The menopause stage

Dear Dr Mitchell,

How long does the menopause last? I was under the impression that it lasted from the pause of the menses until death — the weird symptoms, that is, but I heard that after a while, the symptoms go away, and a woman is basically post-menopausal. Can you explain the stage?

Menopause is defined as the age at which your menstrual period stops. The average age for the last menstrual period is 51 years. The age range is usually 45 to 55 years old. Once you have reached the menopause you can no longer become pregnant because all of your eggs would have been depleted. Menopause is diagnosed after you have gone 12 months without a menstrual period. It is a natural process of ageing.

In the months or years leading up to the menopause, this period is called the peri-menopause. Symptoms and signs you might experience during those years of the peri-menopause include irregular menstrual periods, vaginal dryness, hot flashes, chills, night sweats, difficulty with sleeping, mood changes and irritability, weight gain and slowed metabolism, hair loss with thinning of the hair, dry skin, and loss of breast fullness with sagging of the breast.

The symptoms will vary among women. Irregularity in the menstrual periods usually occur before they end. Pregnancy is possible in the peri-menopause years even if the periods are irregular, and so a safe, effective form of contraception should be used.

Skipping periods during the peri-menopause is common and the periods tend to occur more frequently with shorter intervals between periods. The menstrual periods may also be missing for several months and so a pregnancy test should be done to rule out pregnancy if you are unsure that you have transitioned into the menopause.

As you age you should do regular health screening tests such as colonoscopy, mammogram and blood test to screen for high blood sugar, cholesterol, and fats in the blood. Routine physical examinations including breast, pelvic examination and Pap smears should be done.

Once your menstrual period has stopped for a year, any bleeding after that should be investigated to rule out cancer of the uterus, ovary, cervix and Fallopian tubes. During the peri-menopause, heavy menstrual bleeding should also be thoroughly investigated to rule out cancer of the uterus, cervix and ovaries.

As you approach your late 30s your ovaries start producing less oestrogen and progesterone and your fertility declines, and by age 51 your ovaries stop releasing eggs and the monthly period stops.

Early menopause may be as a result of surgery to remove the ovaries, chemotherapy, and radiation therapy. About one per cent of women experience menopause before age 40 and this is considered premature menopause. This may be due to genetic factors or auto-immune diseases.

After the menopause, the risk of heart and blood vessel disease increases due to the low oestrogen levels. It is the leading cause of death in women, so regular exercise and a healthy diet to maintain normal weight is important. There is also an increased risk of osteoporosis (brittle and weak bones) with increased risk for fractures of the spine, hips and wrist. There is also an increase in urinary incontinence both stress and urge incontinence. Pelvic floor exercises and the use of vaginal oestrogen cream can help to relieve symptoms. Vaginal dryness and loss of elasticity can cause pain and slight bleeding during sexual activity. There may also be decreased sensation resulting in a decreased desire for sexual activity.

Women should eat less and exercise more during the transition to the menopause because of the slowed metabolism. This will reduce the risk of weight gain that can increase the risk of heart disease and diabetes mellitus. The increased weight gain also increases the risk of breast, uterine, ovarian and colon cancers.

For most women, the symptoms of the menopause last less than five years, but you can have symptoms of the menopause up to ten years.

Consult your doctor who will advise you further and schedule all your routine screening tests and physical examinations.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.