Menopause is a non-pathologic condition involving the permanent cessation of menstruation for at least 12 months due to the loss of ovarian follicular activity.1

The transition from the reproductive period to the first year of postmenopause is called perimenopause. This transitional period occurs over several years and is associated with substantial biological changes.2

Perimenopause can be described according to the following stages (Figure 1):2

During this perimenopausal period, there are fluctuations in sex hormones which are more marked than the fluctuations which occur with a normal menstrual cycle and menopausal symptoms may appear during this time.2

In the postmenopausal period, there is a decrease in oestrogen production by the ovaries which leads to common menopausal symptoms such as hot flashes, vaginal dryness, and disrupted sleep (with or without associated night sweats).1

These symptoms typically begin between the ages of 51 and 52. However, about 5 % of women experience early menopause between the ages of 40 and 45.3

Back to top


Figure 1:4
Back to top


Women are often puzzled by the changes in mood, sleep patterns, memory and body shape that occur, as well as the onset of vasomotor and urogenital symptoms (Figure 2). As menopausal symptoms can be very distressing and often affect a woman’s personal and social life, healthcare providers caring for women at all levels of the healthcare system must be well prepared to guide patients through this transition and provide advice to improve quality of life.2 Vasomotor symptoms: Vasomotor symptoms afflict most women during the menopausal transition, although their severity, frequency, and duration vary widely between women. Hot flashes are reported by up to 85 % of menopausal women.3,5 These symptoms are caused by resetting and narrowing of the thermoregulatory system in association with fluctuations in or loss of oestrogen production.5 Urogenital symptoms and Vulvovaginal atrophy: Although they are not frequently reported, urogenital symptoms are often present after menopause.2 Urogenital tissues are extremely sensitive to oestrogen.5 The mucosal layer of the vagina begins to atrophy due to decreased oestrogen levels, which causes this cell layer to become drier and thinner.  As a result, the vaginal mucosa loses its elasticity and becomes fragile.3 Multiple population- and community-based studies confirm that 27 % - 60 % of women report moderate to severe symptoms of vaginal dryness or dyspareunia (genital pain before, during, or after intercourse) in association with menopause.5

Sleep disruption Sleep difficulties, particularly night awakenings, are major complaints and are reported by 40 - 60% of menopausal women.2


Mood changes Depressive symptoms may be worsened by lack of sleep and environmental stressors which are often prevalent during midlife.

Several large studies have shown an increased risk of depressed mood during the menopause transition and an approximately 3-fold risk for the development of a major depressive episode during perimenopause compared with premenopause.5


Cognitive changes Perimenopausal women often report a decline in memory and concentration.2


Migraines The prevalence of migraines during menopause ranges from 10 % to 29 %. It seems that women who are susceptible, particularly those with premenstrual migraines during fertile yearshave more migraine headaches as they transition through menopause.2

Weight and metabolic changes One of the main complaints from women at midlife is increased weight. The prevalence of obesity is higher in postmenopausal women than in premenopausal women.2


Cardiovascular changes Atherosclerosis and the risk of cardiovascular adverse events increase in women after menopause.2


Sexual dysfunction Longitudinal and cross-sectional studies have reported that the menopausal transition is associated with a decrease in sexual desire, independent of ageing. Specifically, the menopausal transition is characterised by a change in hormone-driven sexual desire.2


Musculoskeletal symptoms A major concern in menopausal women is a decline in bone health. Postmenopausal osteoporosis is a degenerative bone disorder characterised by reduced bone marrow density (BMD).2


Skin, mucosal and hair changes Menopause reduces skin thicknesselasticity and hydration and leads to an increase in wrinkling.2

Back to top


Generally, no laboratory tests are required for the diagnosis of menopause. The diagnosis is clinically based on the patient’s age, symptoms, and ruling out other conditions for patients older than 45 years old.3,6
Back to top


Hormone Replacement Therapy (HRT) is considered to be the most effective way to relieve menopausal symptoms. It has been used in clinical practice for over 60 years since the 1960s; however, the benefits and risks of HRT have been controversial.1 In 2002, the Women’s Health Initiative (WHI) found that HRT increased the incidence of coronary heart disease and breast cancer, which led to a precipitous decline in the use of HRT. Upon further analysis of the WHI data and with support from newer studies, international societies and organisations such as the International Menopause Society (IMS), the North American Menopause Society (NAMS), the European Menopause and Andropause Society (EMAS) have formulated guidelines and announced consensus opinions on the use of HRT.1 As understanding of HRT improves, studies have found that HRT is highly beneficial to symptomatic women who are younger than 60 years of age, within 10 years of menopause, and without contraindications such as active liver disease or thromboembolic disease.1

Medical References

  1. Pan M, Pan X, Zhou J, et al. Update on hormone therapy for the management of postmenopausal women. Biosci Trends. 2022 Mar 11;16(1):46-57.
  2. Monteleone P, Mascagni G, Giannini A, et al. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018 Apr;14(4):199-215.
  3. Tenny S, Boktor SW. Incidence. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from:
  5. Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515.
  6. NICE. Menopause: diagnosis and management. NICE guideline. 2015. Available at:
Approved Date: September 2023. Promotional Material Reference Number: SAF2280016. Abbott Laboratories S.A. (Pty) Ltd, Reg. No: 1940/014043/07. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: +27 11 858 2000.

Content Disclaimer:
You understand and acknowledge that all users of the Dis-Chem website or app are responsible for their own medical care, treatment, and oversight. All of the content provided on the website, are for INFORMATIONAL PURPOSES ONLY and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. The content is not intended to establish a standard of care to be followed by a user of the website. You understand and acknowledge that you should always seek the advice of your physician or other qualified health provider with any questions or concerns you may have regarding your health. You also understand and acknowledge that you should never disregard or delay seeking medical advice relating to treatment or standard of care because of information contained in or transmitted through the website. Medical information changes constantly. Therefore the information on this website or on the linked websites should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. Reliance on any information provided on this website or any linked websites is solely at your own risk.
Back to top