Menopause: Understanding Why It Happens

Menopause is the time in a woman’s life that indicates the end of her regular monthly menstrual cycle, it is a normal process that mostly occurs after the age of 45. A woman may seek a doctor’s opinion if they suspect menopause if they have not experienced their monthly menstrual cycle for 12 months.  

Some symptoms like hot flashes, sleep problems, decreased energy levels, and weight gain can occur.

Asian women experience menopause between the ages of 45 to 55, with the average age being 50. Some studies have shown that Asian women generally report lower rates of physical or  emotional symptoms related to menopause. Asian women also reportedly suffer from different postmenopausal symptoms such as backaches, muscle, shoulder, or joint pains, and fewer symptoms like hot flashes. 

Perimenopause, Menopause, and Postmenopause

Perimenopause refers to the period where menstrual periods become inconsistent. Your period may be delayed, you may experience one or more months without periods, or you may experience either a light or heavy flow during your period.  

Menopause is the cessation of menstrual periods for 12 months. 

Postmenopause is the event after menopause has occurred. 

Causes

Menopause is a natural process and the following are some reasons for its occurrence: 

Natural decrease in reproductive hormones

As you age, your ovaries begin to produce less oestrogen and progesterone which are the hormones that regulate menstrual cycles, additionally, as a result, fertility decreases. 

Removing the ovaries (oophorectomy)

If the source of oestrogen and progesterone i.e the ovaries are removed, the menstrual cycle stops and causes sudden menopause and you might experience sudden and intense symptoms. 

Surgery to remove the uterus (hysterectomy)

If this is done without removal of the ovaries, it does not cause sudden menopause. You will not have any manifestations of menopause as the ovaries will continue to generate oestrogen and progesterone and the menstrual cycle.  

Chemotherapy and radiation treatment

These therapies are necessary for the treatment of some cancers and they may cause temporary menopause and the symptoms associated with it. If radiation therapy is directed at the ovaries, it affects ovarian function and results in menopausal symptoms. 

Primary ovarian insufficiency

About 1% of women reach menopause before the age of 40 (premature menopause). This is due to the failure of the ovaries to produce the right amount of reproductive hormones. Generally, the cause of primary ovarian insufficiency is unknown and it is believed to be linked to genetics. Hormone therapy is usually prescribed until the natural age of menopause to maintain brain, heart, and bone health.

Signs and Symptoms

The symptoms of menopause differ between individuals and tend to be more severe if menopause arrives abruptly.

Ovarian cancer, other cancers, surgeries such as hysterectomy, and activities such as smoking, may increase the severity of symptoms. 

Premenopausal women may experience some of the following signs and symptoms:

• Irregular periods
• Vaginal dryness
• Hot flashes
• Chills
• Night sweats
• Sleep disturbances
• Mood swings or depression
• Weight gain and decreased metabolism
• Thinning hair and dry skin
• Loss of breast fullness
• Decreased sexual desire
• Headaches 
• Pounding heart
• Back and muscle pain and fatigue

Complications

Following menopause, women might be at an increased risk of some of the following conditions:

• Heart and blood vessel diseases (cardiovascular disease): due to a decrease in oestrogen levels
• Weak bones (osteoporosis): enhanced risk of fractures after menopause
• Urinary incontinence: due to loss of flexibility of the tissues of the vagina and urethra, some might experience incontinence when they cough, laugh or lift something or otherwise known as stress incontinence. There is also an increased likelihood of getting urinary tract infections 
• Sexual problems: decreased sexual desire or increased pain or bleeding during sexual intercourse due to vaginal dryness 
• Weight gain: metabolism decreases after menopause which might lead to weight gain 

Diagnosis

Symptoms of peri-menopause may appear after the age of 45 and it is essential to talk to your physician if you experience any of these symptoms mentioned above. 

A physician will conduct a thorough medical history, menstrual history, and detailed physical examinations in order to diagnose menopause. Your physician may request blood tests to determine your levels of reproductive hormones such as follicular stimulating hormone (FSH) and estradiol-a type of oestrogen. 

Menopause can be confirmed if the levels of FSH in the blood is 30 mIU/ml or higher in addition to the patient reporting the cessation of menstrual periods for 12 months. 

Other diagnostic blood tests may be done to rule out potential underlying diseases. This includes thyroid tests, lipid profile, liver and kidney function tests, and determining hormone levels such as testosterone, progesterone, prolactin, estradiol, and human chorionic gonadotropin (hCG). 

Treatments

Typically, women experiencing menopause do not require any treatments unless the symptoms they experience affects their quality of life.  

The most commonly used and effective treatment is hormone replacement therapy, where menopausal women are prescribed the hormone they are lacking to regulate hot flashes, night sweats, flushing, vaginal atrophy, and osteoporosis. 

Lifestyle modifications and home therapy 

Some methods to improve mild to moderate menopause symptoms naturally include: 

• Keeping cool and comfortable
• Using vaginal lubricants to decrease discomfort
• Sufficient sleep 
• Regular exercise  
• Practicing deep or paced breathing, and massages 
• Pelvic floor muscle exercises 
• Quitting smoking
• Eating a balanced diet
• Using supplements