This page with references and links

What is the menopause?

The menopause is defined as the last menstrual period. We tend to to consider the menopause to be that period of time when a woman ceases to have reproductive capability. Strictly speaking that span of time is not the menopause but the climacteric.

At the menopause, the ovaries lose much of their function. There is a fall in hormone production, notably oestrogen.

Pre menopause is the time before the menopause and post-menopause is the time after the menopause. Peri-menopause is the time around the menopause and may also be called the climacteric. Post menopause the ovaries are no longer producing significant amounts of oestrogen and no progesterone. As oestrogen protects the heart and bones, post menopause the risks of osteoporosis and heart disease increase.

A natural menopause occurs at the time nature intended. Artificial menopause tends to be medically related. This is usually surgical - the ovaries are removed typically during hysterectomy. Radiation may also cause a menopause.

"Youth is like spring, an over praised season more remarkable for biting winds than genial breezes. Autumn is the mellower season, and what we lose in flowers we more than gain in fruits." 

-- Samuel Butler

When Does the menopause occur?

The average age at menopause is 50.5 years in Caucasian women – half have their last period earlier and half later. One woman in ten will not reach her menopause by the age of 54 and on occasion periods may persist until the age of 57. This has probably not changed over the last 100 years. In contrast, the average age at menarche (first period) seems to be getting lower (puberty). Low financial income and poor education are associated with earlier menopause but age at menarche, marital status, weight, height, number of pregnancies and use of oestrogens in the pill or hormone replacement therapy are unrelated. There may be a tendency for early menopause to follow within a family.

What is regarded as an early menopause or Premature Menopause?

Premature menopause (ovarian failure) is defined as menopause before the age of forty years. Whereas premature menopause is defined, early menopause is used more arbitrarily. Some use early and premature menopause interchangeably but others use early menopause in relation to women under the age 45. For many women, a diagnosis of early or premature menopause comes as devastating news, particularly if fertility is still required. The long-term detrimental health effects of the menopause begin early with premature menopause and HRT should be considered. The subject of premature menopause is discussed in more detail at premature-menopause.

What are the  menopause symptoms and signs?

  • Hot flushes (hot flashes - USA)
  • Night sweats
  • Depression
  • Anxiety
  • Insomnia
  • Reduced sex drive (libido)
  • Dry skin

Strictly speaking these are symptoms of the menopause. A sign is an observation by a doctor during examination.

What are the long-term effects of the menopause?

In addition to the symptoms above, there is strong evidence that the menopause is associated with deterioration of the coronary arteries leading to heart disease. Thinning of the bones is accelerated - osteoporosis.

How can the menopause be diagnosed?

When the ovaries become less active, the pituitary gland increases its output of follicle stimulating hormone (FSH). A blood test showing a high level of FSH is indicative but not absolutely diagnostic of the menopause.

How can the menopause be treated?

The mainstay of treatment is hormone replacement therapy - HRT. HRT is particularly effective relief for hot flushes (flashes) and night sweats.

The benefits and risks of HRT are discussed at HRT.

Is there a male menopause?

By the definition of menopause, a male menopause cannot exist. It has been argued, however, that the male can go through a male e quivalent, called the andropause, that's accompanied by symptoms similar to those experienced by women. The female menopause is triggered by a dramatic fall in the levels of female hormones, whereas the levels of the male hormone testosterone fall gradually and to a lesser degreeover many years. Many 70-year-old men have similar testosterone levels to those of a 25-year-old.

What will happen to me at my menopause?

Throughout your reproductive years, your ovaries have two essential functions - they release both eggs and hormones (Q 2.3). Ovarian hormones are responsible for your female physical characteristics, such as breast development, general body shape and the menstrual cycle and they are fundamental in those indefinablequalities called femininity. When we speak of the menopause, we usually mean the time in a woman's life when the ovaries cease to function doctors call this ovarian failure. The medical term for this phase of a woman's life is 'the climacteric'. It may affect you for a matter of a few weeks or months but may continue to be a problem for several years.

The menopause is defined by doctors as the final natural menstrual period and compares to the menarche which is the first period. The menopause is only one event of the climacteric just as the menarche (puberty) is one event during puberty when there are a whole range of physical and emotional developments. The menopause is the time when you cease to have natural reproductive capability. It is also a time when the majority of women experience a variety of physical and emotional symptoms including, night sweats and mood swings. These symptoms will usually respond to hormone replacement therapy (HRT: Q 27.1).

In association with a normal menopause, periods become lighter and less frequent. Many women, however, experience heavier periods before the menopause. These should be investigated.

Why does nature put women through the menopause?

A baby, although destined to have the mental ability and dexterity that is greatly superior to any other species, is delivered into this world at a relatively early stage of development and is totally reliant on parental care. Nature does not allow a child to bring a baby into the world and similarly avoids a baby having a mother who is beyond middle age. During reproductive years, most of the oestrogen (female hormone - Q 2.9) produced in your body comes from the cells in your ovaries that surround eggs reaching maturity. The ovarian hormones have to be linked to the development of eggs so that the required cyclical changes of the endometrium (lining of the womb; Figure 2.3) are synchronised appropriately in preparation for a possible pregnancy.

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The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

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