What is Menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. It typically occurs in women between the ages of 45 and 55, and causes symptoms which last in the region of 4 to 7 years.

Understanding the science behind menopause is important not just for the women experiencing it, but also for their friends, family and colleagues. By educating ourselves about menopause, we can work towards creating a more supportive and informed society.

In terms of vocabulary, we use the term 'women' throughout this pathway, but we acknowledge and respect that not everyone who experiences menopause identifies as a woman. We hope these people can also find value and interest in this pathway. It was written for anyone who needs it.

The word ‘menopause’ literally means ‘end of monthly cycles’. It comes from ancient Greek mēn (which means ‘month’) and pausis (which means ‘pause’).

On a biological level, the menopause is usually said to occur when a woman has not had a menstrual period for 12 consecutive months. This moment indicates the end of her reproductive years, and results from the loss of activity in a woman’s ovarian follicles.

After the menopause takes place, a woman is described as post-menopausal. For the next few years, the loss of activity in her ovarian follicles will lead to hormonal changes, and these changes can have a significant impact on her life.

Approximately 3 in 4 women will experience physical or mental symptoms after menopause, and for 1 in 4 women, these symptoms will be severe.

The years before and after menopause are often referred to as the menopausal transition. But before discussing that transition in detail, it is important to understand the menstrual cycle.

The menstrual cycle is a complex process which prepares a woman’s body for pregnancy. The primary hormones involved in this process are estrogen and progesterone, which are both produced in the ovaries. Estrogen is responsible for the growth and development of the uterine lining, while progesterone helps maintain this lining in preparation for a potential pregnancy.

Throughout the menstrual cycle, the levels of these hormones fluctuate, leading to the various stages of the cycle. The first half of the cycle, known as the follicular phase, is characterized by increasing estrogen levels. This is followed by ovulation, during which an egg is released from the ovary.

The second half of the cycle, known as the luteal phase, is marked by high levels of progesterone. If pregnancy does not occur, hormone levels drop, leading to a menstrual period — the shedding of the uterine lining.

At a certain point in a woman’s life, hormone production starts to change. This transitional phase is known as perimenopause — it precedes the menopause, and typically starts in a woman's 40s, although it can start as early as her 30s.

During this time, the ovaries gradually produce less estrogen, leading to fluctuations in hormone levels. These fluctuations can cause a variety of symptoms, including irregular periods, hot flashes, and sleep disturbances.

The duration of perimenopause varies among women, lasting anywhere from a few months to several years. As a woman approaches menopause, her menstrual cycles may become less predictable, and the time between periods may lengthen or shorten.

Eventually, those cycles stop altogether. After a period of 12 months, menopause is said to have occurred. This moment marks the end of perimenopause.

After menopause occurs, it is followed by a period of several years which is characterized by more than just an end to a woman’s menstrual cycle. The changes in hormones also have knock-on effects — in particular, the decline in estrogen.

As well as helping to develop the uterine lining, estrogen also plays a crucial role in maintaining other bodily functions, including bone health, cardiovascular health, and cognitive function. Because of this, the decline in estrogen can lead to a variety of health issues, such as osteoporosis and an increased risk of heart disease.

After menopause, progesterone declines as well, but unlike estrogen, this does not directly lead to other symptoms. Its primary purpose is maintaining the uterine lining, as opposed to other functions.

The hormonal changes that take place during a woman’s menopausal transition can cause a range of symptoms, which vary in severity and duration. Physical symptoms are common, affecting up to 70% of women at some point in their lives.

Hot flashes are sudden sensations of warmth, typically affecting the face, neck, and chest, and can last anywhere from a few seconds to several minutes. Night sweats are similar to hot flashes but occur during sleep, often causing disruptions in sleep patterns.

Vaginal dryness is another common symptom, resulting from the decrease in estrogen levels, which can lead to discomfort during sexual activity and an increased risk of urinary tract infections.

In addition to physical symptoms, the menopausal transition can also have an impact on a woman's emotional well-being. Mood swings, irritability, and feelings of sadness or anxiety are common during this process.

It is important to remember that these symptoms are normal, and that seeking support from friends, family, or healthcare professionals can make them a lot more manageable. Additionally, engaging in stress-reducing activities, like exercise or meditation, can make a positive difference.

These emotional changes can often be attributed to the hormonal fluctuations associated with the menopausal transition, but that is not the only cause. Fundamentally, menopause is a major change in a woman’s life, and like any change, it can easily become a source of stress and anxiety.

After a period of (typically) 4 to 7 years, the menopausal transition will come to an end, with many of the symptoms going away. However, the process can still have long-term effects, particularly in relation to bone health and heart disease.

For example, the decline in estrogen can lead to a long-term decrease in bone density, which can result in fractures and other complications. Additionally, the risk of heart disease increases after menopause, as estrogen is known to have a protective effect on the cardiovascular system.

It is important for women to be aware of these long-term health effects, and take steps to maintain their overall health during and after menopause. Factors such as age, family history, and lifestyle choices can also contribute to the risk of these long-term effects.

Diagnosing the menopausal transition is typically based on a woman's age, menstrual history, and the presence of menopausal symptoms.

In most cases, diagnostic tests are not required, as menopause can be determined through a thorough evaluation of a woman's medical history and symptoms. In fact, diagnostic tests can actually be misleading, due to the dramatic and unpredictable variability in hormone levels, especially during perimenopause.

However, in some cases, healthcare professionals may recommend blood tests to measure hormone levels, particularly if a woman is experiencing menopausal symptoms at an unusually early age, or if there is uncertainty about the cause of her symptoms. These tests can help to confirm menopause, and rule out other potential causes of the symptoms.

When it comes to menopause, there are many misconceptions. For example, some people think that menopause is a disease or a disorder, when it is actually a natural biological process that all women experience as they age.

Another misconception is that menopause always occurs at a specific age. While 95% of women have their last period between the ages of 44 and 56, the age of onset can vary significantly. There is also a marked variation between women living in different countries, probably due to lifestyle. The average age of menopause in the USA is 51 years, while in India it is 46 years.

Some people also wrongly believe that menopause marks the end of a woman’s sexual desire. While hormonal changes can certainly contribute to reduced libido and vaginal dryness, many women continue to enjoy fulfilling sex lives.

It is important to debunk these misconceptions, and to promote more accurate understanding. With better understanding comes better support, which makes things easier for women going through this process.