapy; or
• sometimes no clear cause is identified.Early menopause should be assessed by a healthcare professional.
Managing Menopausal Symptoms
Many people manage menopause successfully with lifestyle changes, while others benefit from medical treatment.
Helpful strategies include:
• eating a balanced diet;
• engaging in regular physical activity;
• maintaining a healthy weight;
• getting enough sleep;
• limiting smoking and excessive alcohol consumption;
• managing stress; and
• attending regular healthcare check-ups.For some people, healthcare professionals may recommend treatments such as Menopausal Hormone Therapy (MHT) or non-hormonal medicines, depending on individual circumstances.
Treatment should always be discussed with a qualified healthcare professional.
Possible Long-Term Health Effects
Lower oestrogen levels after menopause may increase the risk of:
• osteoporosis (weakened bones);
• fractures;
• cardiovascular disease; and
• vaginal and urinary symptoms.Healthy lifestyle habits and regular medical care can help reduce these risks.
When Should You See a Healthcare Professional?
Seek medical advice if you:
• experience symptoms that significantly affect your quality of life;
• have menopause before the age of 45;
• have not had a period for 12 months but then begin bleeding again;
• experience very heavy or prolonged bleeding during perimenopause;
• bleed after sexual intercourse; or
• have concerns about treatment options.Bleeding after menopause should always be assessed promptly because it may be a sign of a serious underlying condition.
Myths and Facts
Myth: Menopause happens suddenly.
Fact: Most people go through perimenopause, during which hormone levels change gradually over several years.
Myth: Every person experiences severe menopausal symptoms.
Fact: Symptoms vary widely. Some people have very few symptoms, while others require treatment.
Myth: You cannot become pregnant during perimenopause.
Fact: Pregnancy is still possible until menopause has occurred.
Myth: Bleeding after menopause is normal.
Fact: Any vaginal bleeding after menopause should be assessed by a healthcare professional.
Frequently Asked Questions
- At what age does menopause usually occur?
The average age is around 51 years, although menopause can occur earlier or later.
- How do I know if I have reached menopause?
Menopause is confirmed after 12 consecutive months without a menstrual period, provided there is no other medical cause.
- Can menopause be treated?
Menopause itself is a natural stage of life and does not require treatment. However, treatments are available to help manage troublesome symptoms.
- Will my periods stop suddenly?
Not usually. Most people experience changes in the timing, length and flow of their periods during perimenopause before they stop completely.
Key Messages
• Menopause is a normal stage of life that marks the end of menstrual periods and the reproductive years.
• Perimenopause is the transition before menopause and often causes changes in the menstrual cycle.
• Menopause is confirmed after 12 consecutive months without a menstrual period.
• Symptoms vary widely, and effective treatments are available for those who need them.
• Pregnancy is still possible during perimenopause.
• Bleeding after menopause is not normal and should always be assessed by a healthcare professional.Related Articles
• Understanding the Menstrual Cycle
• Irregular Periods
• Amenorrhoea (Absent Periods)
• Polyendocrine Metabolic Ovarian Syndrome (PMOS)
• Primary Ovarian Insufficiency (POI) (coming soon)Knowledge Hub Series: Period Talk Uganda – Evidence-Based Menstrual Health Resources