Menopause is a normal condition that every woman experiences as she ages, generally after the age of 40. It describes all changes that a woman experiences either just before or after she stops menstruating. This phase marks the end of reproductive period for a woman. It is a natural biological process, and though it ends fertility, women can stay healthy, sexual and vital even after.
Onset of Menopause
A woman is born with a finite number of eggs that are stored in the ovaries. Each month, an ovary releases one egg, under the influence of hormones oestrogen and progesterone, which are also released by the ovary and help regulate ovulation and menstruation. Menopause occurs when the ovaries stop releasing the egg every month. Its most visible sign is the stoppage of menstruation.
Normal menopause sets in by the age of 40, though some women may experience it early due to certain medical or surgical conditions. Natural menopause process sets in gradually, and can be divided into three stages:
- Perimenopause – This stage typically sets in few years before actual menopause happens and lasts up to the point when ovaries stop releasing eggs. It is characterised by a gradual drop in the levels of oestrogen produced by the ovaries. The level drop accelerates in the last two years before menopause occurs.
- Menopause – This stage is defined as the point that is reached after one year of the last menstrual period. At this stage, ovaries have stopped producing most of the oestrogen and no egg is released.
- Postmenopause – These define the years after menopause, and are characterised by menopausal symptoms such as hot flashes and other effects of loss of oestrogen.
Hormonal changes associated with menopause
The following hormonal changes mark menopause:
- Decline and stoppage of production and release of oestrogen and progesterone.
- Continued production of small amounts of testosterone (male hormone) that can be converted to oestrogen in body fat.
- Continued production of androstenedione (male hormone) by the adrenal gland. It is converted to estradiol and estrone in body fat.
However, the total amount of oestrogen in the body is far less as compared to pre-menopausal stage.
Symptoms of menopause
In the perimenopausal stage (or the months or years leading up to menopause), a woman may experience the following:
- Irregular periods
- Hot flashes
- Night sweats
- Vaginal dryness
- Trouble sleeping
- Mood swings
- Slowed metabolism and weight gain
- Dry skin and thinning hair
- Loss of breast fullness
Skipping periods or irregular cycles is very common during the perimenopausal stage. Menstrual periods often occur every two to four months during this time, though it is possible for a woman to get pregnant at this stage too. Women experiencing symptoms of menopause must consult a gynaecologist.
Diagnosis does not really require tests to confirm menopausal transition. However, the doctor may recommend some blood tests to check the following:
- Levels of follicle stimulating hormone (FSH) and oestrogen (estradiol). FSH levels increase and oestrogen levels drop in menopause.
- Levels of thyroid stimulating hormone (TSH), to rule out hypothyroidism that causes similar symptoms.
Other conditions that can induce menopause
The natural cause of menopause is the biological decline of reproductive hormones, oestrogen and progesterone. As these hormones decline, the fertility drops, ovaries stop releasing eggs, and a woman does not get her periods.
However, certain other conditions can also lead to menopause. These include:
- Hysterectomy – Removal of uterus (partial hysterectomy) by itself does not cause menopause as although a woman no longer has her menstrual periods, the ovaries continue to release eggs and produce oestrogen and progesterone. However, total hysterectomy and oophorectomy (removal of uterus and ovaries) does result in abrupt menopause. Periods stop and the woman is likely to experience other symptoms.
- Chemotherapy and radiation therapy – These cancer treatments can cause symptoms of menopause during or after the treatment course. However, the effect may not be permanent.
- Primary ovarian insufficiency – Genetic factors or autoimmune disease can result in premature menopause, with the ovaries failing to produce sufficient levels of reproductive hormones.
Treatment or methods to relieve menopause symptoms
Since menopause is a natural biological phenomenon, it does not require medical treatment. However, the signs and symptoms that accompany menopause can be source of discomfort to most women and treatment focuses on relieving the same. It includes:
- Hormone therapy – Oestrogen therapy remains the most effective method for relieving hot flashes.
- Vaginal oestrogen – Oestrogen may be administered directly to the vagina in form of a cream, tablet or ring to ease vaginal dryness, discomfort during intercourse and urinary symptoms. The vaginal tissue absorbs the oestrogen released.
- Antidepressants – Low dose antidepressants belonging to the class selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes.
- Treating osteoporosis with medication – Doctor may recommend medicines to reduce the risk of bone loss and fractures during menopause.
Lifestyle remedies to tackle menopause
- Hot flashes can be dealt with by avoiding spicy foods, stress, hot beverages like caffeine, hot weather and alcohol.
- Quitting smoking can be helpful in reducing the incidence of hot flashes and may even delay the onset of menopause.
- Getting enough sleep is beneficial. Avoiding caffeine and exercise before bedtime, and drinking too much alcohol are helpful in providing an uninterrupted sleep.
- Exercising regularly helps deal with the various effects of ageing, including osteoporosis.
- Pelvic floor muscle exercises (Kegel exercises) help improve some forms of urinary incontinence.
- Practising relaxation techniques like deep breathing and massages can help relieve menopausal symptoms.
“Medical Causes of Menopause,” WebMD.com, https://www.webmd.com/menopause/guide/medical-procedures-menopause
“Menopause,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/menopause/basics/definition/con-20019726
“Menopause,” NHS.uk, https://www.nhs.uk/Conditions/Menopause/Pages/Introduction.aspx
“Menopause,” ummc.edu, University of Maryland Medical Center (UMMC), https://umm.edu/health/medical/reports/articles/menopause
“Menopause,” womenshealth.gov, https://www.womenshealth.gov/menopause/
“Menopause Basics,” WebMD.com, https://www.webmd.com/menopause/guide/menopause-basics