What is menopause?

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Menopause in women is considered to have occurred 12 months after their final menstrual period.

It is a normal reproductive stage and, on average in Australia, occurs around age 51. Women can experience changes during the stages of the menopause transition or due to early or medically induced menopause.

The menopause transition

The menopause transition is a life stage that includes three phases: perimenopause, menopause (defined as the day 12 months since the last menstrual period) and post-menopause.

At post-menopause, ovulation no longer occurs, periods stop permanently and the ovaries stop producing oestrogen and progesterone.

Most women experience a natural menopause transition between age 45 and 55 years, with the average age of onset at around 51 years. Early menopause can occur before the age of 40 due to natural ovarian function ceasing (premature ovarian insufficiency or POI), or due to medical causes such as surgery, chemotherapy, radiotherapy or hormonal treatment.

Menopause-related changes and symptoms can last for years. Symptoms and severity can vary widely, with some causing potential long-term health impacts.

Changes can include:

  • irregular menstrual cycle
  • vasomotor symptoms (hot flushes and night sweats)
  • genitourinary symptoms (e.g. bladder symptoms, vaginal changes and vulval dryness)
  • sexual dysfunction (including loss of libido and painful intercourse)
  • effect on mood and mental health (e.g. depressive symptoms, increased anxiety)
  • musculoskeletal changes (aches and pains, loss of bone density)
  • cognitive changes (inability to focus, memory issues, vulnerability to dementia)
  • cardiac changes (increased cardiac risk)

Severe and complex menopause

Up to one in four women experience severe and debilitating symptoms associated with menopause.1

NSW Health defines severe menopause as symptoms that are disabling and impact an individual's quality of life, employment and personal relationships despite treatment in primary care.

Management is defined as complex when menopause occurs:

  • early (POI)
  • secondary to medical treatments, such as chemotherapy, radiotherapy or surgery
  • in women who have a complex medical history.

Referral to NSW Health menopause services can support the management of menopause when it is severe and/or complex.

References

  1. Gartoulla P, Worsley R et al. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause. 2015;22(7):694-701. DOI: 10.1097/GME.0000000000000383
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