What happens during menopause?

What is menopause?

Every woman, naturally throughout their youth, experience periods. A period is part of the menstrual cycle. This is when a woman bleeds from her vagina for a few days. This cycle recurs every 28 days on average, but it can vary from 21 days to 40 days, depending on the woman. A period lasts about 3 to 8 days, on an average of 5 days. Periods usually commence around the age of 12, with some girls getting it earlier or later in life.

Menopause occurs when a woman stops experiencing these periods permanently, and subsequently can no longer get pregnant naturally. This process is not abrupt. A few months or years before menopause, periods tend to become less frequent. This is a natural process, a part of aging, usually occurring between the ages of 45 to 55 years. Estrogen levels in women tend to decline around this age. Some women may experience premature menopause, which refers to women going through menopause before the age of 40. 

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What causes menopause?

When a woman is born, she has all her eggs stored in her ovaries. Estrogen and progesterone are also produced by the ovaries, and these hormones control periods (menstruation) and the release of an egg (ovulation) from the ovaries. During menopause, the ovaries stop releasing an egg from the ovaries each month, and menstruation no longer occurs. 

Some women may experience premature menopause, which refers to women going through menopause before the age of 40. Causes of premature menopause can be due to surgical removal of ovaries or damage to ovaries due to chemotherapy. 

Premature ovarian failure is a condition characterized by the premature stopping of ovulation for unknown reasons.  When this occurs, the levels of estrogen and progesterone in the body is altered. When this happens to a woman before the age of 40, it is referred to as premature ovarian failure. Unlike premature menopause, premature ovarian failure is not always premature and periods can commence again. 

Menopause process

When menopause occurs naturally, it is not induced by any medical or surgical treatment. It occurs in 3 phases:
Perimenopause: This phase normally begins a few years before menopause, as the ovaries gradually make less estrogen. This perimenopause phase lasts until menopause starts. In the last 1 or 2 years of perimenopause, the levels of estrogen start to decline more quickly, and this is when women begin experiencing menopause symptoms. 
Menopause: Ovaries have stopped releasing an egg, and estrogen is no longer being produced. 
Postmenopause: This phase occurs years after menopause happens. Symptoms of menopause have eased or even halted. Some women might experience some health risks associated with the loss of estrogen.

Symptoms:

There are some key symptoms that women experience during menopause. These include:

• Hot flushes - a sudden feeling of heat usually around the face, neck, and chest. You might notice your skin going red and sweaty 
• Night sweats - hot flushes that occur at night 
• Trouble sleeping (insomnia)
• A reduced libido 
• Problems with memory and concentration 
• Headaches
• Changes in mood (mood swings) - low mood or anxiety 
• Palpitation - noticing your heart race
• Stiffness in the joints, aches and pain
• Recurrent urinary tract infection
• Pain, discomfort, itching or vaginal dryness during sex

As a result of menopause, women are also at a higher risk of developing certain problems such as weak bones (osteoporosis). 

Diagnosis:

Due to the distinct symptom of hot flushes, you can usually suspect if you’re going through menopause.  Alternatively, a doctor can diagnose you with menopause based on the symptoms you come in with. If you track your periods closely, you will notice a trend of your periods becoming more irregular, which can serve as another clue. 

Doctors can also test different hormone levels in your blood. 

• Follicle-stimulating hormone (FSH): This hormone level usually rises around the time of menopause. 
• Estradiol: This hormone level indicates the amount of estrogen your ovaries are producing. 
• Thyroid hormone: Changes in the level of thyroid hormone due to problems in your thyroid gland can be a reason behind the changes in your period and mimic symptoms of menopause. 

Treatment:

Menopause is a natural process, and hence the symptoms tend to fade over time. However, if they are causing you problems in your life, hormone replacement therapy (HRT) is a treatment option to resolve your symptoms and make you feel better. 

HRT treatment helps replace the declining estrogen levels in your body. HRT is offered to most women going through menopause. There are two main forms of HRT:

• Estrogen-only: this is for women who have had a hysterectomy (surgical removal of the womb)
• Combined HRT: a combination of estrogen and progesterone offered to women who still have a womb. When estrogen is taken alone, it increased the risk of developing womb cancer, therefore, it is not offered to women with a womb

HRT comes in multiple forms: pills, patches, or a gel. HRT is highly effective at relieving menopausal symptoms, especially hot flushes and night sweats. However, as with any treatment, it comes with its own risks. HRT can increase the risk of blood clots and breast cancer in some women. Thus, HRT is not recommended in women who are at risk of getting breast cancer or have certain types of breast cancer. It is advised to thoroughly discuss HRT with your doctor before deciding to start it. 

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