The menopause marks the time in a woman's life when her menstruation stops and she is no longer fertile (able to become pregnant).
In the UK the average age for the menopause is 52 (National Health Service), while in the USA it is 51 (National Institute of Aging). About one fifth of women in India experience menopause before the age of 41.
The menopause is a normal part of life - it is a milestone, just like puberty - it is not a disease or a condition. Even though it is the time of the woman's last period, symptoms may begin many years earlier. Some women may experience symptoms for months or years afterwards.
The peri-menopause is the 3 to 5 year period before the menopause when a woman's estrogen levels begin to drop.
Symptoms of menopause
Experts say that technically, the menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms and signs of menopause generally appear well before that one-year period is over. They may include:
Women going through the menopause may experience problems with focusing and learning.
This is usually the first symptom; menstrual pattern changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time.
During the peri-menopausal stage of a woman's life, her estrogen levels will drop significantly, lowering her chances of becoming pregnant.
Vaginal drynessThis may be accompanied by itching and/or discomfort. It tends to happen during the peri-menopause. Some women may experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen.
Approximately 30% of women experience vaginal atrophy symptoms during the early post-menopausal period, while 47% do so during the later post-menopausal period. There are cases of women who experience vaginal atrophy more than a decade after their final period. The majority of post-menopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help.
Hot flashes (UK term: hot flushes)
A sudden feeling of heat in the upper body. It may start in the face, neck or chest, and then spreads upwards or downwards (depending on where it started). The skin on the face, neck or chest may redden and become patchy, and the woman typically starts to sweat. The heart rate may suddenly increase (tachycardia), or it may become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman's final period.
Night sweatsIf the hot flashes happen in bed they are called night sweats. Most women say their hot flashes do not last more than a few minutes.
Sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause.
Moodiness often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep.
Problems focusing and learningSome women may also have short-term memory problems, as well as finding it hard to concentrate on something for long. Some women may not be able to learn as well shortly before menopause compared to other stages in life.
Other symptoms of menopause can include:
- More fat building up in the abdomen.
- Hair loss (thinning hair).
- Loss of breast size.
If left untreated, all of the symptoms mentioned will usually taper off gradually over a period of two to five years. However, symptoms can persist for much longer. In some cases, vaginal dryness, itching and discomfort can become chronic, and eventually get worse if left untreated.
Causes of the menopause
The hormones estrogen and progesterone regulate menstruation - more specifically, estrogen regulates menstruation while progesterone is more involved with preparing the body for pregnancy.
When the ovaries start producing less of these two hormones, the peri-menopause will start. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. By the time she is in her 40s, the post-ovulation spike in progesterone becomes less emphasized. A woman's fertility starts to decline a long time before she may notice any menopausal or peri-menopausal symptoms.
As time passes and the ovaries produce less and less estrogen and progesterone, the ovaries eventually shut down completely and the woman no longer has any more menstrual periods. The vast majority of females experience a gradual change in menstrual activity, while some go on normally until they suddenly stop.
Some women may experience premature menopause - their ovaries fail earlier than they are supposed to (before the age of 45). Ovarian failure can occur at any age - but very rarely - and often the doctor and patient will never find out why. Some who experience ovarian failure may still have periods and some degree of fertility for a while. Premature menopause may be caused by:
- Enzyme deficiencies
- Down's syndrome
- Turner's syndrome
- Addison's disease
- Removal of the ovaries (bilateral oophorectomy surgery)
- Radiotherapy to the pelvic area
- Hysterectomy surgery (the uterus - womb - is surgically removed)
- Some infections - such as mumps or TB (tuberculosis), malaria and varicella. However, in all cases risk of ovarian failure is extremely small.
- Genetic factors - scientists have been able to identify genetic factors that influence the age at which natural menopause occurs.
- Being a twin - twins are more likely to have a premature menopause.
How is menopause diagnosed?
A GP (general practitioner, primary care physician) should be able to diagnose menopause or peri-menopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her on her symptoms.
Apart from a blood test which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or peri-menopause. FSH blood levels rise when a woman is in the menopause. However, as FSH levels tend to fluctuate a lot during the menopause and peri-menopause, the test may provide a little data, and is not that helpful for a diagnosis. Under certain circumstance a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, a blood test to determine the woman's level of thyroid-stimulating hormone may be recommended.
On the next page we look at the available treatments for menopause, including hormone replacement therapy, plus the complications and possible ideas for self help.