Menopause: (The Change in Women)

What Is Menopause?

Menopause is the general term used to describe the ‘change of life’ in women, when their sex hormones production decreases and often initiates a complex of symptoms called the ‘menopause syndrome’. Menopause refers to the one year without bleeding immediately following the last menstrual period. Menopause is preceded by a period known as the peri-menopause. Peri-menopause is the period of time, generally about three to five years before menopause, which has its own complex. The post-menopause is the time after the menopause when symptoms may or may not be present. The average age of menopause is 50 years, even though it can occur early in some women.

Normal Menstrual Cycle

The Hypothalamus (a special part of the brain) senses a lack of certain sex hormones in the blood stream and stimulates the pituitary gland, also located in the brain. It produces a hormone called follicle stimulating hormone. This hormone circulates to the ovaries and stimulates the follicles or potential eggs. One or more of the follicles are then selected to ovulate, and along with ovulation, produce estrogen, progesterone – female sex hormones and male hormones which go into the blood stream and stimulate the uterine lining (lining of the womb) to get ready to accept the egg. If no fertilized egg reaches the uterine lining, also called the endometrium, the hormone levels then decrease and the menstrual cycle starts all over again.

With menopause, the ovaries do not respond to the follicle stimulating hormone stimulation from the pituitary glad. The pituitary gland then produces more of the follicle stimulating hormone trying to force ovulation. This produces an increase in follicle stimulating hormone in the blood and this can be used as a diagnostic test for menopause.

Peri-Menopause and its symptoms may begin up to eight years before menopause. Usually the first manifestation is abnormal bleeding which is characterized by shorter menstrual intervals. If one’s regular cycle length is 28 days, in the peri-menopause the menses may shorten to 24-26 days. Later there are irregularities in the cycle length and longer intervals caused by missing periods. These are normal expected changes due to the inconsistent production of hormones made from the older less efficient ovaries. Bleeding between the periods, or inter-menstrual bleeding is not normal and often represent an anatomic cause for the bleeding rather than a hormonal one. Uterine fibroids (growth on the womb) or intra-uterine polyps are the most frequent causes of such bleeding.

Menopause is the transition in a woman's life when the ovaries stop releasing eggs, menstrual activity decreases and eventually ceases, and the body decreases the production of the female hormones estrogen and progesterone.

Along with the inconsistent bleeding often come symptoms of hormonal irregularities. During the months when normal hormones are produced and bleeding is normal, there may not be any specific symptoms. In the months when ovulation does not occur, hormone secretion does not occur in a normal pattern. During these months one may have menopausal type syndrome like hot flashes, insomnia (inability to sleep at night) and irritability which may also seem a lot like peri-menopausal syndrome. These are secondary to estrogen deficiency. In some of the cycles, adequate estrogen is still present but without ovulation no progesterone is produced and similar peri-menopausal syndrome-like symptoms can be present from progesterone deficiency. The key to the peri-menopausal syndrome is therefore the inconsistency of both bleeding and symptoms.