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A middle-aged menopausal women looking confident and smiling

MENOPAUSE
– AN OVERVIEW

The transition from the reproductive period to menopause begins with the perimenopause stage. During perimenopause, women experience marked fluctuation in levels of sex hormones, including a decline in oestrogen and persistent irregularity of the menstrual cycle. Menopause is defined as the cessation of menstrual periods for at least 12 months. The postmenopausal stage of life starts at menopause.1,2

Line graph of the stages of menopause: perimenopause, menopause, and postmenopause.
Line graph of the stages of menopause: perimenopause, menopause, and postmenopause.

During the menopausal transition, many women experience sleep disturbances, anxiety, depression, migraine, changes in cognitive performance, and vasomotor symptoms, as well as numerous physical changes.¹

 

Physical changes can continue long into postmenopause:¹

  • Changes in body shape related to 
cardiometabolic changes

  • Increased risk of cardiovascular events

  • Hair loss

  • Sexual dysfunction
  • Musculoskeletal alterations, including osteoporosis

  • Ageing of the skin

  • Vulvovaginal atrophy

Onset and duration of menopausal symptoms

On average, women can expect to experience about 30 years of postmenopausal life. In other words, many will be postmenopausal for a third of their lives. For about 50% of women, some menopausal symptoms begin around 2 years before their final menstrual period, while other studies have shown that women may experience symptoms much earlier. When looking at duration of symptoms, a study found that a third of women aged 65 to 79 years still reported at least 1 symptom.1,3-6

Impact on women’s lives

Although menopause is a natural transition, its symptoms occur when many women are handling a full-time job, actively raising a family, and caring for ageing parents.¹ The impact of individuals’ quality of life (QOL) can be significant. Women may experience VMS, sleep problems, fatigue, anxiety, and depression, that may impact the ability to work and carry out day-to-day activities.7

References:

  1. Monteleone P, Mascagni G, Giannini A, et al. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol 2018;14(4):199-215.
  2. Santoro NF. Menopause. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A Clinician’s Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society 2019:1-21.
  3. Freeman EW, Sammel MD et Sanders RJ. Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort. Menopause 2014;21(9):924-32.
  4. Biglia N, Cagnacci A, Gambacciani M, et al. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric 2017;20(4):306-312.
  5. Zeleke BM, Bell RJ, Billah B, Davis SR. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study. Fertil and Steril 2016;105(1):149-155.
  6. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015;175(4):531-539.
  7. Nappi RE, Kroll R, Siddiqui E, et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause 2021; 28(8):875-882.