Menopause: questions and answers

Dr Sumayya Ebrahim answers questions that readers sent through regarding menopause.

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1. What is menopause?

Menopause literally means the cessation of menstruation. In other words, when your period stops and you have not had one for six to 12 months. For most women, this will happen naturally somewhere between 45-55 years of age. The peri-menopause is the time leading up to this last period. This peri-menopause phase  can last anytime from a few months to as long as a few years.

2. Why does menopause happen?

Menopause occurs when the ovaries (the two small organs on either side of the uterus) are no longer able to produce eggs. During this time, hormone levels like oestrogen and progesterone decline. When this happens, women are no longer able to produce children naturally and a new physiological phase is entered.

Menopause can either occur naturally or happen because of surgical removal of the ovaries. It can even be triggered by medications, like chemotherapy, used to treat breast cancer. Studies have shown that when chemotherapy was used in the treatment of breast cancer in women around 40 to 45 years of age, they were more likely to become menopausal than if chemotherapy was used in younger women.

3. How do I know I am in menopause?

The most common way to know is when your period stops and you’re in the appropriate age range. Blood tests can confirm what you suspect.

4. What is a hot flush?

Hot flushes are the commonest symptom that women mention around the time of menopause. A hot flush occurrs as a rising feeling of heat, starting in the chest and spreading upwards, with sweating behind the neck. It doesn’t last for more than a few minutes. When it is over, you can feel cold and feel the need to cover up. These flushes can occur many times in a day and even lead to waking up at night. They can be extremely distressing, leading to insomnia and anxiety. Trigger events are common. Drinking coffee or red wine can spark them off.

They happen because of the dropping hormone levels, mainly oestrogen, which affect the part of the brain that controls temperature regulation in the body. In simple terms, a ‘short circuit’ occurs.

5. What else can I expect to feel with menopause? 

There are many symptoms, though some women will experience no symptoms at all, except for the absent period. Most women, however, can expect to experience some changes. Different combinations can occur as listed below:

6. Do I have to take hormone replacement therapy?

Not all women are candidates for hormone replacement therapy (HRT). Most women will take it to improve quality of life if they’re struggling with symptoms.

Other women will use it to target specific concerns like osteoporosis or risk of heart disease. Either way, a thorough assessment needs to be made by your general practitioner or gynaecologist first. A recommendation will be made based on your individual situation, balancing your personal risks versus the benefits you can expect. These may vary for different individuals.

7. Can HRT cause cancer?

A landmark study, conducted on HRT, called The Women’s Health Initiative (WHI), found that after five years of usage, the breast cancer risk increased significantly. The risk was highest when oestrogen and progestins were used together as opposed to oestrogen alone. For this reason,  caution is advised in women with a family history of breast cancer.

8. At what age should I stop taking HRT?

This is a decision made on an individual basis. In general, it is continued for the minimum time-period necessary to improve symptoms in the lowest possible dosage; or for a period of five years. The option to continue after this period, depends on personal risk factors for breast cancer and stroke.