Breast changes in older women

As you get older, it’s natural for your breasts to lose their firmness, change shape, shrink in size and become more prone to certain abnormal lumps.

In most cases, breast lumps are harmless but, whatever your age, it’s important that you report any new lumps to your doctor.

From around the age of 40, you can expect your breasts to change in size and shape. It’s normal for breast tissue to become less glandular and more fatty as you get older, which makes them feel less firm and full.

With age, there’s also an increasing risk of abnormal growths in the breast. These are often harmless breast lumps, like cysts, but they can also be a sign of serious conditions like breast cancer.

As the years go by, you might also notice a wider space between your breasts and that your breasts shrink in size, sometimes by a cup size or more (unless you put on weight, in which case your breasts may get bigger). The area around the nipple (the areola) tends to become smaller and may nearly disappear, and the nipple may turn in slightly.

Many of the breast changes that happen as you get older are caused by hormonal changes.

Declining oestrogen levels at the menopause make breast tissue dehydrated and less elastic, so that your breasts lose their once rounded shape and begin to sag.

On the plus side, you may stop having any of the premenstrual lumps, pain or nipple discharge that you used to have.

Breast cancer screening

Screening for breast cancer is currently offered on the NHS to women aged 50-70 in England. However, it’s in the process of being extended as a trial to some women aged 47-73.

Breast screening uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.

This short video explains what happens when you have a mammogram.

It’s your choice whether to have breast screening, but bear in mind that most experts believe it’s beneficial in picking up breast cancer early.

If you’re over 70, you’ll stop receiving screening invitations through the post, but you can still carry on with screening if you want to. To arrange an appointment, contact your local breast screening unit.

Find breast screening units in your area.

Read more about breast cancer screening.

Dense breasts

Young women who have not yet gone through the menopause often have what’s known as dense breasts.

Dense breasts contain more glandular and less fat tissue than usual. It’s not the same as having firm breasts and it has nothing to do with how big or what shape your breasts are.

Having dense breasts isn’t abnormal and it’s not something that you can change, but a potential drawback is that dense breasts can make breast cancer screening more difficult, because the dense tissue can mask potential tumours on a mammogram.

Breast tissue tends to become less dense as you get older, especially after the menopause, so it becomes easier to detect breast cancers on a mammogram.

Breast lumps

Breast lumps are common around the menopause. They’re usually cysts, which are harmless lumps filled with fluid. But if you notice a lump, don’t wait to be offered screening – see your GP, to rule out breast cancer.

Breast cancer is most common in women over 50. Other warning signs of breast cancer include:

• puckering of the skin
• nipple changes (like scaling or discharge)
• a swollen, red or "inflamed" breast

Read more about breast lumps.

Women over 70

Women over 70 are particularly at risk of breast cancer, because a woman’s risk of getting breast cancer increases with age. Don’t assume that because you’re in your 70s or older that you’re in the clear. Always report any unusual breast symptoms to your doctor.

Find out how to spot breast lumps.

Hot flushes: how to cope

Hot flushes are the most common symptom of the menopause but there are a range of medical treatments and self-help techniques to beat the heat.

Not all women experience hot flushes going through the menopause, but most do. Three out of every four menopausal women have hot flushes. They’re characterised by a sudden feeling of heat which seems to come from nowhere and spreads through your body. They can include sweating, palpitations, and a red flush (blushing), and vary in severity from woman to woman.

Some women only have occasional hot flushes which don’t really bother them at all, while others report 20 hot flushes a day, that are uncomfortable, disruptive and embarrassing.

Hot flushes usually continue for several years after your last period. But they can carry on for many, many years – even into your 70s or 80s. They’re probably caused by hormone changes affecting the body’s temperature control.

Causes of hot flushes

Most women going through a natural menopause experience hot flushes. But there are other causes of hot flushes, including:

• Breast cancer treatment – according to Cancer Research UK, seven out of 10 women who’ve had breast cancer treatment have hot flushes, and they tend to be more severe and frequent than those of women going through a natural menopause. This is because chemotherapy and tamoxifen tablets reduce oestrogen levels.
• Prostate cancer treatment – men having treatment for prostate cancer can also have hot flushes, sometimes for years. Hormone treatment causes hot flushes in men by lowering the amount of testosterone in their body. Read advice for men with prostate cancer on how to tackle hot flushes.

