Mention the word “menopause” and the first thing that comes to mind is the dreaded hot flushes that women experience during midlife, along with mood swings and various bodily changes. The word “hormones” is also bandied about at this stage in life. But what exactly is menopause and is it an illness?
What is menopause?
Menopause is not an illness but a transition into a new phase of life. A woman’s reproductive years start at puberty and ends when her monthly menstrual cycle stops during midlife. The point in time when the menstrual cycles have permanently ceased for a period of 12 months is defined as menopause. This marks the permanent end of fertility. Menopause is characterized by three stages:
- Perimenopause is the first stage of the menopausal process and can start up to ten years (with an average of 4 years) before menopause, when the ovaries gradually produce less estrogen. The drop in estrogen levels accelerates during the last two years of perimenopause, which ends at menopause when the ovaries stop releasing eggs.
- Menopause is the point where the ovaries have stopped releasing eggs and produce fewer female hormones, such as estrogen, while menstrual cycles have stopped for a period of twelve months.
- Postmenopause is the period after menopause, meaning the rest of a woman’s life after menopause. The lower levels of estrogen place postmenopausal women at an increased risk for several health conditions, but on the upside, menopausal symptoms, such as hot flushes, may ease for many women.
Hormonal changes associated with menopause:
Estrogen: The estrogens are a group of hormones that play a major role in the sexual and reproductive development in woman. It is one of the two sex hormones, the other being progesterone. Most of the estrogen in the female body is made in a woman’s ovaries, while the adrenal glands and fat cells make small amounts. A woman’s eggs are also produced in the ovaries.
Just like other steroid hormones, estrogen easily diffuses across the cell membrane. Within the cell it binds to estrogen receptors, which modulate the expression of various genes, for example the genes responsible for the development of breasts and regulating the menstrual cycle.
Estrogen is not only responsible for the development, but also for the regulation of the female reproductive system, such as the menstrual cycle. Estrogen also plays a role in the reproductive tract, the urinary tract, bones, skin, hair, blood vessels, pelvic muscles, the heart, and the brain (including mood), while also keeping cholesterol in check. It stands to reason that reduced levels of estrogen at menopause can affect many areas of the body. Estrogen levels usually decline during perimenopause but in an irregular fashion.
The body makes three types of estrogen, with estradiol (E2) the most common type during childbearing age. Estriol (E3) is the primary estrogen produced during pregnancy, while Estrone (E1) is the only estrogen produced after menopause.
Progesterone: This female hormone is also produced by the ovaries and its main function is to prepare the lining of the uterus for a fertilized egg and plays a role in maintaining early pregnancy. During perimenopause intermittent decreases in progesterone affect menstrual periods and the lack of progesterone can cause irregular and heavier periods. The production of progesterone stops when there is no ovulation and after the final menstrual cycle.
Testosterone: Although testosterone is known as a male hormone, the ovaries produce small amounts. It plays a role in the production of estrogen and contributes towards libido. Testosterone levels slowly declines after a woman’s 20s and is at half its peak by the time she reaches menopause. The ovaries still produce testosterone after the production of estrogen has stopped and levels decline further with aging.
Symptoms of menopause:
As women age, the reproductive cycle that has been active since puberty, begins to slow down and prepares to stop functioning. As they are no longer needed for reproduction, the levels of the hormone’s estrogen and progesterone fall or can fluctuate. With menopause approaching, the ovaries produce less estrogen, which brings changes to the menstrual cycle, such as becoming irregular and then stopping. Less estrogen means the body must adapt to different levels of hormones. The symptoms that women experience during the three stages of menopause forms part of the way the body adjusts to hormonal changes.
Each woman will experience menopause differently, while many experience various physical symptoms. These symptoms may start before menstruation ends and can last for several years.
- Hot Flushes are a common symptom and feel like a sudden sensation of heat in the upper body: Vasomotor instability due to low levels of estrogen results in hot flushes and night sweats. Hot flushes usually start during the first year that menstruation ends and can continue for many years after menopause.
- Vaginal dryness, itchiness, discomfort, and painful intercourse may start during perimenopause and continue into menopause. Lower hormone levels can contribute to some women experiencing a loss of sex drive.
- Sleep disturbances can occur during menopause and may be caused by high levels of anxiety, night sweats, an increased urge to urinate more frequently, or urinary incontinence (leakage) due to weakening of the pelvic floor muscles. Insomnia can occur.
- Many physical changes can develop, such as weight gain and the buildup of fat around the abdomen, changes to hair color, hair loss and thinning, breast reduction and tenderness of the breasts, thinning and decreased elasticity of the skin, and increased facial hair growth.
- Emotional changes are common during menopause, such as anxiety, depression, headaches, mood swings, irritability, tiredness, sadness, and spells of crying.
- As women approach menopause they may have trouble with concentration and memory.
When the uterus is removed during a hysterectomy the menstrual cycle will stop.
Whenever the ovaries are removed, the symptoms of menopause will start.
Increased risk of other health conditions:
The depletion of ovarian follicles and largely reduced functioning of the ovaries that is associated with menopause result in lower levels of the reproductive hormones. As estrogen is linked to various other processes in the body, reduced levels appear to increase the risk of certain health conditions.
- Osteoporosis: Estrogen plays an important part in bone health as it signals osteoclastic cells in bone to stop dissolving bone material. Reduced estrogen levels result in women losing an average of 25% of bone mass from menopause till age 60. The insides of bones become less dense and more fragile, making them “brittle” and more likely to fracture.
- Coronary heart disease: As estrogen contributes toward healthy arteries and healthy levels of cholesterol, reduced levels of estrogen can contribute towards coronary artery diseases. This condition is characterized by the narrowing or blockage of the arteries surrounding the heart muscle, due to the buildup of fatty plaque deposits in arterial walls.
- Breast cancer: While menopause does not cause cancer, the associated hormonal changes appear to increase the risk of breast cancer.
Treatment and lifestyle choices:
The most widely used treatment to alleviate or reduce the symptoms of menopause is hormone replacement therapy. Treatment options should be discussed with a medical practitioner
However, some lifestyle choices can help manage the challenges of menopause enormously, such as getting regular exercise, following a healthy diet, quitting smoking, limiting the intake of alcohol, implementing good sleeping habits, and seeking counselling to assist with mood changes and anxiety.
Conclusion:
For many middle-aged women, menopause is not the only transitional factor to deal with. Changes may occur in family life, as this is often the time children start leaving home. Changes can also occur at work or in relationships and together so many changes can be overwhelming. Living active and healthy lives during these stages of transition, while embracing change, may well be the start of an exciting new chapter in life, free from menstrual cycles and concerns about falling pregnant!
References:
Menopause. Published online. UCLA Health. University of California. Los Angeles. (www.uclahealth.org)
Menopause, perimenopause, and postmenopause. Published online and reviewed 24 December 2019. Cleveland Clinic. (www.clevelandclinic.org)
What is menopause? Published online and reviewed 27 June 2017. National Institute on Aging. U S Department of Health & Human Services. (www.nia.nih.gov)
What to expect during menopause. Published 28 January 2020. Medical news Today. (www.medicalnewstoday.com)
What is estrogen? Published online and updated August 2018. Hormone Health Network. USA. (www.hormone.org)
Menopause. Published online and updated September 2016. Hormone Health Network. USA. (www.hormone.org)
What is estrogen? Published online and updated August 2018. Hormone Health Network. (www.hormone.org)
Menopause. Published online and updated September 2016. Hormone Health Network. (www.hormone.org)
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