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The menopause- what is it?
The menopause is defined as the last menstrual period. This happens as a result of the ovaries running out of eggs (follicles), which causes a fall in hormone production (oestradiol). However, most people use the term menopause to refer to the time in a woman's life when her hormone levels are falling and she is getting symptoms. This stage of life is more properly referred to as the climacteric or peri-menopause.
The average age for periods to finish is 51 - 52 years. With an increasingly ageing population, most women in Western countries will expect to live at least thirty years post-menopausal - this means that a woman should expect to live a third of her life after the menopause.
The climacteric is the time around the menopause when the change takes place from a woman having sufficient amounts of oestrogen and progesterone hormones in her body, to the time when the levels are very low. The typical symptoms (hot flushes, night sweats) begin as the hormone levels fall. This time of change ends when symptoms stop being a problem. The symptoms start on average four years before the menopause, although in some women they can last for many years. In others, menstruation can stop abruptly with no preceding warning symptoms at all.
Bleeding more than twelve months after the last menstrual period is considered abnormal and needs to be reported to your GP.
What causes the menopause?
The menopause occurs naturally when the store of eggs (oocytes) runs out. The ovaries normally produce eggs and hormones as a result of the effects of two other hormones, FSH (follicle stimulating hormone) and LH (luteinising hormone). These are released from a part of the brain called the pituitary. When the supply of eggs has finished, the ovaries cannot respond to the stimulation of these hormones. Therefore the body puts out more and more of the stimulating hormones to try to build up the hormone levels again and so the levels rise (FSH greater than 30iuL).
Once the level of oestrogen falls below a certain level in the blood stream, the endometrium (lining of the womb) is not stimulated to grow any more and so menstruation (period bleeding) stops. FSH and LH levels then remain permanently high. (link tests page).
In some women there are other causes for the menopause such as surgery (removal of both ovaries), radiation or chemotherapy used to treat cancers such as Hodgkin's disease. A premature or early menopause is defined as the menopause at less than 45 years of age. This is called 'premature ovarian failure' (POF).(link to premature menopause page)
What are the effects of the menopause?
Symptoms usually begin during the climacteric or perimenopause, before the last menstrual period. The effects of low oestrogen levels can be noticeable in most parts of the body. Some signs such as hot flushes and night sweats are evident at an early stage (short term symptoms), others tend to come on much later (long term effects)