What does a hot flush feel like?

Women often describe a hot flush as a creeping feeling of intense warmth that quickly spreads across your whole body and face ‘right up to your brow’ and which lasts for several minutes. Others say the warmth is similar to the sensation of being under a sun bed, feeling hot ‘like a furnace’ or as if someone had 'opened a little trap door in my stomach and put a hot coal in’.

Watch these videos where women describe what a hot flush feels like.

Hot flush triggers

Hot flushes can happen without warning throughout the day and night, but there are well-known triggers, including woolly jumpers, especially polo necks; feeling stressed; drinking alcohol or coffee; or eating spicy foods.

Treatments for hot flushes

Many women learn to live with menopause-related hot flushes, but if they’re really bothering you and interfering with your day-to-day life, talk to your doctor about treatments that may help.

The most effective is HRT which usually completely gets rid of hot flushes. But other medicines have been shown to help, including vitamin E supplements, some antidepressants, and a drug called gabapentin, which is usually used to treat seizures.

Note that doctors recommend that you don’t take HRT if you've had a hormone dependent cancer such as breast or prostate cancer.

Here’s more information on help for hot flushes from your GP.

Complementary therapies for hot flushes

Women often turn to complementary therapies as a ‘natural’ way to treat their hot flushes.

There have been small studies indicating that acupuncture, soy, black cohosh, red clover, pine bark supplement, folic acid, and evening primrose oil may help reduce hot flushes.

However, the research is patchy, the quality of the products can vary considerably, and the long-term safety of these therapies isn't yet known.

It’s important to let your doctor know before you take a complementary therapy because it may have side effects (for example liver damage has been reported with black cohosh) or mix badly with prescription medicines (red clover is unsuitable for women taking anticoagulants).

Be aware, too, that soy and red clover contain plant oestrogens so may be unsafe for women who have had breast cancer.

Read more about complementary therapies and whether they work.

Self help remedies for hot flushes

Try these everyday tips to ease the overheating:

• cut out coffee, tea, and stop smoking
• keep the room cool, use a fan – electric or handheld – if necessary
• if you feel a flush coming on, spray your face with a cool water atomiser or use a cold gel pack (available from pharmacies)
• wear loose layers of light cotton or silk clothes so you can easily take some clothes off if you overheat
• have layers of sheets on the bed rather than a duvet so you can remove them as you need to and keep the bedroom cool
• cut down on alcohol
• sip cold or iced drinks
• have a lukewarm shower or bath instead of a hot one
• change the timing of your medicine. If tamoxifen is causing your hot flushes, Cancer Research UK suggests taking half your dose in the morning and half in the evening

Is a hot flush anything to worry about?

Hot flushes are generally a harmless symptom of the menopause. But very occasionally they may be a sign of a blood cancer or carcinoid (a type of neuroendocrine tumour).

See your doctor if, in addition to hot flushes, you've been unwell with, for example, fatigue, weakness, weight loss or diarrhoea.

Now read about the best foods to eat during the menopause.

Read other articles about the menopause.

Menopause and your bone health

Women can lose up to 20% of their bone density in the five to seven years after the menopause.

The drop in bone density is caused by falling levels of the female hormone oestrogen. Oestrogen helps to protect bone strength.

Although your bone density decreases at the menopause, your risk of osteoporosis (weak bones) and fractures (broken bones) stays relatively low until you get much older.

This is because bone density is only one of the things that affects your bone strength.

However, the menopause is a good time to take stock and adopt a healthier, bone-friendly lifestyle.

Healthy bones after the menopause

While you can't halt bone loss entirely after the menopause, there is plenty you can do to maintain your bone strength as you get older.

Stay active

Eat a healthy, balanced diet

Get some sunlight

Drink sensibly and don't smoke

Hormone replacement therapy (HRT)

Stay active

It's recommended that adults aged 19 to 64 do at least 150 minutes of moderate-intensity activity in bouts of 10 minutes or more each week. This could include activities such as cycling or brisk walking.

You should also try to avoid sitting for long periods, for example, watching TV or sitting at a computer.

