What is menopause?



~95% of women experience menopause after the age of 45


FSH and LH are produced by the pituitary, a small endocrine gland located at the base of the brain. Each month, FSH and LH are involved in the production of an egg from our ovaries. As the number of eggs diminishes with ageing, the brain produces increasing levels of FSH and LH to encourage the ovaries to keep ovulating. Therefore, these levels can be raised before the last period occurs, which means it’s not a reliable test for the diagnosis of menopause. Raised levels of FSH and LH are in keeping with perimenopause. During the menstrual cycle, FSH levels rise and then fall; therefore, the test needs to be done at a certain stage of the cycle, usually at the start of your period (days 2-4).

The thyroid is an endocrine gland located at the front of your neck, below the voice box. The thyroid produces hormones that regulate metabolism and other biological functions. It also influences nearly every organ in the body, including the reproductive system. At times, the thyroid can produce too many or too few hormones. An underactive thyroid (hypothyroidism) can cause symptoms similar to those of perimenopause, such as abnormal uterine bleeding and irritability. It is common and affects nearly 5% of women.

When this happens, the pituitary gland in the brain floods the bloodstream with thyroid stimulating hormone to stimulate the thyroid gland to produce more thyroid hormones to meet the body's needs to regulate systems such as body temperature, metabolism, and heart rate. Low oestrogen affects the thyroid gland’s ability to produce enough triiodothyronine (T3) and thyroxine (T4) to meet the body’s needs to regulate things such as your body's temperature, metabolism, and heart rate. As well as the effect of declining oestrogen levels on the thyroid, the function of the thyroid itself declines as we age, albeit slowly. High TSH is indicative of an 'underactive' thyroid. Moodiness, forgetfulness, depression, abnormal uterine bleeding, and weight gain are all associated with both hypothyroidism and the perimenopause. That said, hyperthyroidism (i.e., an overactive thyroid gland) also produces similar symptoms such as disturbed sleep, palpitations, sleep intolerance, and hot flushes.

Given the overlap of symptoms of hypothyroidism and perimenopause, blood tests to assess thyroid function may be necessary. If the thyroid gland is underactive, your GP will prescribe thyroid replacement therapy.


51% say it affects their relationship


Surgical menopause occurs when both ovaries are surgically removed. This may be part of treatment for severe endometriosis, chronic pelvic inflammatory disease, or cancer. Women who carry particular gene faults that put them at an increased risk of ovarian cancer will also be advised to undergo surgical menopause between the ages of 35 and 40.

Removal of the ovaries causes an abrupt menopause, with women often experiencing more severe menopausal symptoms than if they were to experience menopause naturally. It is advisable to discuss treatment options pre-surgery if possible. In the absence of contraindications, Menopause hormone therapy (MHT) should be considered, particularly if under 45 years of age.

Certain chemotherapy drugs can result in early or premature menopause in many women. The likelihood of spontaneous ovarian recovery depends on the type of chemotherapy used, the woman's age, and the number of eggs remaining in the ovary prior to chemotherapy.

Primary ovarian insufficiency occurs when the ovaries stop functioning as they should before age 40. When this happens, your ovaries don't release eggs regularly, resulting in a decline in oestrogen. Women with ovarian insufficiency can have irregular or occasional periods for years and may fall pregnant if not using contraception.

Menopause hormone therapy (MHT) should be offered to women with POI (unless contraindicated), as there are significant long-term health benefits (bone and heart health).

Early menopause is when a woman under 45 goes through menopause, while premature menopause (or premature ovarian failure) occurs in women under 40. It can negatively impact a woman’s ability to fall pregnant.

If you want to have children, ask your doctor to refer you to a fertility specialist. There may be ways to preserve or enhance your fertility.