What is Menopause?

Menopause is the natural biological process that occurs in every woman’s life. It is the permanent cessation (end/stop) of monthly menstrual periods and fertility. During this transition, a woman is no longer able to conceive due to less production of reproductive hormones and her ovaries stop producing eggs.

Spontaneous menopause is confirmed when a woman has amenorrhea (absence of menstrual period) for 12 succeeding months, for which there is no other obvious pathological or physiological cause.

The average onset of menopause ranges between the ages of 45 and 55 years, however, onset may vary geographically.

Stages of Menopause Transition

  • Premenopause- Is when the monthly cycles become noticeably unpredictable in timing, and the reproductive hormone levels are becoming more irregular and lower.
  • Perimenopause- Sometimes called the “menopausal transition” During this period, the reproductive hormones are often with wide fluctuations. Contributing to physical changes, such as hot flashes;night sweats; vaginal dryness;and atrophy;restless sleeping; loss of bone density and heart disease. Moreover, during this transition, fertility reduces due to the unpredictability of the cycle.
  • Menopause- Menopause is by definition the last menstrual period, following the release of the body’s own hormones. It can be only defined retrospective, as there should not be any bleeding for at least 12 monthsafter this bleeding.
  • Postmenopause- This refers to the period after menopause. Postmenopausal women are at an increased risk of osteoporosis and heart disease due to decreased level of the hormone estrogen. The risk of these conditions may be reduced by living a healthy lifestyle and taking recommended and prescribed hormone therapy. Our consultants will discuss More information during your consultation.

What is premature menopause?

Menopause is considered “natural” when it occurs between the ages of 45 and 55.

However, some women may experience early menopause as a result of any surgical intervention, such as removal of both ovaries. It may be a damage to the ovaries such as from chemotherapy, due to excessive ovarian surgery. In seldom cases, it can be due to genetic abnormalities (e.g. fragile X syndrome) or genetic predisposition. In many cases, no explanation can be found. Menopause that occurs at the age of 40 years or earlier is termed as premature menopause.

What are the symptoms of Menopause?

Symptoms of the menopause can vary from one person to another person. The majority of women during menopause will experience both emotional and physical symptoms that are caused by hormonal imbalance. These symptoms include:

  • Irregular periods- Which is usually the first symptom, there will be changes in the normal menstrual pattern.
  • Cessation of fertility- During the peri-menopausal stage (first stage of the menopause) of woman’s life, estrogen levels drop significantly, reducing the chances of becoming pregnant to almost zero.
  • Hot flushes
  • Night Sweats
  • Vaginal dryness and pain during intercourse
  • Disturbed sleep- e.g.Difficulty falling asleep and staying asleep
  • Mood swings- As described as an extreme or rapid change in mood due to hormonal imbalance.
  • Hair loss or thinning hair and dry skin
  • Weight gain and slowed metabolism: e.g. more fat is building up in the abdomen
  • Loss of breast fullness

What are the causes of Menopause?

Menopause is the result of the permanent loss of eggs in the ovaries due to increased age. Females are born with their ovaries filled with eggs, those eggs representing the reserve for a lifetime. If all the eggs have been used or gone, no more reproductive hormones (estrogens and progesterone), can be produced. Therefore there will be no stimulus for the endometrial lining to thicken and later shed again.

Natural menopause is a permanent cessation of menstruation that can be caused by any medical treatment. This transition from potentially reproductive period to a non- reproductive period is a result of natural aging.

Also, surgical removal of the uterus and both ovaries (total hysterectomy and bilateral oophorectomy), does also cause a menstruation to stop immediately. Moreover, cancer therapies like chemotherapy and radiation therapy can also induce menopause.

How is menopause diagnosed?

The doctor will be able to diagnose menopause through a thorough assessment of age, information about the menstrual patterns and medical history. To diagnose menopause extra blood tests to measure the levels of FSH (follicle stimulating hormone) and Anti-Mullerian-Hormone (AMH), will be performed to assess the results obtained by anamnesis and examination.

What are the management options for Menopause?

If menopause occurs after the age of 50 it is not a disorder but it is a natural stage of life and, therefore, it does not need any medical treatment.

However, in some cases where the physical and emotional symptoms significantly affects a woman’s everyday life, a hormonal replacement treatment that focuses on providing a relief with the symptoms may be discussed.

Hormone Replacement Therapy (HRT)

HRT is a very effective treatment for many menopausal symptoms by replacing estrogen and progestin hormone. The response of HRT may vary for each patient.

It appears to be effective to treat hot flushes, night sweating, vaginal dryness and also preventing loss of bone density. In some patients it could increase the risk of strokes and blood clots, breast and ovarian cancer. So indication for hormonal replacement treatment has to be made very carefully by the physician after knowing the whole history of a patient.


Many women do not know what they might expect during the menopausal transition period and how long the process might last. As a result, they might become confused and worried that something unusual is happening. It is essential to understand the changes happening in the body during menopause. Therefore there is a strong need for more information and more education on this.

Besides being better informed what to expect during this years, improving the lifestyle with a healthy diet and regular exercise program will also help in minimizing the symptoms.

More management options can be discussed with our consultants in our outpatient department during the consultation.

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