Menopause is a biological stage in a woman’s life when menstruation (periods) stops permanently, due to loss of ovarian activity. Menopause typically occurs in the age range of 45 – 55 years, with 51 being the mean age in the UK.
Types of menopause
- Menopause: occurs with the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea (no periods)
- Perimenopause: period before the menopause when ovaries are beginning to decline in function. Periods in the perimenopause are characterised by irregular cycles of ovulation and menstruation. It can also be known as ‘menopause transition’, or ‘climacteric’
- Early menopause: menopause occurring naturally between 40 and 45 years old (excluding other causes of amenorrhoea)
- Premature menopause: menopause occurring before 40 years old, when menstruation completely stops
- Premature ovarian insufficiency: clinical syndrome defined as the transient or permanent loss of ovarian function before the age of 40 years. Blood tests are used for this specific diagnosis. It is characterised by menstrual disturbance (no periods or fewer periods); however differs from premature menopause due to the potential of spontaneous resumption of ovulation, menstruation, and potentially pregnancy.
Causes
In menopause, ovarian activity begins to fall. This impacts hormone production levels, including oestrogen, progesterone and testosterone.
These hormones play a wide role in multiple systems in the body, including the brain. Decreased levels of oestrogen, progesterone and testosterone are the basis behind the symptoms of menopause.
Menopausal symptoms (women may not experience all symptoms; only some may be present)
- Changes to usual menstrual pattern. Menstrual cycles may shorten to 2-3 weeks, or lengthen to many months
- Changes to amount of menstrual blood loss (e.g. heavier or lighter periods than normal)
- Hot flushes / night sweats
- Cognitive symptoms: mood disturbance, anxiety, irritability, lack of interest in doing things, low mood (low mood is distinct from depression, and is due to disturbed hormonal levels), poor cognition and memory
- Sensory symptoms: sudden feeling of heat in the upper body (face, neck, and chest) that spreads upwards and downwards, typically lasting 2–4 minutes
- Vaginal irritation, discomfort, dryness, burning; and urinary problems
- Altered sexual function and libido
- Sleep disturbance
- Generalised pain: joint and muscle pains, headaches
- Fatigue.
How long will I have symptoms for?
The duration and severity of symptoms experienced in menopause vary markedly between different women. Studies show symptoms typically last for 5–7 years, but some women continue to experience symptoms for at least 10–15 years. In reality, symptoms may persist for any length of time and vary on an individual basis.
Treatment options
The mainstay of treatment for menopause is Hormone Replacement Therapy (HRT). This aims to administer hormones (usually oestrogen and progesterone, can be testosterone) to try and restore levels of each hormone back to the regular, or physiological, level. It can be taken in different ways – tablets, patches, gel, spray or vaginal rings, pessaries or cream
Complications of menopause
- Women who have gone through menopause have increased risk of the following:
- Osteoporosis and fractures (e.g. neck of femur; and compression wedge vertebral fractures (which can lead to a ‘widows/dowagers’ hump)
- Stroke
- Cardiovascular disease
- Diabetes.
Written by Jawad Chowdhury, Medical Student
