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What is the menopause?

Most women become aware of the menopause from the stories told about the debilitating symptoms that it brings - hot flushes, night sweats, insomnia, depression - the list goes on and on and at least 30 different symptoms have been recorded. It seems that future health becomes uncertain, with little understanding or explanation of what is to come.

There is also a confusion with the wording, with various terms used interchangeably so that no-one really knows how to talk about it. There's peri-menopause, menopause and post-menopause, to the point that “The word “menopause” tends to be used as shorthand for “all the crap that goes on while your ovaries gradually crinkle into useless raisins.

The medical definition of the menopause is when a woman stops having her monthly period for 1 year. It typically occurs in a woman's late 40s to early 50s as a normal part of ageing and marks the end of reproductive years. The process is gradual and is usually described in 3 stages:

Peri-menopause or the menopausal transition: Peri-menopause can begin 8 to 10 years before menopause, when the ovaries gradually produce less oestrogen. It usually starts in a woman's 40s, but can start in the 30s as well. Peri-menopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1-2 years of peri-menopause, the drop in oestrogen accelerates. At this stage, many women can experience menopause symptoms. Women are still having menstrual cycles during this time, and can get pregnant.

Menopause. Menopause is the point when a woman no longer has menstrual periods. At this stage, the ovaries have stopped releasing eggs and producing most of their oestrogen. Menopause is diagnosed when a woman has gone without a period for 12 consecutive months.

Post-menopause. These are the years after menopause. During this stage, menopausal symptoms, such as hot flashes, can ease for many women. But, as a result of a lower level of oestrogen, postmenopausal women are at increased risk for a number of health conditions, such as osteoporosis and heart disease. 

This sounds like it should be an orderly transition from the hormonal storms of periods to the calm seas of… but many women are suffering with symptoms of sexual dysfunction, insomnia, hot flashes, night sweats, a lack of overall well-being, anxiety and brain fog to name just a few.

In some women these symptoms are mild; others have symptoms that are mild but go on for a long time; other women go through a couple years of difficulty; and then there are women who have symptoms well into post-menopause; and some who just sail through the whole thing.

I can’t think of any other health condition where the range of symptoms is so vast and the response is so varied. Conventional thinking says that its because oestrogen affects every part of the body and so when it starts declining, all hell breaks loose. The effects of oestrogen withdrawal have been studied in virtually every body system, including the heart, bones and skin, but none of these investigations have explained the origin of the symptoms that women suffer with the most - the hot flushes, the night sweats, the anxiety - where is the deficiency that causes those symptoms? Medics are keeping pretty quiet on that one, but the origins are not difficult to find.