Weight-bearing exercises and resistance exercises are particularly important for improving bone strength and helping to prevent osteoporosis:

Weight-bearing exercises

These are exercises where your legs and feet support your weight.

High impact weight-bearing exercises, such as running, skipping, dancing and aerobics are all great for strengthening muscles, bones and joints.

These can be part of your weekly 150 minutes of moderate intensity activity.

Resistance exercises

These are ones where you use your muscle strength to work against resistance. When your muscles pull on your bones it boosts your bone strength.

Examples include press-ups, exercising with weights or using weight equipment at a gym.

Do resistance exercises twice a week if you can.

See more exercises for strong bones.

Eat a healthy, balanced diet

Eating a healthy, balanced diet will help keep your bones healthy after the menopause.

For help with eating a balanced diet that includes all the main food groups, see the Eatwell Guide.

A couple of nutrients are particularly important for building strong bones: calcium and vitamin D.

Calcium

Good sources include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese.

Lower-fat dairy products contain just as much calcium as full-fat ones.

Vitamin D

Good food sources include oily fish, eggs, and fat spreads or breakfast cereals fortified with vitamin D.

It's difficult to get enough vitamin D from food alone, so all adults are advised to consider taking a daily vitamin D supplement, particularly in the winter months (October to March).

See more on eating for bone health.

Get some sunlight

Sunlight on your skin helps to build up your body's supply of vitamin D.

Aim to spend short periods outdoors each day from late March/April to the end of September. Take care not to let your skin redden or burn.

Read more on vitamin D and sunlight.

Drink sensibly and don't smoke

Smoking is linked to a higher risk of osteoporosis and so is drinking too much alcohol.

As well as protecting your bones, quitting smoking will help to lower your risk of heart disease, cancer and other smoking-related diseases.

Read more about NHS stop smoking services.

Men and women are advised not to regularly drink more than 14 units a week.

See how to keep track of your alcohol units.

Will I need a drug treatment for my bones?

You'll usually only need treatment to strengthen your bones at the menopause if you have a higher risk of osteoporosis or fractures.

Examples of things that can affect your fracture risk include:

• having rheumatoid arthritis
• taking glucocorticoids (steroids) for more than three months
• having already broken a bone (or bones) after a minor fall or injury

See the National Osteoporosis Society website for more risk factors for osteoporosis.

If you have risk factors for osteoporosis or fractures, talk to your doctor.

You may need a bone check-up, known as a fracture risk assessment. This may include a bone density (DEXA or DXA) scan to help measure your bone strength (strength is about more than bone density).

Hormone replacement therapy (HRT) and bone health

HRT can help to maintain bone density and reduce the risk of osteoporosis.

However, it's not recommended as a way to maintain bone strength for most women around the menopause.

One reason is that the beneficial effects of HRT on your bones wear off when you stop taking it (usually before the age of 60). So your bones won't have protection when you're older, which is when they really need it.

HRT also carries some risks, including a slightly higher risk of stroke. This means it's not suitable as a bone treatment in older women, whose risk of stroke is already higher.

See more about the risks of HRT.

HRT may be recommended if:

• you have a premature menopause (when your periods stop before the age of 40), as you have a higher risk of osteoporosis
• you have an early menopause (when your periods stop before the age of 45) and you also have other risk factors for osteoporosis

HRT may be offered as an osteoporosis treatment to other menopausal women with a high risk of fracture.

But it's usually only advised if other drug treatments for osteoporosis aren't suitable and you also need treatment to relieve menopausal symptoms like hot flushes.

For more information about the risks and benefits of HRT see your GP.

Read more about HRT and the menopause.

The recipe for strong bones for life

Bone health is a bit like saving for your pension: hard to get excited about when you're young but the sooner you start, the better.

Taking care of your bones is a lifelong investment that will pay dividends by helping you to stay fit and independent later in life.

Like pensions, it's never too late to start. There's plenty you can do to keep your bones fit for purpose, whatever your age.

Let's be clear: bone health isn't just about bones. "It's about your quality of life as you get older," says Ruthe Isden of charity Age UK.

"Bone health is about staying fit and well as we get older so we can continue to do the things we enjoy," she says.

