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Hrt: when does the menopause happen? (part 2) HRT: WHEN DOES THE MENOPAUSE HAPPEN? (part 2)
The first thing a woman is most likely to notice is her periods becoming more irregular. The time between them may be less than usual or they may be further apart; they may last for a longer or shorter time; be heavier or lighter; or a combination of all these, varying from month to month. Very occasionally, a woman says she had a period at the expected time and then never had another, but this is unusual; irregular and unpredictable is how things are likely to be for quite a while.
(A small warning here: It's quite normal to have irregular periods at regular intervals, or normal periods at irregular intervals, but continual 'spotting' between periods is something to see your doctor about.)
The next stage is to miss one or more, even several, periods completely. The menstrual loss may be less than normal, even scanty, but as long as periods continue, ovulation is still taking place and pregnancy is still possible. Gradually, the gap between periods increases and the duration of bleeding becomes less and less, until a woman might think, 'Hurray, it's all over.' She may be right — or she may suddenly get another period months and months later (often at a most awkward time, such as during a holiday on a remote Greek island with the nearest chemist's shop a three-hour boat trip away!). The moral is: If you are under 50 and have had no periods for two years, or over 50 and have had none for one year, then you can probably relax; otherwise, never go away without being prepared! (This rule of thumb also applies to the likelihood of becoming pregnant, but is probably unnecessarily cautious.)
The timescale over which all these changes occur varies greatly from one woman to another, so this is one instance where your friends' experiences may not be very helpful. It is highly likely that during this time you will be experiencing a whole range of menopausal symptoms that you might feel unprepared for. The more you know about them - and what can be done about them — the more confident you will feel in yourself, and your self-confidence and self-esteem are less likely to suffer. Research has shown that many of those who find it hard to cope at this time just don't realise what's happening to them, or why, or what can be done to help them. The women who cope best are those who understand about the menopause and are able to develop a positive attitude to managing it.
Many women say, 'I've had a hysterectomy. How will this affect my menopause?' The answer is that it depends on the sort of hysterectomy you had. It is surprising how many women have no idea how much of their body was removed during their hysterectomy. Was it just the uterus (womb), or the uterus and cervix, or all that and the ovaries as well? To anyone reading this book who may have a hysterectomy at some time in the future (and to those who are still in touch with the hospital who carried out their hysterectomy in the past), it is advisable to know your body. In other words, don't just let 'them' do things to you unless you know what it is, and why. Surgeons who would be very reluctant to remove a man's testicles (where the male hormones are produced) will whip out a woman's ovaries (where the female hormones are produced) in the twinkling of an eye, and she may never know. So ask, because it will greatly affect the next few months and years of your life.
There are two sorts of menopause: a natural menopause and a surgical menopause. With a natural menopause, hormone levels gradually fall over quite a long timespan and symptoms build up slowly. This usually happens between the mid-forties and mid-fifties, though it can start much earlier and end rather later. A surgical menopause is not gradual. You may have been on the waiting list for a hysterectomy for weeks (or even months), but as far as your body is concerned it is a sudden event. One minute you have all those female bits inside you, and an hour or so later they have gone.
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