MENOPAUSE

A guide to understanding the menopause

MENOPAUSE: A guide to understanding the menopause

This work is licensed under the Creative Commons Attribution 4.0

International License. To view a copy of this license, visit
http://creativecommons.org/licenses/by/4.0/

About this booklet

The aim of this booklet is to help answer some of the questions

women may have about the menopause. It explains what the
menopause is, what can be expected with menopause, and
provides information about how to manage some of the symptoms
that women may experience.

This booklet was developed in collaboration with South African

women who advised us on what information should be included
and helped us to design it. We also worked closely with researchers,
healthcare professionals and menopause specialists.

Acknowledgements

We thank the following women in South Africa for their advice:

Sarah, Lerato, Agnes, Refilwe, Anna, Constantia, Nelly, Pauline, Bina,
Grace, Wendy, Pricilla, Matha, Busisiwe, Constance, Cindy, Teressa

Thanks to Professor Lineo Matsela, Sefako Makgatho Health

Sciences University, Council member, South
African Menopause Society

Thanks to Dr Nicole Jaff, North American Menopause Society

Certified Menopause Practitioner (NCMP), Department of Chemical
Pathology, National Health Laboratory Service and University of the
Witwatersrand Faculty of Health Sciences, South Africa,
Council member, South African Menopause Society

Thanks to Dr Trudy Smith, Gynaecological oncologist, Wits Donald

Gordon Medical Center, South African Menopause Society President
2019-2021, Council member, South African Menopause Society.

Endorsed by the South African Menopause Society (SAMS).

If you would like more information about the menopause, please

visit the South African Menopause Society (SAMS) website at
https://www.menopause.co.za/

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What is the The menopause is when a woman no
longer has her periods. It is the last day
menopause?
of a woman’s last period ever and when
she has gone for 12 months (1 year)
without any period at all. Some women
call it the ‘change of life’. It is a normal
part of getting older and happens to
every woman.

What causes the

menopause?

Menopause is caused by changes in the

hormones in your body. Hormones are
chemicals produced by the body that
signal to organs and tissues to tell them
what to do. From the first time you had
your period, these hormones have
helped you have regular periods every
month and have caused ovulation
(when an egg from your ovaries inside
your body, is released each month so
that you can have a baby). When you
reach menopause (remember, this is 12
months after your last menstrual
period) your ovaries no longer release
an egg every month, so you can’t
become pregnant anymore.

3
 What happens You don’t usually become menopausal suddenly, it
when you are in can happen slowly. In the time leading up to
menopause? menopause your hormones start to rise and fall
causing some changes in your body that you may or
may not be aware of. The time when you are
moving towards menopause is called the
‘perimenopause’, or the menopause transition, and
you may notice some physical and emotional
changes happening to you.

In perimenopause you will notice that your periods

start to change. These changes are often different in
each woman. Sometimes you will miss a period for
a month or two and then they start again,
sometimes periods are much heavier than usual or
much lighter. These changes can carry on for a few
months or even years before periods stop
completely. In some women periods can just stop
suddenly. Every woman’s experience is different.

How do you know when

you are in menopause?

If you are in your mid-40’s or older and haven’t had a period at all for 12 months
in a row you can usually be confident that you are in menopause. However,
certain things such as losing too much weight, lots of stress and unhealthy
lifestyle habits like smoking and drinking too much alcohol, can also cause your
periods to stop. So be aware if there are other reasons for your periods to stop or
change. It is important to know that menopause symptoms can be similar to
some changes caused by certain health problems that may not be caused by
your ovaries getting older, so it’s good to be aware of these. If you don’t think that
the reason for these health issues and symptoms is because you are moving
towards your menopause, you should talk to your doctor or clinic sister. They
might refer you to a gynaecologist who may do some blood tests to help confirm
whether you have reached menopause or have a health problem.

4
What symptoms
Most women will experience some menopausal symptoms.
can you get with
These will probably start some time before you have your
the menopause? last period. These symptoms can be uncomfortable and
sometimes very troublesome. Symptoms include:

● Hot flushes (suddenly feeling very hot) on the face, neck and chest along
with night sweats
● Tender breasts.
● Irritability and emotional feelings
● Memory problems (forgetting things or not concentrating well)
● Mood problems (feeling anxious or depressed)
● Battling to sleep well or to stay asleep
● Weight gain
● Muscle and joint pains
● Dryness of the vagina and eyes

Perimenopause can last up to 9 years. All women are different, so how you
experience menopause may not be the same as your friends. Although you
and many other women may struggle in the years leading up to menopause,
some women have no problems at all. Once you are fully into menopause
the hot flushes and other symptoms usually stop although some women,
especially those women who experience a sudden menopause due to
having an operation to remove their womb or who receive certain medicines
that are only used sometimes for specific illnesses, may experience
symptoms into their 80’s. Most women get a dry vagina which may cause
sex to be uncomfortable or painful. A low sex drive (not wanting to have sex)
is also common and some women experience urinary problems (pain when
urinating or urinary infections) after they have reached the menopause.

