News Desk Reporter
Menopause can bring changes that affect a woman’s health, relationships and daily life. But many women still struggle to find reliable information and support during this stage.
The World Health Organisation (WHO) says awareness of menopause and access to related health services remain limited in many countries. The subject is often not discussed in families, communities, workplaces or healthcare settings.
Most women experience natural menopause between the ages of 45 and 55. It marks the end of menstrual periods as ovarian function declines and oestrogen levels fall.
Menopause is confirmed after 12 consecutive months without menstruation, provided there is no other obvious cause. The transition usually begins with changes to the menstrual cycle.
The period leading up to menopause is known as perimenopause. It ends one year after a woman’s final menstrual period and can last several years.
The experience varies from woman to woman. Some have few or no symptoms, while others experience changes that affect their physical and emotional well-being. Symptoms can also disrupt sleep, relationships and work, and may continue for several years.
Hot flushes and night sweats are common. Hot flushes can cause a sudden feeling of heat in the face, neck and chest. They may also bring sweating, a racing heartbeat and physical discomfort.
Other symptoms include irregular periods, vaginal dryness, pain during sex and urinary incontinence. Some women experience difficulty sleeping, mood changes, depression or anxiety.
The hormonal changes can also affect long-term health. Declining oestrogen levels are associated with changes in cardiovascular risk. Menopause can weaken pelvic support structures, increasing the risk of pelvic organ prolapse. Reduced bone density also contributes to a higher risk of osteoporosis and fractures.
Menopause does not always occur naturally with age. Some women experience it before the age of 40, a condition known as premature menopause. Possible causes include certain chromosomal abnormalities, autoimmune disorders and other unknown factors.
It can also be triggered by medical treatment or surgery. Removing both ovaries causes ovarian function to stop. Chemotherapy and radiation therapy can also bring on menopause.
Some women stop menstruating before menopause because they have undergone a hysterectomy or surgery to remove the uterine lining. Certain hormonal contraceptives and medicines can also cause periods to become irregular or stop.
However, the absence of periods does not necessarily mean a woman has reached menopause. She may still experience other changes associated with the transition.
Pregnancy remains possible during perimenopause. The WHO recommends contraception until a woman has gone 12 consecutive months without menstruation to prevent an unintended pregnancy.
After menopause, pregnancy is unlikely without fertility treatment involving donor eggs or previously frozen embryos.
Sexual health remains important during and after menopause. Women can still contract sexually transmitted infections, including HIV, through unprotected oral, anal or vaginal sex.
Thinning of the vaginal wall after menopause can increase the likelihood of tears and lesions. This can raise the risk of HIV transmission during vaginal sex.
The WHO says sexual well-being among menopausal women is overlooked in many countries. Vaginal dryness and pain during intercourse may go untreated. Older women may also underestimate their risk of sexually transmitted infections or not receive advice about safer sex and testing.
Access to information and treatment remains a challenge. Women may not recognise their symptoms as menopause-related or know that counselling and treatment are available.
Some feel embarrassed or ashamed to discuss their experiences and seek help. Healthcare workers may also lack the training needed to recognise symptoms and advise women on treatment options.
The WHO says menopause receives limited attention in the training of many healthcare workers. Many governments also lack policies and funding to include menopause diagnosis, counselling and treatment in routine health services.
These services can be difficult to provide in healthcare systems where funding is already stretched by other urgent needs.
The organisation says women should have access to physical, psychological and social support during the transition and after menopause. This includes reliable health information, counselling and appropriate treatment.
Both hormonal and non-hormonal treatments can help relieve symptoms. Women whose symptoms affect their health or quality of life should discuss management options with a healthcare professional. Decisions should take their medical history, values and preferences into account.
The WHO is calling for menopause diagnosis, counselling and treatment to form part of universal health coverage. It also wants healthcare workers to receive training on menopause and the available treatment options.
The organisation stresses that care should address sexual health and support healthy ageing. Women should have access to appropriate information and services before, during and after menopause.
A woman’s health during this period is influenced by her earlier health and reproductive history, lifestyle and environment. The WHO says care during perimenopause can help promote healthy ageing and quality of life.
Menopause is also a social transition. Gender expectations, family circumstances and cultural attitudes towards ageing can influence how women experience it.
The number of women living after menopause is growing as people live longer. In 2021, women aged 50 and older accounted for 26% of all women and girls globally. This was up from 22% a decade earlier.
A woman aged 60 in 2019 could expect to live, on average, another 21 years, according to United Nations figures cited by the WHO.
The organisation says menopause can provide an opportunity for women to reassess their health, lifestyle and personal goals.
Although menopause is not a disease, its symptoms can affect quality of life. The WHO says social, psychological and physical support should be an integral part of healthcare.
The organisation also notes that transgender men and some people who identify as neither men nor women can experience menopause.
Their specific health needs should be considered, with referrals to specialist services where necessary.