World expert on menopause separates fact from fiction
Hot flushes, sleep disturbances and mood swings are some of the most commonly discussed symptoms of menopause yet not all women experience menopause in the same way.

Dr Elizabeth Farrell AM, a world expert in menopause and a founding member of the Jean Hailes for Women’s Health organisation, says this is a common misconception among women. “A bit like the periods, everyone’s experience of menopause is individual to them,” she says. 

Dr Farrell tells us more about the different stages of menopause and how to separate fact from fiction. 

What is menopause? 

“Menopause takes place with the final period. We use the word in a colloquial way, but medically it means final period,” explains Dr Farrell. 

Most women reach menopause between the ages of 45 and 55, with the average for Australian women lying somewhere between 51 and 52 years. 

The different stages of menopause

There are three stages of menopause: perimenopause, menopause and postmenopause.

In perimenopause, oestrogen and progesterone production by the ovaries starts to slow down. This happens over months or years as you approach menopause. Eventually, your hormone levels will decrease to a point where your menstruation will cease. 

“This is a time where periods start to change in frequency and they can become irregular…There are swings between high oestrogen and low oestrogen,” says Dr Farrell. Some women can also experience “double ovulation” during this time. 

“Some women can ovulate twice in their menstrual cycle, once during ovulation and again in their period. Because of the risk of double ovulation, the recommendation is that women over 50 should be using contraception right up until one year after their last period and women under 50, until two years after the final menstrual period,” says Dr Farrell. 

The second stage is menopause. Menopause has taken place if you have not had any bleeding for 12 months. 

After this, women enter what’s called the postmenopause stage. 

What are the common symptoms? 

Symptoms range from hot flushes and night sweats, to vaginal dryness and reduced sex drive, to emotional symptoms such as forgetfulness, lack of self-esteem and irritability.

Should I expect all these symptoms?  

“Expectation is often worse than the experience, in that the majority of women going through menopause have mild to moderate symptoms,” says Dr Farrell.

She says that one in five women don’t experience any symptoms with menopause (apart from their period stopping), another one in five will experience severe symptoms, and the rest will experience very mild to moderate symptoms. 

Factors that affect menopause  

For some women, menopause may be induced by surgery or cancer treatment. This causes a sudden drop in oestrogen and progesterone levels, and as a result, menopause symptoms may be more severe.

There are several factors that affect your experience of menopause. These include cultural background, health, lifestyle and previous experience of mood problems. In fact, according to Dr Farrell there are numerous studies that show a relationship between menopause symptoms and ethnicity or cultural background. 

“Asian women don’t tend to present with hot flushes. These women have slightly lower oestrogen levels, which may be the reason,” she says. 

In a 2007 study of Chinese women living in Sydney, researchers found that while these women still experienced menopausal symptoms, they reported fewer hot flushes and night sweats compared with Caucasian women. In another study by the same authors, this time among Greek Australians, the most commonly reported symptoms related to fatigue, stamina and lower-back aches. 

Managing menopause

In addition to experiencing uncomfortable symptoms, a drop in hormones during menopause may lead to higher risk of osteoporosis and heart disease. 

You can reduce your risk of health problems and manage symptoms with lifestyle changes and treatments, such as hormone replacement therapy (HRT) or natural therapies. 

Lifestyle: Combat fatigue and moodiness with a healthy diet and staying physically active. Keep a small fan or water spray handy to ease hot flushes and sweats, and try meditation, controlled breathing and yoga to deal with stress.  

HRT: Hormone replacement therapy may be suitable for use by women with moderate to severe menopausal symptoms, however there are risks involved and these should be discussed with your doctor.  

Natural remedies: Herbal or natural remedies, such as soy, lentils and St John’s Wort may help with some symptoms, however much like any other medication, these may come with side effects. It’s important to speak to your doctor about natural remedies, especially if you are taking them in conjunction with hormone therapy.