Main facts

Menopause comes from the Greek words, menos (month) and pausos (ending). Menopause is the time that marks the complete end of your menstrual cycle. It’s defined as when you’ve gone 12 months without a menstrual period.

As your age advances, your reproductive cycle, which has been continuously occurring since puberty, starts to become erratic and prepares to stop. As the time of menopause approaches, your ovaries make less estrogen.

It is the falling levels of estrogen that make your periods irregular and then stop.

In some women, menopause can set in their 40s or 50s, but the average age for menopause is 51 years for non-smokers and 49 for smokers, with a typical age range between 47 and 55 years. About 80% of women reach menopause by the age of 54 years.

Menopausal changes

Menopause is a change in a woman’s life into a different stage. It is a natural phenomenon of aging and signifies the end of your reproductive years. It brings about biological, social, and emotional changes.

  • Biological changes in menopause are natural changes that occur as a woman’s ovaries stop producing eggs, and the production of hormones such as estrogen and progesterone declines.
  • Emotional changes vary in intensity. Some women experience anxiety and depression, but women who have a lower stress threshold are more susceptible to the more intense emotional changes of menopausal syndrome.
  • Social changes include social embarrassment, discomfort, and lowered confidence caused by emotional changes. Additionally, hot flushes can be visible and further increases anxiety which triggers further hot flushes. Hot flashes cause a sudden feeling of warmth, sweating, and reddening of the skin in the upper body, which is usually most intense over the face, neck, and chest.

Puberty and menopause

Puberty and menopause both bracket the reproductive years of a woman’s life. One signifies the beginning and the latter signifies the end of your reproductive life. Yet, both share some common characteristics:

  • They are both transitions
  • Both are triggered by hormones
  • Both cause physical and emotional changes
  • Both close doors to the previous stage and open doors to the new one

Perimenopause, Menopause, and Postmenopause

  • Perimenopause is the period that leads to menopause, the cessation of periods. Your estrogen production is slowing down and a lot of symptoms such as hot flashes and mood swings take place during perimenopause. It can begin eight to 10 years before menopause when your ovaries gradually start producing less of the hormone, estrogen. In most cases, perimenopause usually starts when in your 40s and lasts till menopause begins when your ovaries stop producing eggs. During the final two years of perimenopause, the drop in estrogen production accelerates and many women may start experiencing menopause symptoms. However, you still continue to have erratic periods and are capable of getting pregnant.
  • Menopause means the end of menstruation. During the year that leads up to menopause, your periods are erratic; you’re not sure which will be the last one. You’ve officially attained menopause only after you haven’t had a period for one year. At this stage, your ovaries have stopped releasing the eggs and have stopped producing most of the estrogen.
  • Postmenopause is the period after your last menstrual cycle.  This is the name given to the rest of your life after you haven’t had a period for an entire year. During this stage, menopausal symptoms, such as hot flashes, may improve. However, some women may continue to have menopausal symptoms for a decade or more. Due to the lower estrogen level, the woman is at an increased risk for health conditions, such as osteoporosis and heart disease.

What hormonal changes happen during menopause?

Menopause occurs when your ovaries no longer produce high levels of the hormones, estrogen, and progesterone. They were producing and secreting these hormones since puberty when your periods started.

Ovaries are the reproductive glands that produce, store and release an egg into the fallopian tube during the ovulation time of your menstrual cycle. They also produce and secrete the hormones estrogen and progesterone, which control the menstrual cycle.

When the ovaries stop producing estrogen and releasing eggs, you’ll have your last menstrual cycle.

Before menopause, most of the estrogen is produced in the ovaries. After menopause, the ovaries no longer produce much estrogen, and estrogen mainly comes from fat tissue.

What happens during menopause? Signs and symptoms

Your menopause symptoms, which can be even physical, manifest due to the falling levels of the hormones produced by your ovaries. It’s your body’s way to adapt to the varying levels of hormones. This happens during each stage of menopause (perimenopause, menopause, and postmenopause).

Following symptoms present when you step into menopause. They are caused by changes in hormone levels.

Not everyone will have the same symptoms as they transition to menopause and the intensity of the symptoms also varies from woman to woman. They may be mild in some women and intense in others.

Symptoms of menopause can last for up to 10 years after your last period, but for most women, they last for less than five years.

