Menopause is more accurately defined as the permanent cessation of the primary functions of the ovaries that is the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining, and the subsequent shedding of the uterine lining (a.k.a. the menses or the period).
This transition from a potentially reproductive to a non-reproductive state is the result of a reduction in female hormonal production by the ovaries this transition is normally not sudden or abrupt, tends to occur over a period of years, and is a consequence of biological aging. Occurs in women in midlife, during their late 40s or early 50s, and it signals the end of the fertile phase of a woman’s life. Menopause has a wide starting range, but can usually be expected in the age range of 42–58.
Menopause can be officially declared (in an adult woman who is not pregnant, is not lactating, and who has an intact uterus) when there has been amenorrhea (absence of any menstruation) for one complete year.
In rare cases, a woman’s ovaries stop working at a very early age, ranging anywhere from the age of puberty to age 40, and this is known as premature ovarian failure (POF).
Spontaneous premature ovarian failure affects 1% of women by age 40, and 0.1% of women by age 30. POF is not considered to be due to the normal effects of aging.
Known causes of premature ovarian failure include autoimmune disorders, thyroid disease, mellitus, chemotherapy, being a carrier of the fragile X syndrome gene, and radiotherapy. However, in the majority of spontaneous cases of premature ovarian failure, the cause is unknown, i.e. it is generally idiopathic POF is diagnosed or confirmed by high blood levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) on at least 3 occasions at least 4 weeks apart.
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:
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.
This 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. The majority of post-menopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help.
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.
If 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.
Women tend to be more susceptible urinary tract infections, such as cystitis. Having to urinate may also occur more frequently.
This often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep.
Problems Focusing & Learning
Some 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.
If left untreated, these symptoms 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.
After the menopause it is common for the following chronic conditions to appear.
A drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease is not exclusively a male problem, it is the main cause of death among both men and women. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her blood pressure within normal levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet.
A woman may lose bone density rapidly during the first few years after menopause. The lower a person’s bone density gets the higher their risk is of developing osteoporosis. The absolute risk of a second clinical fracture is highest in the five years after any first clinical fracture for post-menopausal women.
The menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem – urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body as may happen when we temporarily lose our balance.
This is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found.
During the menopausal transition women are much more susceptible to weight gain. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain – or burn of that number of calories each day with extra exercise. The chances of becoming obese rises significantly after the menopause.
Women are at a higher risk of breast cancer after the menopause. Regular exercise after menopause significantly reduces breast cancer risk.
Only about 10% of women seek medical advice during the menopause. Many women require no treatment. However, if symptoms are affecting the woman’s daily life she should see her doctor. The kind of treatment the patient should have depends on her symptoms, her medical history, as well as her own preferences. Available treatments include:
This is very effective for many of the symptoms that occur during the menopause, including vaginal dryness, vaginal itching, vaginal discomfort, urinary problems, bone-density loss, hot flashes and night sweats. HRT tops up the woman’s levels of estrogen. However, as with many treatments, HRT has its risks and benefits:
Benefits of HRT:
Risks of HRT:
“Not all women need HT, but many with troublesome symptoms were needlessly scared away from that option due to misunderstandings about the actual risks associated with it.”
Older women who take hormone therapy to relieve menopausal symptoms may get the added benefit of reduced body fat if they are physically active, a study revealed.
Hormone therapy in early menopause? – estrogen-progesterone hormone replacement therapy, if initiated soon after the menopause, not only improves symptoms considerably, but also improves some cardiovascular risk factors and mood.
Postmenopausal bleeding is defined as vaginal bleeding occurring over 12 months after periods have stopped in a woman of the age where the menopause can be expected. Hence it does not apply to a young woman who has had amenorrhoea from anorexia nervosa or a pregnancy followed by lactation. It can apply to younger women following premature ovarian failure or premature menopause.
It is common and represents 5% of all gynaecology OPD attendances.
It is likely to occur if exogenous oestrogens are taken. Polycystic ovary disease increases risk. Use of combined oral contraceptives decreases risk.
History and examination may possibly indicate cause but the dictum is that postmenopausal bleeding should be treated as malignant [cancer] until proved otherwise. This requires urgent evaluation by a qualified gynaecologist.