How do The changes in your hormones can cause changes to your body.
women’s In the time leading up to the menopause your breasts can
often feel bigger and sometimes very tender. It becomes easier
bodies
to put on weight, and at this time, some women also eat
change when unhealthy food when they are feeling anxious or depressed to
they go make them feel better. But this feeling doesn’t last long, and
through the you may feel even more depressed if you are overweight. The
information below will explain how you can maintain a healthy
menopause?
weight during menopause. You may also find that you lose
some hair and some women find that they grow hair on their
faces. You may also find that your eyes feel dryer.

5
 What can you do to
Dealing with hot flushes and night sweats
manage symptoms?
● Wear loose comfortable clothes that are made only
of cotton, so that the fabric breathes.
● Wear layers so you can take something off if you get
too hot.
● Carry a small spray bottle of water and spray it on the back of your neck and
wrists and knees when you feel a hot flush coming on. Keep one next to your
bed at night.
● Don’t have spicy food like curry, or very hot food and soup. Drink tea or coffee at
room temperature.
● Don’t overeat or drink too much alcohol or caffeinated drinks like coffee.
● Don’t smoke.
● Exercise regularly or be as physically active as possible.
● Stress can make you have a hot flush, so try to relax and stay calm.
● If you feel stressed practice breathing calmly. Breathe in through your nose with
your mouth closed for four counts. Hold the breath for four counts and let it out
slowly through your mouth for four counts. Repeat this for a minute or two.

Dealing with weight gain

● Eating a healthy diet and being physically active are very important. See below for
more information on this.

Dealing with uncomfortable sex

● If sex is uncomfortable, there are creams and moisturizers that sometimes help
with vaginal dryness. Lubricants (gels) can also help to make sex more comfortable.
These can be bought from local pharmacies. Please note these must not have any
perfumes or flavourings. Please do not use household products such as cooking oil
or Vaseline. This is because they may cause infection and damage condoms if you
are using them.
● Doctors can also prescribe estrogen cream that can be applied to a dry vagina.
This can be used twice a week to relieve painful sex due to menopause.

Hormone Therapy
● Hormone Therapy (HT) is the most effective treatment if you are really battling with
symptoms such as hot flushes. Your doctor will advise you of the risks and benefits.
If you take HT, you must have a thorough medical examination and then an annual
gynaecological examination and a mammogram. Tell your doctor your family and
medical history. Take the smallest, effective amount of HT for the shortest possible
time. Each year check with your doctor to see whether you still need to use it.
● For women who can’t take HT, there are sometimes other treatments. Ask your
doctor or clinic sister about these.

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How should women look after themselves as they enter midlife?
How should women look
after themselves
As many women putgoing
on some weight, it is very important to watch what you eat
into midlife?
and have a healthy diet. To do this you should aim to:

Fresh fruit and Brown foods are good

vegetables are low for your heart and help
in fat and contain you stay healthy. These
lots of essential include oats, brown rice
vitamins and Mabela and brown
minerals. bread.

Calcium helps to keep your bones Protein helps you to build

milk
strong and is very important for muscle and stay strong. Foods
women in menopause. These include that contain protein include
dairy, e.g. milk and yoghurt, bony fish beans and peas, sugar free
e.g. sardines and pilchards, and green peanut butter, fish, chicken
leafy vegetables like spinach. and meat e.g. lamb or beef.

Only eat as much food as you need: It is Eat less ‘white’ starchy
important that you only eat as much foods: White starchy foods
as you need to stay healthy are not as healthy as brown
and active. If you eat more foods. These white starchy
than this you will gain weight, foods include white pap,
even if the food is healthy. white rice and white bread.

Fat is an important part of your diet. Cut down on sugary foods, sweets and drinks:
Healthy fats include avocados, canola oil They are not healthy and make you gain
and olive oil. But you should try to avoid weight. It can be hard to give up sweet things
eating too much unhealthy fat found in but begin by gradually having less sugar in
cakes, biscuits, pastries and butter, as your tea or coffee and you will get used to
these may make you gain weight. having less sugar and still enjoy your hot drink.

Eat less salt: Salt is one of the Drink plenty of water: Drink at least 6 glasses
main causes of high blood of water daily.
pressure. To reduce your salt, try
to eat fewer salty snacks like
chips and avoid adding salt to
your cooking and meals.

Stay active: It is important to be as physically active as you can, and

try not to sit for long periods of time. You should aim to do at least 3
hours of moderate or vigorous intensity physical activity each week.
This includes brisk walking, dancing and busy housework. If you are
not used to being physically active, start slowly and build up to doing
more gradually. Regular exercise can help you sleep better.