You may experience some or all of the following symptoms:

  • Hot flashes (a sudden feeling of warmth throughout the body). Hot flashes cause feelings of sudden warmth, along with flushed skin and sweating. They can come on suddenly at any time during the day or night. They can last for a few seconds or for several minutes at a time.
  • Night sweats
  • Vaginal dryness
  • The urgency to pass urine
  • Insomnia or sleeplessness
  • Mood swings, irritability
  • Dry skin, dry eyes, or dry mouth
  • Breast tenderness
  • Worsening of premenstrual syndrome (PMS)
  • Irregularly spaced periods or periods that may be heavier or lighter than usual

Other symptoms that some women may also experience:

  • Rapid heartbeat
  • Headaches
  • Joint and muscle pains
  • Reduced sex drive
  • Weight gain
  • Hair loss

Why does menopause happen? Causes

Normal menopause is a natural part of aging. Natural menopause (end of menstrual bleeding) is one that happens on its own in the absence of any surgical intervention or a medical condition that may cause bleeding to stop.

There are unnatural causes of menopause such as hormonal birth control, radiation therapy, or (surgical menopause caused by surgical removal of your ovaries.

The natural and unnatural causes of menopause include:

  • Naturally falling reproductive hormones. Sometime during the late 30s, your ovaries start producing less of the hormones, estrogen, and progesterone. These are the hormones that regulate menstruation and fertility. In your 40s, your menstrual periods may become irregular. They may be longer or shorter, heavier or lighter, with increasing or decreasing frequency. The age of 51 years is the average age of menopause when your ovaries stop releasing eggs, and you have no more periods.
  • Surgical removal of the ovaries (oophorectomy). Surgical removal of your ovaries causes immediate menopause. There may be indications for this surgery but the immediate fallout is the cessation of your periods. You’re likely to experience hot flashes and experience other menopausal symptoms, which will likely be severe due to the abrupt hormonal changes that occur. In the natural course, the fall in hormonal levels is gradual.
  • Surgical removal of the uterus (hysterectomy). Surgery that removes only your uterus but not your ovaries usually doesn’t cause the onset of immediate menopause. Your periods will stop, but your ovaries will still produce estrogen and progesterone and release eggs.
  • Chemotherapy. Some types of chemotherapies can cause damage to the ovaries giving rise to the early onset of unnatural menopause, which may happen immediately or months after chemotherapy. It depends on the type and amount of chemo drug administered. It also depends on your age. The younger you are, the less likely you will have early menopause from chemo. Chemo also stops the ovaries from producing eggs due to which the woman stops having a period and goes into temporary menopause. In most cases, the woman starts menstruating naturally eight months to two years after stopping chemotherapy and can become pregnant again. Therefore, birth control measures may still be desired.
  • Radiation therapy. Radiotherapy uses radiation to kill cancer cells. Radiotherapy to the pelvis is given to treat cancers of the uterus, cervix, ovaries, vulva, vagina, and anus. Pelvic radiotherapy can cause early menopause by stopping your ovaries from functioning. The symptoms of menopause caused by pelvic radiotherapy can be more intense if they come on suddenly.
  • Primary ovarian insufficiency. About 1% of women experience premature menopause before the age of 40 years. This happens because their ovaries fail to produce normal levels of reproductive hormones due to primary ovarian insufficiency, which can be due to genetic factors or autoimmune disease. Such women are typically put on hormone therapy till the natural age of menopause in order to protect the brain, heart, and bones from the complications of hormone insufficiency.

Complications

Menopause increases your risk of certain health problems. Examples include:

  • Cardiovascular disease. After menopause, your risk of cardiovascular disease increases due to the fall in estrogen levels. It’s important, therefore, to maintain cardiac discipline. exercise, eat a heart-healthy diet, and maintain a normal weight. Control your cholesterol or blood pressure if it’s high.
  • Osteoporosis. Menopause can cause osteoporosis, in which the bones become brittle and weak, increasing the risk of fractures mostly of the spine, hips, and wrists. Bone density loss is most marked during the first five years after menopause. Postmenopausal women should, therefore,
  • Urinary incontinence. In postmenopausal women, the vagina and urethra lose elasticity. This can cause frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine. or the passage of urine with coughing, laughing or lifting a weight. Kegel exercises and the use of topical vaginal estrogen may help relieve symptoms of incontinence. Some doctors may recommend hormone therapy to combat the changes that can result in urinary incontinence.
  • Sexual function. Vaginal dryness, also referred to as atrophic vaginitis or vaginal atrophy is caused by the natural decline in estrogen levels during menopause. There is decreased moisture production and loss of elasticity. The vaginal tissues become thinner and can cause discomfort and slight bleeding during sexual intercourse. The decreased sensation may reduce your desire for sexual activity (libido). The use of water-based vaginal moisturizers and lubricants can help. Many women benefit from the use of local vaginal estrogen applications available as a vaginal cream, tablet, or ring.
  • Weight gain. During the transition into menopause and during the postmenopausal period, many women gain weight because of the slowing down of the body’s metabolism. To combat this weight gain, you need to eat less fatty foods and exercise more, to maintain a healthy weight.

Your doctor will confirm the diagnosis of menopause and put you on an effective treatment option to make your postmenopausal life comfortable.