As we live longer, more and more of us will become vulnerable to weak bones (osteoporosis) and breaking bones from falls.

Life-changing fracture

About one in three people over 65, and half of people over 80, fall each year in the UK. One in two women, and one in five men over 50, will break a bone, typically in the wrist, hip and spine, as a result of osteoporosis.

A fall later in life can be life-changing, leading to distress, pain, injury, loss of confidence, loss of independence and even death.

Half of older people never regain their former level of function after a hip fracture and one in five dies within three months.

According to a blog by Professor Kevin Fenton, Public Health England's national director for health and wellbeing, "Falls are the number one precipitating factor for a person losing independence and going into long-term care,".

What you can do

But it doesn't have to be this way, says leading bone and joint expert Professor Anthony Woolf, a rheumatologist at the Royal Cornwall Hospitals NHS Trust. "Osteoporosis and falls are not an inevitable part of ageing and much can be done to prevent them," he says.

Preventing osteoporosis starts in childhood, if not earlier, when our bones are growing, and continues throughout life. "Building healthy bones actually starts in the womb where the baby's skeleton is developing," says Professor Woolf. "A real life course approach is needed to help people have bones fit for purpose as they age."

The recipe for lifelong strong bones includes:

• a healthy balanced diet that includes calcium
• vitamin D, from sunlight, food and supplements
• regular exercise
• avoiding smoking, too much alcohol and other risk factors

The same lifestyle advice applies to people with the menopause, osteoporosis or who are at risk of fracture as it will help reduce the rate of bone loss and their risk of falling.

Get diet advice and exercise tips to help people of all ages build and maintain strong bones.

Bone-building years

The key bone-building years are those up to our mid-20s, when the skeleton is growing. For example, the bone accumulated in girls aged 11 to 13 is about the same amount lost during the 30 years following the menopause. Research has shown that gymnasts aged 10 have much stronger bones than inactive youngsters of the same age.

The gains achieved during youth put the skeleton in a better position to withstand the bone loss that occurs with age. Get tips on boosting your child's bone health. After about 35, bone loss gradually increases as part of the natural ageing process.

Work out if you're at risk of developing osteoporosis and breaking a bone in the next 10 years.

Get tips on maintaining strong bones as you get older.

Read how Judi Paxton beat osteoporosis by making some simple changes to her lifestyle.

Preventing falls

People with osteoporosis have weak bones, but it's falls that break bones. Work out if you're at risk of falling.

While it is impossible to prevent all falls, there are lifestyle and practical measures that can reduce their occurrence.

The most effective measures to prevent falls among people considered at risk involve:

• strength and balance exercises
• checking the home for trip and other hazards
• checking eyesight
• reviewing medication, which may affect balance

For more fall prevention tips download Get Up and Go: A Guide to Staying Steady (PDF, 2.6Mb).

"Physical activity and exercise can turn back the clock on some of the losses in bone strength caused by age and disease," says Professor Woolf.

Research suggests that a programme of strength and balance exercises tailored to the individual can reduce the risk of falls by 35% to 54% (PDF, 309kb).

Age UK says that fall prevention exercises could prevent 7,000 unnecessary deaths a year – 19 a day – from hip fractures.

Sex after hysterectomy

How a hysterectomy might affect your sex life, how long you should wait before having sex again and how to cope with issues such as vaginal dryness.

It takes time to get back to normal after an operation, but having a hysterectomy can have a strong emotional impact too, which can affect how you feel about sex.

If you experience problems with sex after your operation, don't suffer in silence. There is help available – you can talk to your GP, a counsellor or an organisation such as the Hysterectomy Association.

How long should you wait before having sex after a hysterectomy?

You will be advised not to have sex for around four to six weeks after having a hysterectomy. This should allow time for scars to heal and any vaginal discharge or bleeding to stop.

If you don't feel ready for sex after six weeks, don't worry – different women feel ready at different times.

There are many different types of hysterectomy, which will affect how it is performed and what is removed.

A total hysterectomy is the removal of the uterus (womb) and cervix. If the cervix remains intact, this is a subtotal hysterectomy. Sometimes the ovaries or fallopian tubes are removed as well.

Which organs are removed will depend on your own personal circumstances and the reasons you're having a hysterectomy.

