All women will experience the menopause. Natural menopause takes place when the ovaries become unable to produce the hormones estrogen and progesterone. Menopause can also occur when the ovaries are damaged by specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed, often at the time of a hysterectomy. Ovaries naturally fail to produce estrogen and progesterone when they have few remaining egg cells; the maximum number of egg cells in the ovaries is present before birth, with a reduced number already at birth, gradual reduction from puberty, and a rapid decline from 40 onwards. With less egg cells, the ovaries become less able to respond to hormones from the pituitary gland in the brain: follicle stimulating hormone (FSH) and luteinising hormone (LH) and less estrogen is produced. Levels of FSH and LH subsequently rise and a measurement of FSH is sometimes used to diagnose menopause. The resulting low, and changing levels of ovarian hormones, particularly estrogen, are thought to be the cause of menopausal symptoms and later consequences in many women.
The term climacteric refers to the time in which the hormone levels are changing, up to the periods stopping; reducing and changing hormone levels can cause early menopausal symptoms. At this stage, there may still be enough hormones produced to stimulate the lining of the womb (endometrium) to produce monthly periods (menstruation).
Menopause means the last menstrual period. Periods stop because the low levels of estrogen and progesterone do not stimulate the lining of the womb (endometrium) in the normal cycle. Hormone levels can fluctuate for several years before eventually becoming so low that the endometrium stays thin and does not bleed.
Perimenopause is the stage from the beginning of menopausal symptoms to the postmenopause.
Postmenopause is the time following the last period, and is usually defined as more than 12 months with no periods in someone with intact ovaries, or immediately following surgery if the ovaries have been removed.
Menopausal symptoms, which affect about 70% of women, are thought to be due to the changing hormone levels, particularly estrogen, but many other factors such as diet and lifestyle, exercise and other medications can also influence symptoms.
Therefore for some women, lifestyle factors such as stopping smoking, eating healthily, reducing caffeine, reducing alcohol intake, reducing stress and taking regular exercise can considerably help the symptoms of the menopause.
For others hormone replacement therapy (HRT) may be beneficial, and indeed menopausal symptoms are the main reason for using HRT.
Menopause - when?
The average age of the natural menopause is 51 years, but can occur much earlier or later. Menopause occurring before the age of 45 is called early menopause and before the age of 40 is premature menopause.
Generally, women having an early or premature menopause are advised to take HRT until approximately the average age of the menopause, for both symptom control and bone protective effect.
What are the symptoms of the menopause?
Early menopausal symptoms include Physical, Sexual and
Physical symptoms include: -
- Hot flushes
- Night sweats
- Joint aches
Flushes and sweats (known as vasomotor symptoms) are due to altered function of the body’s temperature control. They can occur without warning but may be precipitated by a hot drink, change in room temperature, alcohol and stress. Headaches, palpitations and dizziness may be associated with vasomotor symptoms. Insomnia (sleeplessness) or disturbed sleep may in part be due to night sweats, control of which can improve sleep patterns. Joint aches can be a common symptom but their association with the menopause often goes unrecognised.
Psychological menopause symptoms such as mood swings, irritability, anxiety, difficulty coping, forgetfulness and difficulty concentrating may be related to hormonal changes, either directly or indirectly, for example due to sleep disturbance.
However, other life events such as worry over teenage children, elderly relatives and stresses of work may also contribute to such “symptoms” around the time of the menopause.
Sexual problems may be caused by vaginal dryness due to low estrogen levels, resulting in discomfort during intercourse.
Effective treatments are available. As men and women get older, interest in sex may decrease but this particularly affects women. Treatment of other menopausal symptoms may indirectly improve libido by improving feelings of well being and energy levels e.g. by improving sleep through control of night sweats, but restoring hormone levels can also improve sensation. Hormonal treatment may not however be the “magic” answer as relationship problems can also affect libido.
Late menopause may also occur but by the age of 54, 80% of women will have stopped having periods.
Produced by Dr H Currie & Sr. K Martin