Menopause, explained simply: what it is, when it starts, and what to actually expect

Menopause is having a moment. Your news feed, conversations at the school gate, even your group chats seem to be full of perimenopause and menopause talk. After years of being brushed aside, women's midlife health is finally getting the attention it deserves.

That is the good news. The not-so-good news is that alongside the helpful information, there is a lot of confusion. Conflicting advice. Old assumptions sitting next to new research. Influencers selling things they probably shouldn't be.

So before we get into any of the bigger conversations, like hormone therapy or why menopause isn't the beginning of old age, let's start with the basics. What it actually is. What it isn't. And what you can reasonably expect.

First, the definitions

You cannot tell when you are at menopause in the moment. You can only know in hindsight. This catches a lot of women out.

Menopause literally translates as “the end of monthly cycles”. It is the point in time, 12 months after your final menstrual period, when you can look back and say “that was it. The last one”. 

Perimenopause is the years leading up to menopause. This is when ovarian function begins to wind down and symptoms can start to appear. Periods become irregular. Hormones fluctuate. Things start to feel different.

Postmenopause is the rest of your life after that 12-month marker.

A lot of women, and frankly a lot of doctors, use the word "menopause" to cover all of this. The whole transition. That is fine in everyday conversation, but it helps to know there are three distinct phases.

When does it actually happen

In Australia, the average age of menopause is 51 to 52. Most women reach menopause somewhere between 45 and 55.

Some women reach menopause earlier. Menopause before 40 is called premature menopause. Menopause between 40 and 45 is called early menopause, and is more common than people realise.

If your periods become irregular or stop before the age of 45, this is worth a conversation with your GP. It is not something to wait out, and it is the kind of thing where specialist input early can make a real difference. Your GP can refer you on to a gynaecologist if that is helpful.

Perimenopause can begin years before your final period. For most women, it starts in their mid-to-late forties, but it can start earlier. The length varies too. Some women breeze through it in a year or two. Others have a transition that takes five to ten years.

There is no single timeline that fits everyone, which is part of why this stage of life can feel so unpredictable.

What is happening in your body

Oestrogen is the hormone doing most of the work behind the scenes. It has been quietly running things for decades, helping regulate your periods but also playing a role in keeping your bones, heart, pelvic muscles and brain healthy. It does more than people give it credit for.

As you enter perimenopause, oestrogen levels begin to fluctuate. When they swing, you feel it. Those fluctuations are largely responsible for the symptoms most people associate with menopause. Over time, ovarian function gradually slows until you are no longer ovulating each month. Eventually, periods stop altogether.

This is not decline. It is transition. Your body is doing exactly what it is designed to do.

The symptoms you might experience

Some women breeze through with barely a hiccup. Others find themselves blindsided by changes they did not connect to hormones at all.

Common symptoms include changes in the length and flow of your cycle, hot flushes and night sweats, insomnia, brain fog, low libido, generalised aches and pains, mood changes, and genitourinary symptoms such as vaginal dryness, painful intercourse, urinary urgency, frequency and recurrent UTIs.

That last category, the genitourinary symptoms, gets talked about far less than it should. Many women suffer in silence with vaginal dryness or painful sex, assuming it is just something they have to live with. It is not.

Symptoms can last anywhere from a few years to a decade. Most settle with time, though some, particularly the genitourinary ones, can continue and benefit from treatment.

Where to find good information

There is a lot of menopause content online right now, and the quality varies enormously.

The Australian sources I trust and point women to are:

• Jean Hailes for Women's Health (jeanhailes.org.au), which has clear, evidence-based information and resources in multiple languages.

• The Australasian Menopause Society (menopause.org.au), particularly their Find an AMS Doctor tool if you want to see someone with specific menopause expertise.

• healthdirect.gov.au, the federal government's health information service.

Start there. If something you read online contradicts these sources, treat it with caution.

When to see your GP, and when to see someone like me

If symptoms are affecting your daily life, your sleep, your work, your relationships, your sense of yourself, that is a good reason to make an appointment with your GP. You do not need to wait until things are unbearable.

Make a long appointment so you have time to cover more than just the most obvious symptom. Your GP can also use this visit to talk about a general health check up and cervical, breast, bowel and skin cancer screening which often slips during the busy middle years of life.

If your symptoms are complex, if you have a history that makes treatment decisions more nuanced, or if you would simply like specialist input, your GP can refer you on. That is when someone like me comes into the picture. A gynaecologist with experience in this stage of life can spend more time on the details, work through the options with you, and tailor a plan to what you actually need.

You can find more information on the areas of women's health I work in at www.drmargiescanlon.com.au, and your GP can refer you directly to me through GYON at the Mater Private Suites.

Menopause is not something you have to ride out alone, and you do not have to figure it out from random corners of the internet. Get good information. Talk to someone who knows what they are doing. The transition is much easier when you have both.