Bleeding after sex after a hysterectomy

Any woman who notices bleeding after sex should see a doctor to find out why it is happening. This includes women who have had a hysterectomy. Your doctor may be able to offer treatment, and can check that everything is healing well.

Feeling sexually attractive

Having the uterus removed can cause women to worry about feeling less womanly, or losing their sexual attractiveness. Many women also talk about feelings of loss or sadness after a hysterectomy. However, these feelings should pass.

You may find it helps to focus on your recovery – eating healthily, getting some exercise (your doctor will tell you how much activity you should aim for) and talking to your partner or friends about how you're feeling.

If you're finding it hard to cope with these emotions, talk to your GP or consultant. You may be able to have counselling to help you work through your feelings. Find a counsellor near you.

It can also help to read about how other women have coped with similar experiences. You can read about women's experiences of hysterectomy at healthtalk.org.

Sex and menopause

If you have your ovaries removed as well as your uterus, this will trigger the menopause whatever your age. The change in hormone levels that occur during the menopause can affect your sex life. Read more about sex after menopause and how to deal with any problems.

Sex drive

Some women have less interest in sex after having a hysterectomy. If this happens to you, your interest in sex may return as your recovery progresses.

If you and your partner feel it's a problem, talk about it together so that it doesn't become an unspoken issue between you. You can also talk to your GP or find a counsellor who can offer help with sexual problems.

Our talking about sex page has tips from a psychosexual therapist, which you might find useful.

Lack of sex drive can be made worse by depression, menopausal symptoms, relationship problems and stress. These problems are often temporary, but if symptoms of the menopause or depression persist, see a doctor. Treating menopausal symptoms may boost your sex drive indirectly by improving your general wellbeing and energy levels.

Read more about keeping the lust alive.

Vaginal dryness, sensation and orgasm

Having a hysterectomy doesn't mean you can't have an orgasm. You still have your clitoris and labia, which are highly sensitive.

It's not known what role the cervix plays in orgasm. Some experts have argued that removing the cervix can have an adverse effect, but others have found that it doesn't.

A review of the evidence comparing subtotal with total hysterectomy in premenopausal women found both types offered similar results for sexual function.

In a study comparing different surgical methods of hysterectomy, a number of women noticed reduced sexual sensation. This included reduced feeling when their partner penetrated their vagina, a dry vagina and less intense orgasms. If, before hysterectomy, you had noticeable uterine contractions during orgasm you may find you don't experience these anymore.

If your hysterectomy has made your vagina feel drier than it used to be, try using a sexual lubricant. You can buy these over the counter at a pharmacy.

Your surgeon will have advised you to do pelvic floor exercises to help your recovery. These exercises can also tone up the muscles of your vagina and help improve sexual sensation. Read more about pelvic floor exercises.

Other women in the study mentioned above said their hysterectomy had removed their pre-surgery symptoms (such as pain), and they had a greater sense of wellbeing and happiness.

The Royal College of Obstetricians and Gynaecologists has leaflets about recovering after hysterectomy:

Recovering well after abdominal hysterectomy

Recovering well after vaginal hysterectomy

Recovering well after a laparoscopic hysterectomy

Sex after the menopause

When the menopause hits, so can a variety of sexual problems. But don't despair, there are solutions.

'So many women suffer in silence because they are embarrassed to speak to their GP.' Dr Sarah Jarvis

Sex can become less enjoyable for some women after the menopause. The natural decline in oestrogen levels can make it uncomfortable. Some women also find their interest in sex declines, and the body changes that happen with ageing don’t help. Dry skin, greying hair and middle-age spread can erode self-esteem.

Painful sex after menopause is common

A survey suggests that 84% of menopausal women find sex painful. In the survey, nearly 70% said their relationships had suffered as a result.

Women’s health expert and GP, Dr Sarah Jarvis, says women should overcome their shyness and seek help. "It always seems sad to me that so many women suffer in silence with common menopausal symptoms such as vaginal dryness, because they are embarrassed to speak to their GP.

"We see these problems regularly and entirely understand how much impact they have on quality of life. There are so many effective treatment options and we’re more than happy to offer them."

