What is the menopause and what are the main symptoms?
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Every woman goes through the menopause, and symptoms normally start in the mid-40s.
What happens to the body during menopause, and what treatments are available?
What is the menopause?
The menopause describes the end of a woman's reproductive years, and normally happens around the age of 51.
The lead-up to this happening is known as the peri-menopause. It starts, on average, at 46.
This is when many women notice their periods becoming unpredictable - heavier, lighter, longer or shorter - and experience feelings or physical problems they haven't had before.
The menopause has happened when a woman hasn't had a period for 12 months.
For some, it can happen earlier in their life - either naturally, or as a result of treatment for another condition.
What happens to the body during the menopause?
Hormone levels change during menopause - most significantly oestrogen, which controls the menstrual cycle and contributes to a number of other bodily processes.
As women age, the ovaries produce fewer eggs, oestrogen levels fluctuate and then gradually reduce, and this leads to menopausal symptoms.
It can take several years for oestrogen to fall to low levels, and the drop causes a number of changes to the body along the way.
Once the ovaries have stopped producing eggs altogether, pregnancy is no longer possible and the menopause happens.
What are the main symptoms of the menopause?
The menopause - and the years leading up to it - affect women in different ways.
The brain, periods, skin, muscles and emotions are all affected by falling levels of oestrogen.
Women can have some, all or none of the common symptoms - and for varied lengths of time:
heavy or irregular bleeding
hot flushes
night sweats
low mood
vaginal dryness
bladder problems
Poor memory and concentration, usually called brain fog, is also often mentioned, as are painful joints and dry skin.
Not all women get symptoms - but most do, around 75%. A quarter of women say they are severe.
Symptoms last for an average of seven years, with one in three women experiencing them for even longer.
Falling oestrogen production can also have a long-term effect on the bones and heart.
Women can still get pregnant if their periods are irregular - experts advise using contraception until the age of 55.
If you're taking the pill it may be more difficult to know when you've reached the menopause because it also affects your periods.
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What causes hot flushes?
Oestrogen helps regulate the body's thermostat in the brain.
Normally, the body copes well with temperature changes, but when oestrogen levels start to drop, the thermostat goes wonky and the brain thinks the body is overheating when it's not.
Oestrogen can affect mood too. The hormone interacts with chemicals in brain receptors which control mood, and at low levels it can cause anxiety and low mood.
How do other hormone levels fluctuate during the menopause?
Progesterone and testosterone levels also change - but this doesn't have the same impact as falling oestrogen.
Progesterone helps to prepare the body for pregnancy every month, and levels fall when ovulation ceases and periods stop.
Testosterone, which women produce in high levels, has been linked to sex drive and energy levels.
It declines from the 20s onwards, and some women need it topped up.
What treatments can reduce menopause symptoms?
A growing number of women take hormone replacement therapy (HRT), external to alleviate menopause symptoms.
HRT tops up and stabilises oestrogen levels, sometimes in combination with a synthetic version of progesterone.
But it may not suitable for people who have a history of some cancers, blood clots and high blood pressure.
Women may also be able to improve how they feel by:
eating a balanced diet, low in fat and high in calcium to strengthen bones and protect the heart
exercising regularly, to reduce anxiety, stress and guard against heart disease
stopping smoking, to prevent heart disease and hot flushes
avoiding alcohol, to reduce hot flushes
There is even some research that suggests eating plant oestrogens - contained in soy and red clover - could help with symptoms. Vitamin D supplements could improve bone health.
Talking therapy known as CBT (cognitive behavioural therapy) may be offered to women over 40, alongside HRT or, if the patient's individual circumstances call for it, in place of it.
That is according to the latest guidance, external for health professionals in England and Wales.
This marks a change from earlier draft guidelines, published in late 2023, which suggested that talking therapy could replace HRT as the default treatment.
Is there a test for the menopause?
Tests are sold and marketed for diagnosing the menopause, but experts agree that they are not useful after the age of 45.
A better approach is to talk to a GP or nurse about the pattern of your periods and any symptoms you are experiencing.
The tests measure levels of a hormone called FSH (follicle-stimulating hormones). However, hormone levels go up and down all the time, even during the course of a day, so the test can't really pin down what's going on.