Menopause

Definition

Menopause represents the end of menstruation. While technically it refers to the final period, it is not an abrupt event, but a gradual process. Menopause is not a disease that needs to be cured, but a natural life-stage transition. However, women have to make important decisions about "treatment," including the use of hormone replacement therapy (HRT).

Description

Many women have irregular periods and other problems of "pre-menopause" for years. It is not easy to predict when menopause begins, although it is agreed that it is complete when a woman has not had a period for a year. Eight out of every 100 women stop menstruating before age 40. At the other end of the spectrum, five out of every 100 continue to have periods until they are almost 60. The average age of menopause is 51.

There is no mathematical formula to figure out when the ovaries will begin to scale back either, but a woman can get a general idea based on her family history, body type, and lifestyle. Women who began menstruating early will not necessarily stop having periods early as well. It is true that a woman will likely enter menopause at about the same age as her mother. Menopause may occur later than average among smokers.

Causes and symptoms

Once a woman enters puberty, each month her body releases one of the more than 400,000 eggs that are stored in her ovaries, and the lining of the womb (uterus) thickens in anticipation of receiving a fertilised egg. If the egg is not fertilised, progesterone levels drop and the uterine lining sheds and bleeds.

By the time a woman reaches her late 30s or 40s, her ovaries begin to shut down, producing less oestrogen and progesterone and releasing eggs less often. The gradual decline of oestrogen causes a wide variety of changes in tissues that respond to oestrogen—including the vagina, vulva, uterus, bladder, urethra, breasts, bones, heart, blood vessels, brain, skin, hair, and mucous membranes. Over the long run, the lack of oestrogen can make a woman more vulnerable to osteoporosis (which can begin in the 40s) and heart disease.

As the levels of hormones fluctuate, the menstrual cycle begins to change. Some women may have longer periods with heavy flow followed by shorter cycles and hardly any bleeding. Others will begin to miss periods completely. During this time, a woman also becomes less able to get pregnant.

The most common symptom of menopause is a change in the menstrual cycle, but there are a variety of other symptoms as well, including:

  • hot flushes
  • night sweats
  • difficulty sleeping
  • mood swings/irritability
  • memory or concentration problems
  • vaginal dryness
  • heavy bleeding
  • fatigue
  • depression
  • hair changes
  • headaches
  • sexual disinterest
  • urinary changes
  • weight gain

Diagnosis

The clearest indication of menopause is the absence of a period for one year. It is also possible to diagnose menopause by testing hormone levels. One important test measures the levels of follicle-stimulating hormone (FSH), which steadily increases as a woman ages.

However, as a woman first enters menopause, her hormones often fluctuate wildly from day to day. For example, if a woman's oestrogen levels are high and progesterone is low, she may have mood swings, irritability, and other symptoms similar to premenstrual syndrome (PMS). As hormone levels shift and oestrogen level falls, hot flushes occur. Because of these fluctuations, a normal hormone level when the blood is tested may not necessarily mean the levels were normal the day before or will be the day after.

If it has been at least three months since a woman's last period, an FSH test might be more helpful in determining whether menopause has occurred. FSH test alone cannot be used as proof that a woman has entered early menopause. A better measure of menopause is a test that checks the levels of estrogen, progesterone, testosterone and other hormones at mid-cycle, in addition to FSH.

 
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