Lubricants help vaginal dryness

According to Dr Jarvis, it’s worth trying self-help options in the first instance. There are a variety of ways to relieve vaginal dryness and thus make sex easier and pleasanter:

• Avoid intimate washing with soap, bath oils and shower gels – they can aggravate dryness. Instead, use lukewarm water alone or with a soap-free cleanser.
• Try using a lubricant such as KY Jelly, Astroglide, Sylk, Senselle or Replens. These are available from pharmacies without needing a prescription.

Medical treatments for painful sex

If these measures don’t help, your doctor can prescribe hormone treatment. Hormone replacement therapy alleviates dryness, but if you can’t or don’t want to take HRT, you can use oestrogen applied "locally", that is just to the vagina, to increase the flow of natural lubrication.

There are different options including an oestrogen cream (applied using an applicator), pessaries, small tablets (again inserted with an applicator) or an oestrogen-releasing vaginal ring which stays in place for three months at a time.

Read more about HRT for vaginal dryness.

Tips for sex drive problems

Some women find that they lose their desire for sex after the menopause. It’s normal for sex drive to reduce over the years, but it can be made worse by depression, menopausal symptoms, relationship problems and stress.

These problems are often temporary and being able to talk things through with an understanding partner may be all that’s needed. But if symptoms of the menopause or of depression persist, then it may be best to see a doctor for treatment.

Treating menopausal symptoms may boost your sex drive indirectly by improving your general well-being and energy levels, but restoring your hormone levels can also improve sensation.

Read more about how to keep the passion alive.

Do this short quiz about sexual desire to find out whether or not you should consider seeing a health professional about your lack of interest in sex.

Read more about female sexual problems.

Healthy eating during the menopause

Good nutrition is important for all women around the time of the menopause.

Although there is no special diet that women going through the menopause need to follow, it's particularly important that they have a healthy, balanced diet with regular meals, as irregular eating can make certain symptoms worse, such as feeling tired.

When it comes to a healthy diet, balance is vital. This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight.

Base your meals on starchy foods

Starchy foods should make up just over a third of everything we eat. This means we should base our meals on these foods.

Potatoes are a great source of fibre. Leave the skins on where possible to keep in more of the fibre and vitamins. For example, when having boiled potatoes or a jacket potato, eat the skin.

Try to choose wholegrain or wholemeal varieties of starchy foods, such as brown rice, wholewheat pasta and brown, wholemeal or higher-fibre white bread. They contain more fibre (often referred to as "roughage"), and usually more vitamins and minerals than white varieties.

Read more about starchy foods.

Eat at least five portions of fruit and veg a day

Fruit and vegetables are a vital source of vitamins and minerals. It's advised that we eat at least five portions of a variety of fruit and vegetables each day.

There's evidence that people who eat at least five portions a day have a lower risk of heart disease, stroke and some cancers. But surveys show that most women aged 50 to 64 eat less than this.

Eating lots of different types of fruit and vegetables, so that you get a variety of nutrients, is thought to bring the greatest benefits.

Getting your 5 A DAY isn't as hard as it sounds:

• just one apple, banana, pear or similar-sized fruit is one portion
• a large slice of pineapple or melon is one portion
• three heaped tablespoons of cooked vegetables or pulses is another portion
• having a sliced banana with your morning cereal is a quick way to get one portion
• swap your mid-morning biscuit for a tangerine, and add a side salad to your lunch
• have a portion of vegetables with dinner, and snack on fruit in the evening

Read more about how to get the vitamins and minerals you need.

Calcium is vital for bone health

It's especially important to get enough calcium in your diet, as it's vital for bone health.

Good sources of calcium include milk and dairy foods, such as cheese and yoghurt, which also contain protein.

To enjoy the health benefits of dairy without eating too much fat, choose semi-skimmed, 1% fat or skimmed milk, as well as lower-fat hard cheeses or cottage cheese, and lower-fat yoghurt.

Read more about bone health during the menopause and milk and dairy foods.

Why protein is important

As we get older we need more protein, and it plays a vital role in helping the body recover from illness, infections and surgery.

Beans, fish, eggs and meat are all good sources of protein, and contain a range of vitamins and minerals.

Meat is a good source of protein, vitamins and minerals, including iron, zinc and B vitamins. It is also one of the main sources of vitamin B12.

