Menopause

Menopause is the natural, permanent end of menstrual periods, marking the end of a woman's reproductive years. It is officially confirmed retrospectively, after 12 consecutive months without a menstrual period, and typically occurs between ages 45 and 55, with the average age around 50. Menopause results from the natural decline in ovarian function and the hormones oestrogen and progesterone, and is preceded by a transitional period called perimenopause, which can last several years and is when most of the noticeable symptoms begin. Menopause is a normal life stage, not a disease, but the hormonal changes involved can cause symptoms significant enough to affect quality of life, and effective treatments are available for women who need them.

Symptoms vary widely between individuals in both type and severity: • Hot flushes and night sweats, sudden sensations of heat often accompanied by sweating and flushing of the face and chest • Irregular periods during perimenopause, before they stop altogether • Vaginal dryness and discomfort during intercourse • Sleep disturbance, often related to night sweats • Mood changes, including irritability, anxiety, or low mood • Difficulty concentrating or mild memory lapses ("brain fog") • Reduced libido • Joint aches • Changes in skin and hair texture, and weight redistribution, particularly increased abdominal fat

Menopause is caused by the natural, age-related decline in the number and function of ovarian follicles, leading to progressively lower and eventually absent production of oestrogen and progesterone. This is a normal, expected biological process rather than a disease. Menopause can also be induced earlier than the natural average by surgical removal of the ovaries, certain cancer treatments (chemotherapy or pelvic radiation), or, less commonly, occur spontaneously before age 40 (premature ovarian insufficiency).

• Age: the strongest factor, with natural menopause typically occurring between 45 and 55 • Smoking, which is associated with menopause occurring one to two years earlier on average • Family history: age at menopause tends to run in families • Surgical removal of the ovaries or certain cancer treatments, which cause immediate or early menopause regardless of age • Certain autoimmune conditions, which are associated with earlier menopause

• Osteoporosis: the decline in oestrogen accelerates bone loss, significantly increasing fracture risk after menopause • Increased cardiovascular disease risk, as oestrogen's protective effect on blood vessels is lost • Vaginal and urinary changes (genitourinary syndrome of menopause), causing dryness, discomfort, and increased urinary tract infections • Significant impact on sleep, mood, and quality of life in women with severe symptoms • Weight redistribution and metabolic changes that increase the risk of type 2 diabetes

Menopause itself is a natural process that cannot, and does not need to, be prevented. The focus instead is on managing symptoms and reducing the long-term health risks that follow the loss of oestrogen's protective effects: • Weight-bearing exercise and adequate calcium and vitamin D intake support bone health • Regular cardiovascular exercise and a heart-healthy diet reduce cardiovascular risk • Avoid smoking, which worsens symptoms and accelerates bone and cardiovascular risk • Hormone replacement therapy (HRT) is highly effective for moderate-to-severe symptoms in appropriately selected women, and non-hormonal treatments are available for those who cannot or prefer not to use HRT • Regular health screening, including bone density and cardiovascular risk assessment, is recommended after menopause