Why the ‘arbitrary’ way we define menopause needs to change

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For decades, menopause has been defined as not having a period for 12 months.

But a new international review calls for an overhaul of this definition so that the focus is no longer on menstruation.

Researchers from Australia, the US and Italy say our current depiction of menopause does not capture millions of women who have irregular periods, hysterectomies or have used certain types of contraception.

Twins Demi and Voula Papadoiliopoulos had their last period on the same day.Credit: Eddie Jim

Professor Susan Davis, who led the project and heads Monash University’s women’s health research program, said the 12-month time frame was “fairly arbitrary”.

“The definition is no longer fit for purpose,” she said. “We know that you can’t apply that definition to up to 50 per cent of women.”

In a paper published in the international journal Cell, the researchers proposed that menopause, a natural part of female ageing, instead be described as the “final cessation of ovarian function”.

This might be determined by telltale symptoms such as hot flushes and night sweats, or sometimes a blood test that measures hormone levels.

The academics, who looked at more than 200 studies into menopause spanning 71 years, are also calling for more research into hormone treatment.

While hormone treatment alleviates many menopause symptoms, Davis said longer-term research into the safety of the popular hormone treatment, progesterone, was needed.

Davis only prescribes hormone treatment to women with severe menopause symptoms and outlines the “very small” risk of breast cancer from the treatment.

“I have a very honest conversation with them and women will make a choice about their quality of life,” she said.

Like many key moments in their lives, twins Demi and Voula Papadoiliopoulos had their last period on the same day.

“It was Christmas Day 2016 and we were in New York,” Demi said.

“Then in April we started experiencing hot flushes, night sweats, body aches, joint aches.”

This was coupled with insomnia, changes to their once-muscular bodies and a loss of libido.

“I felt dead inside,” Demi said.

“We would be sitting on the couch and experience a hot flush at the same time,” Voula added.

The 53-year-old twins, who live in Bentleigh in Melbourne’s south-east, initially tried to treat their symptoms with Chinese medicine and a naturopath. They had read about the potential risks of hormone replacement therapy and were worried.

But in 2019, after extensive research and ongoing symptoms, the twins sought out Davis and she prescribed them hormone treatment. They said most of their symptoms disappeared within a week.

They would like to see more awareness around the symptoms of menopause and treatment.

While some people experience severe symptoms, others have no noticeable symptoms.

The average age of menopause in Western countries is about 50 years old. Peri-menopause – the period leading up to this – can be accompanied by irregular periods, hot flushes and mood changes.

Sarah White, chief executive of Jean Hailes for Women’s Health, said many women used the term menopause to also refer to peri-menopause.

She said many women often linked every single problem they experienced in their late 40s and 50s to menopause.

“There is a lot more work to be done to define exactly what menopause symptoms are,” she said.

“A lot of consumers talk about brain fog. Is that because your hormones are fluctuating or is that because you are caring for school aged kids, plus your elderly parents, plus you have work on? That mental load that women predominantly bear at that point in their life.”

White welcomed discussions about new ways of defining menopause.

“We wouldn’t have been having these conversations five years ago.”

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