Try to eat lean cuts of meat and skinless poultry whenever possible to cut down on fat. Always cook meat thoroughly.

Learn more about meat in your diet.

Fish is another important source of protein, and contains many vitamins and minerals. Oily fish is also rich in omega-3 fatty acids.

Aim for at least two portions of fish a week, including one portion of oily fish. You can choose from fresh, frozen or canned, but remember that canned and smoked fish can often be high in salt.

Eggs and pulses (including beans, nuts and seeds) are also great sources of protein. Plain unsalted nuts are high in fibre and a good alternative to snacks high in saturated fat or sugar, but they still contain high levels of unsaturated fats, so eat them in moderation.

Learn more about eggs and pulses and beans.

Cut down on fats and sugar

Some fat in the diet is essential, but should be limited to small amounts. It's important to get most of our fat from unsaturated oils and spreads. Swapping to unsaturated fats can help to lower cholesterol.

Too much saturated fat can increase the amount of cholesterol in the blood, which increases your risk of developing heart disease, while regularly consuming foods and drinks high in sugar increases your risk of obesity and tooth decay.

Find out more about why we need to cut down on saturated fat and sugar in our diet, which foods they occur in and how we can make healthier choices in Eight tips for healthy eating.

More information

Read about healthy eating and check out our healthy recipes section.

To get motivated, check out our five self-help tips for those going through the menopause.

Early menopause: Johanna's story

Johanna, 33, was 17 when doctors told her she had premature ovarian failure (POF).

It affects about 1 in 100 women before the age of 40, and 5 in 100 women before the age of 45.

The "normal" age for menopause is debatable, but most doctors consider menopause to be early if a woman's periods stop before she is 45.

Johanna, a teacher from Clitheroe in Lancashire, had one period when she was 13, "and that was it," she says.

"I went back to the doctors a few times. They said it was normal for things to settle into some sort of pattern. I had the mood swings and hot flushes, but I put that down to puberty and being a moody teenager, rather than the menopause. I started having a series of blood tests at 16 and, when I was 17, I was diagnosed.

"I had two great aunts and neither of them were able to have children, so I wondered whether it might be the same thing."

The causes of POF are described as primary or secondary.

Ovaries just stop working

Primary POF is when a woman’s ovaries stop working. It's usually not possible to explain why this happens, but the reasons can include:

• chromosome abnormalities – such as in women with Down’s syndrome
• enzyme deficiencies – where enzymes in the body affect the ovaries by damaging the eggs and preventing the production of oestrogen
• autoimmune diseases – where the body’s natural defence mechanisms start producing antibodies that destroy its own tissues

Medical treatments that damage egg production

Secondary POF can be due to cancer treatments such as radiotherapy or chemotherapy. The risk of POF depends on the type of treatment given and the patient's age.

Girls who haven't reached puberty can tolerate stronger treatment than older women without losing their fertility. It might be possible to remove eggs for storage before treatment.

Surgery that triggers menopause

Other causes of secondary POF include surgical menopause, which is an operation to remove both ovaries, or having a hysterectomy, which is surgery to remove the womb.

Infections, such as tuberculosis and mumps, can also cause POF, though this is rare. Other infections linked to POF include malaria and chickenpox.

'I can feel quite philosophical and I think, "What’s happened, happened". Sometimes it hits me very hard'

Risks associated with premature menopause

Women who have an early menopause have an increased risk of osteoporosis, due to reduced oestrogen levels. Because of this, most doctors recommend HRT until a woman reaches the normal age of natural menopause (which is around 52).

Though she isn’t on HRT, Johanna has been on the pill since her diagnosis. "It was ironic really, given that it is a contraceptive, but it balanced my oestrogen levels and I still take it now. I was also on calcium tablets."

However, the calcium hasn’t been sufficient to protect Johanna’s bones, which were affected from an early age. "I had various scans at 21. When the results came back, they revealed my hip bone was the same as that of a 65-year-old woman," she says.

"I’ve got very osteoporotic bones, but it hasn’t affected me a great deal. I haven’t had any fractures, but I have to be careful."

Coping with infertility

Women who experience an early menopause before they've been able to have children may find it hard to deal with.

