The term “menopause” refers to the end of menstruation during the transition period in your life when the ovaries stop producing eggs regularly. As a result, the production of the female hormones oestrogen and progesterone declines – a process that could have significant short- and long-term health consequences.
The three stages of menopause: the perimenopause, the menopause and the post-menopause.
1. The perimenopause
The perimenopause is an important time for many women. This is when you first start to notice changes in your body. Often the first sign of the approaching menopause is loss of the regular cycle of your periods. You may also start to have symptoms such as hot flushes and night sweats.
Once you reach your 40s, ovulation becomes erratic. Before ovulation stops altogether, the menstrual cycle often lengthens. This can start anything from two to eight years before menopause. This is the reason why older women often find it more difficult to fall pregnant.
The perimenopause usually kicks off in a woman’s 40s. For some, however, it can start even earlier. On average, the perimenopause lasts four years, but this differs from woman to woman. During this time, you’ll start to experience the physical and emotional changes discussed below.
2. The menopause
The exact event of menopause – in other words, the permanent cessation of menstruation, when you become permanently infertile – can only be determined retrospectively after no menstrual periods have occurred for 12 consecutive months.
Natural menopause usually occurs between the ages of 48 and 55. It’s a normal life event that designates the end of fertility, and may bring with it various physical and emotional changes.
In the beginning (in the perimenopause phase), hot flushes, night sweats (nocturnal hot flushes), sleep disturbances, mood swings and joint pains are the most common symptoms. Forgetfulness is quite common. These are followed by the thinning of the vaginal wall, which can lead to vaginal dryness and result in sexual discomfort. Your skin and hair gradually thin and you have a greater chance of developing a belly. There’s also a greater risk of heart disease and osteoporosis. Other symptoms include bladder incontinence and diminished libido.
Some women live through the whole menopausal period without suffering any of the classic symptoms, but they’re a small minority.
Some women experience “induced” climacteric and menopause due to a medical intervention, for instance if their ovaries are removed before they enter their natural menopause. Induced menopause can also occur if the ovaries are damaged by radiation, chemotherapy or certain other drugs. In such cases, there’s an abrupt hormonal decrease, usually resulting in the sudden onset of menopause-related symptoms.
If you had induced menopause, early menopause (before age 40) or went for a prolonged time without menstrual periods (for example because of excessive exercising or dieting), you may be at a greater risk later in life for health problems such as heart disease and osteoporosis. This is simply because you spent a long time without the protective effect of oestrogen.
If you had a partial hysterectomy, where your uterus was removed but not your ovaries, you’ll most probably continue to produce hormones and will therefore not experience early menopausal symptoms. However, sometimes a hysterectomy damages nerves and blood supply to the ovaries, resulting in some changes, which may worsen when the ovaries shut down further and natural menopause occurs.
To determine whether you’ve reached menopause, your doctor will review your medical history and perform a physical examination. If symptoms occur inappropriately or too early, your doctor will also do blood tests. These tests are not essential but can assist diagnosis and management. If blood tests show an elevation in the follicle-stimulating hormone (FSH) and a drop in the hormone oestradiol, you’ve reached menopause.
3. Post menopause
During the post-menopausal years, the uncomfortable symptoms of menopause start to ease. However, the loss of oestrogen can start to take its toll on your body.
Quite simply, menopause is the warning you get before your quality of life starts diminishing, and warding off these threatening conditions before they become serious is the key to a longer, healthier life.
Be aware of the following changes, and discuss your best options for preventing chronic disease with your doctor:
- Oestrogen deficiency accelerates the bone depletion that occurs during the normal ageing process. This can eventually contribute to osteoporosis.
- Oestrogen decrease is thought to cause unfavourable changes in levels of cholesterol and other blood fats, as well as in fibrinogen, a substance that affects blood clotting. These changes may increase your risk for heart disease and stroke.
- As oestrogen levels decline, muscle mass decreases, body fat increases (increasing your risk for heart disease) and skin collagen gradually becomes thinner and less elastic.
- Low levels of oestrogen have been linked to a decrease in mental abilities and alertness. It’s also been linked to Alzheimer’s disease and dementia.
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