7
 What happens At what age do
Each month when you are a young woman, the hormones
in your body make your womb ready in case you get to the blood women go through The menopause is a natural part of
pregnant. They do this by building up the womb lining. If from your getting older and can happen between
the menopause?
you don’t get pregnant the womb lining bleeds away and 45 and 55 years of age. The average age
period when
the blood comes out through your vagina. After each for a woman to reach the menopause
you go through is around 50 years old.
period the womb gets ready again, just in case you might
get pregnant, and this goes on every month until you reach the
menopause. When you can no longer get pregnant menopause?
(because your ovaries stop releasing an egg each month),
the womb doesn’t need to prepare for pregnancy, and no
lining is built and you don’t bleed anymore. It is important
Why is age at menopause
to remember that if you have not bled at all for 12 months
and then start to bleed again, even if it is a small amount different for different women?
of blood, then you must see your clinic sister and/or doctor.

All women are different and just as you started your periods at an
Can going through the menopause affect earlier or later age than your friends, you may have your
menopause earlier or later than other women you know. Several
your sex life?
things can affect the age at which you will become menopausal.
The most important is the age at which your mother reached
menopause, so you will probably become menopausal around the
When you become menopausal, changes in hormones may mean same time. But this is not always true, and there are other factors
that you may feel less desire for sex. In addition, a dry vagina can that can affect your age at menopause. These include certain
make sex uncomfortable and sometimes painful. However, there illnesses and health conditions, some medications, treatment for
are helpful treatments for a dry vagina, and sexual desire may cancers, and also your lifestyle. Smoking is a reason why some
improve when your menopausal symptoms become less severe. women have an earlier menopause, because smoking can
damage your ovaries so they don’t work as well as they should. So
if you smoke but your mother didn’t it is likely that you will reach
menopause earlier than she did. If you are very, very thin your
periods may stop, and you may have an early (premature)
Can you still get pregnant when you menopause.
are going through the menopause?

When you have finally reached the menopause (at least one year after
Can menopause No. However, it is always
your last period) you can no longer get pregnant. But if you do not
want to have a baby, be careful not to become pregnant by mistake.
cause health important to be responsible
problems such for your health. Always
Even if your periods are not regular when you are getting older, you
report any unusual
can still become pregnant. Until you are absolutely sure that you as cancer?
symptoms to your clinic
haven’t had a single period for at least 12 months, you should still
sister and/or doctor.
use contraception during sex if you do not want to get pregnant.

8 9
 Can the
menopause Changes in hormones affect your bones, and after the
affect my menopause your bones can break more easily, such as
breaking a wrist from a fall. The bones in your spine can
bones?
also be affected which can make some women become
shorter. If you do break a wrist or any bone, it is very
important to get your clinic to refer you to a hospital
where they can check how strong your bones are.

What can I do to
keep my bones
healthy?

Your bones keep changing throughout your life so that they remain as strong as
possible. If you eat the right foods with enough calcium in your diet, stay active
and lead a healthy lifestyle, you can help your body to build and maintain strong
bones for as long as possible. Bones stay strong if you give them work to do.
To keep your bones strong, you need to do:

● Weight-bearing exercise with impact. Impacts are felt

when you are on your feet and you add force or a jolt
through your body. This could be anything from walking,
skipping, running or jumping. You are weight-bearing
when you are standing, with the weight of your whole
body helping your bones to stay strong.

● Muscle strengthening exercise. When your muscles pull

on your bones it gives your bones work to do. Then your
bones keep their strength. As your muscles get stronger,
they pull harder, meaning your bones are more likely to
become stronger. To strengthen your muscles, you need
to move them against some resistance. Increasing
muscle resistance can be done by adding a load for the
muscles to work against, such as lifting a weight in your
hand above your head, or squatting down and standing
up again. As your muscles get stronger and you find the
movements easier, you can gradually increase the
weight of the object you lift.

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 Are perimenopause
Women with HIV reach menopause at a
similar age to women who do not have and menopause
HIV. If you have HIV, the experiences and different for women
symptoms you have should not be living with HIV?
different from women who are not HIV
positive. Some women living with HIV
may be more troubled by anxiety and
depression and may find that these
symptoms become worse during this
time. Every woman’s symptoms through
the menopause are different and you may
be fortunate and not experience many
symptoms even if you have HIV, or you
may have several symptoms for many
years.

Some women living with HIV struggle

when they have perimenopausal
symptoms and they may find it hard to
manage their HIV. Sometimes it is
difficult to take HIV medicines, or go to
clinic appointments, and this can make
your health worse. If you have severe
symptoms, speak to the nurse or doctor
at your HIV clinic and ask them to help
you get some treatment to help with your
perimenopausal symptoms. Hormone
therapy may help, and it will work well
whether you have HIV or not. Please note
that your HIV treatment still works well
even when you are going through
menopause. It is important to take care of
your bone health especially if you have
HIV, and it is important to have your
bones checked because both HIV and the
menopause can make your bones weaker.

Remember, the menopause is a new phase of life for you. We hope

this information is useful and will help you live a full and active life
during this change and beyond.

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Version 1, July 2021