What is Menopause?

By: Sydney L. Murray

The change of life. The end of fertility. The beginning of freedom. Whatever people call it, menopause is a unique and personal experience for every woman. It¹s a natural event that marks the end of fertility and childbearing years. Technically, menopause results when the ovaries decrease production of the sex hormones estrogen, progesterone and androgen.

Why or how does this happen? You were born with about 500,000 egg cells, but only about 400 to 500 ever mature fully to be released during the menstrual cycle. The rest degenerate over the years. During the reproductive years, a gland in the brain generates hormones that cause a new egg to be released from its follicle each month. As the follicle develops, it produces the sex hormones estrogen and progesterone, which thicken the lining of the uterus. This enriched lining is prepared to receive and nourish a fertilized egg, which could develop into a baby. If fertilization does not occur, estrogen and progesterone levels drop, the lining of the uterus breaks down, and menstruation occurs.

For reasons unknown, your ovaries gradually begin to decline in hormone production during your mid-30s. In your late 40s, the process accelerates and hormones fluctuate more, causing irregular menstrual cycles and unpredictable episodes of bleeding. By your early to mid-50s, periods finally end altogether. However, estrogen production does not completely stop. The ovaries decrease their output significantly, but still may produce a small amount. Progesterone, the other female hormone, works during the second half of the menstrual cycle to create a lining in the uterus as a viable home for an egg, and to shed the lining if the egg is not fertilized. If you skip a period, your body may not be making enough progesterone to break down the uterine lining. However, your estrogen levels may remain high even though you are not menstruating. At menopause, hormone levels don't always decline uniformly. Production of estrogen and progesterone is erratic and unpredictable.

Most women can tell if they are approaching menopause because their menstrual periods start changing. Perimenopause is a term used to describe this time. Perimenopause is what some describe as "being in menopause," but menopause itself is only one day in a woman's life after she had not had a menstrual period for 12 consecutive months, and no other biological or physiological cause can be identified. Until 12 consecutive months have passed without a period, a woman may still be able to get pregnant.

Although the majority of women experience natural menopause, some women may experience induced menopause due to one of a number of medical interventions. Surgically removing both ovaries (bilateral oophorectomy) before natural menopause causes surgical menopause. Induced menopause can also occur if the ovaries are damaged by radiation, chemotherapy, or certain other drugs. These women, as well as women who experience early natural menopause (before age 40) or prolonged time without menstrual periods due to excessive exercising or dieting, may be at a greater risk later in life for health problems such as osteoporosis or early heart disease because they spend more years without the protective effect of estrogen.

Just as every woman¹s body is unique, your menopause experience will be a highly personal one. For example, 15 to 20 percent of women experience no physical symptoms at all, except the end of their menstrual periods.

Some women go through menopause before age 51 and some experience it a bit later. Early menopause is defined as occurring at any age younger than age 51. Early menopause can occur naturally, but premature menopausal symptoms may signal an underlying condition, so it is important to discuss any symptoms with your healthcare professional. Menopause can occur as early as your 30s and, rarely, as late as in your 60s. However, there is no correlation between the time of a woman's first period and her age at menopause. In addition, age at menopause is not influenced by race, height, the number of children a woman has had, or whether she took oral contraceptives for birth control.

What does influence the time of menopause? Genetics are a key factor. Ask your mother and And, cigarette smoking can cause you to reach menopause two years earlier than nonsmokers.

About six years prior to natural menopause is when menopause-related changes begin (perimenopause). Fluctuations in the levels of hormones produced by the aging ovaries lead to normal, physical changes such as: Irregular menstrual patterns. One of the most common and annoying symptoms you may notice during your 40s is that your periods become irregular. They may be heavier one month and then very light the next. They may get shorter or last longer. You may even begin to skip your period every few months or lose track of when your periods should start and end. These symptoms are caused by irregular estrogen and progesterone levels. For example, if you don¹t ovulate one month ‹ which is common for women in their late 40s ‹ progesterone isn¹t produced to stimulate menstruation and estrogen levels continue to rise. This can cause spotting throughout your cycle or heavy bleeding when menstruation does start. One note of caution: although irregular menstrual periods are common as you get closer to menopause, they can also be a symptom of uterine abnormalities or uterine cancer. If your periods stop for several months and then start again with heavy bleeding or if you start bleeding after menopause, consult with an obstetrician/gynecologist as soon as possible for an evaluation. Be sure to mention any menstrual irregularities during regular check-ups. A uterine biopsy or vaginal ultrasound are the only ways to evaluate if irregular symptoms are abnormal.

Other changes and signs of menopause include:

hot flashes (sudden warm feeling, sometimes with blushing)

night sweats (hot flashes that occur at night, often disrupting sleep)

fatigue (probably from disrupted sleep patterns)

mood swings

early morning awakening

vaginal dryness fluctuations in sexual desire or response

difficulty sleeping

Although there is a wide range of possible menopause-related conditions, most women going through natural menopause have mild disturbances during the perimenopausal years. However, you should be aware that there are at least two major conditions that can develop as the hormones in your body change: coronary artery disease and osteoporosis.

Up until menopause, estrogen has helped keep your blood vessels stable and open and your arteries free of plaque build-up. Estrogen helps raise HDL cholesterol (good cholesterol), which helps remove LDL-cholesterol (the type that contributes to the accumulation of fat deposits called plaque along artery walls). After menopause, your risk for developing coronary artery disease (CAD) ‹ a condition in which the veins and arteries that take blood to the heart become narrowed or blocked by plaque ‹ increases steadily. Heart attack and stroke are caused by atherosclerotic disease, in most cases.

Also, estrogen helps prevent bone loss and works together with calcium and other hormones and minerals to help build bones. Your body constantly builds and remodels bone through a process called resorption and deposition. Up until around age 30, the body makes more new bone than it breaks down. But, once estrogen levels start to decline, this process also slows down. By menopause, your body breaks down more bone than it rebuilds. In the years immediately after menopause, some women risk losing as much as 20 percent of their bone mass. Although bone loss eventually levels out in your late 50s, in the years ahead, your body will need help to keep bone structures strong and healthy and to prevent osteoporosis. Osteoporosis occurs when bones become too weak and brittle to support normal activities.

Not all women develop heart disease or osteoporosis. Many more things affect your heart and your bones than estrogen alone. For example, exercise improves your cardiovascular system ‹ your heart, lungs, and blood vessels ‹ at any age. It can help decrease high blood pressure, a concern for one out of every three women over age 60. It can also help reduce weight gain, a major risk factor for heart disease, diabetes, and many other health conditions common to older women. You are never too old to begin or continue exercising. A simple walking routine five days a week can provide health benefits. There are other exercise options. Talk to your healthcare professional about which ones fit your lifestyle and medical needs.

If your bones are strong and healthy as you enter menopause, you¹ll have better bone structure to sustain you as you age. Bone loss is variable from woman to woman. You can also improve bone strength as you age by exercising regularly and making sure you get enough calcium in your diet or from supplements. Exercise also helps improve balance, muscle tone, and flexibility, which can be casualties of aging. Weakness in these areas can lead to more frequent falls, broken bones, and longer healing periods.

Women today can expect to live as much as one-third of their lives beyond menopause. In the next decade, more women than ever before ‹ as many as 52 million ‹ will be age 50 or older. And they can be healthy years, depending on how you take care of yourself.