Although they can have children, it involves undergoing IVF using eggs donated by another woman.

The reality of having gone through the menopause didn’t really hit Johanna initially. "At 17, you’re not really thinking about having children. I didn’t think a huge amount about it until I was getting to the end of university and the reality of my infertility sunk in. I became really quite depressed and was on medication for a few years."

Johanna's outlook now varies. "I can feel quite philosophical and I can think, ‘What’s happened, happened’. But sometimes it hits me very hard, especially as a lot of my friends are having children or have had children. I try to cope with it by spoiling my godchildren rotten."

Support for premature menopause

Counselling or support groups may be helpful if you have had or are experiencing POF. Counselling is a charity dedicated to POF, and runs self-help groups for women.

"The Daisy Network is a huge source of support," says Johanna. "It's not something that people tend to talk about much, but it really helps to know that there are other people out there who have gone through the same sort of thing.

"They have regular support meetings and a quarterly newsletter, which is informative and always has news of the latest research, which makes me think there’s hope. There’s also a telephone network, which I haven’t used that much, but I know it’s always there."

Menopause: the facts

Every woman will go through the menopause, but each experience of it is different.

Around 80% of women experience the most common symptoms of hot flushes and night sweats

It doesn’t happen at a particular age or last for a fixed period of time, and it can cause a variety of different symptoms – both physical and emotional. The menopause can be an unsettling time in a woman’s life, while some women go through it with no problems.

The menopause is the time when a woman’s periods stop. It happens because as women age, they slowly run out of eggs. Some scientists believe this happens to protect women and their children from the dangers of late childbearing.

This article covers the female menopause. Here is our information on male menopause.

When will I go through the menopause?

The average age that women go through the menopause is 52, but a woman could start to experience menopausal symptoms between the ages of 45 and 55. The symptoms can last two to five years.

Medical conditions can cause the menopause to happen much earlier, sometimes in a woman’s 20s or, in extreme cases, in childhood. This is known as premature ovarian failure (POF).

Menopause symptoms

Changes in hormone levels can produce different symptoms. It's estimated that around two-thirds of women experience the most common symptoms of hot flushes and night sweats. However, some women also report psychological symptoms, including depression, tiredness, lack of energy and vaginal dryness, which can be associated with a reduced interest in sex.

Long-term effects of the menopause include increased risk of osteoporosis and cardiovascular disease.

Find out how to tell if it's the menopause if you take the contraceptive pill.

Read what to do about hot flushes.

Watch the personal experiences of women who have gone through the menopause.

Osteoporosis after the menopause

Bone strength depends on bone tissue density and structure. Reduced amounts of minerals in the bone and slower production or replacement of bone cells weakens bones.

This happens to everybody as they age, but the change is faster in women after the menopause. This is why one in three women over 50 has osteoporosis, compared with only one in 12 men.

Osteoporosis increases the risk of breaking bones, especially those in the wrist, hip or spine. One in seven British women breaks a hip after the menopause.

Because oestrogen is important for healthy bone growth, hormone replacement therapy (HRT) can help to protect a woman’s bones from osteoporosis whilst she is on treatment.

Read how to look after your bones after the menopause.

Breast changes after the menopause

After the menopause it’s natural for your breasts to lose their firmness, change shape, shrink in size, become less dense and become more prone to certain abnormal lumps.

Read more about breast changes at the menopause.

Heart disease after the menopause

Cardiovascular disease is any disease of the heart or blood vessels, including heart attacks and strokes, usually caused by blocked arteries. It is the most common cause of death in women over 60, and there is evidence to suggest that women are more likely to get blocked arteries after the menopause.

Read how women can look after their heart.

Menopause treatments

As well as helping to protect women from osteoporosis, hormone replacement therapy (HRT) is extremely good at controlling menopausal symptoms.

HRT can however, in some women, slightly increase the risk of developing conditions such as breast cancer, deep vein thrombosis (DVT), stroke and heart disease.

If your menopausal symptoms are troubling you, have a chat about the risks and benefits of HRT with your GP to help you decide if you want to try it.

Read more about HRT.

Lifestyle changes such as changing your diet and doing more exercise can also help with symptoms of the menopause. Find out more in Menopause: five self-help tips.