Menopause – the climacteric period
The menopause, also known as the ‘change of life’ is marked by the ending of menstruation. The menopause occurs at an average age of about 50, but the usual range is from 47 to 52. Occurrences outside this range are quite common.
Sometimes the menopause is delayed to 55 or later; sometimes it may occur at 40 or earlier.
A premature menopause can have one of many causes, and also occurs if for any reason the ovaries have to be removed surgically (perhaps as part of a total hysterectomy).
The menopause involves the end of egg production (ovulation) by the ovaries. Menstrual cycles can occur without ovulation taking place as the menopause approaches. For this reason, pregnancy is very rare after 50. A woman’s periods do not usually stop suddenly, although sometimes this does happen. As a general rule, they first become more scanty, then the odd period is missed, then they stop.
The main effect of the menopause is a greatly reduced production of the hormone estrogen.
Some menopausal women suffer psychologically from the awareness that they have come to the end of reproductive life. Some view the menopause as a significant stage in ageing.
Climacteric period and its symptoms
The most common symptom is hot flushes affecting the face and neck. These vary greatly in frequency and duration. For some women they are very brief and infrequent; others may have many episodes in a day that last for as long as 15 minutes.
Flushes do not indicate a rise in blood pressure, but merely a rise in the flow of blood through the affected parts. The cause of flushes remains uncertain, but it is thought they have something to do with estrogen deficiency.
Other reported menopausal symptoms include night sweats, insomnia, headaches, weight gain and general irritability. Often these symptoms are severe enough in themselves to justify hormonal treatment.
Most of the physical effects associated with the menopause are due to estrogen deficiency. Pubic hair becomes more sparse, the labia flatten, the walls of the vagina become thinner and smoother and the secretions diminish with the fall in estrogen levels. The womb becomes smaller and its lining thin.
Ligaments that support the womb become weaker and, as a result, the tendency for the womb to ‘come down’ (prolapse) increases, especially if the pelvic floor muscles have been weakened in childbirth.
The changes in the vagina and the reduction in lubricating secretions can cause difficulty and discomfort in sexual intercourse.
The reduction in acidity from lactic acid deficiency often leads to changes in the germ population of the vagina, and this can result in bladder infection (cystitis). Much of the bladder trouble in post-menopausal women is now recognized as originating in this way.
During the reproductive period, women are strongly protected by estrogen against the major arterial disease atherosclerosis. As a result, heart attacks and strokes are rare in non-smoking women during this span of life.
Unfortunately, this protection is lost after the menopause, and the incidence of these diseases soon rises to equal that in men.
Loss of bone bulk and osteoporosis is a natural feature of ageing, but loss of estrogen accelerates the process in post-menopausal women. It is important to include enough calcium in the diet.
Treatment of climacteric symptoms and discomfort
In the United States, Hormone Replacement Therapy (either estrogen-only or progesterone and estrogen combination) is used to reduce menopausal symptoms such as hot flushes, vaginal dryness, depression, mood swings and night sweats.
Recently, there has been some concern about the side-effects of HRT, due to results from an American study which showed a small increase in the risk of breast cancer and heart disease in patients taking a specific type of HRT.
Current advice from the Department of Health states that for women taking HRT on a short-term basis to relieve menopausal symptoms, HRT is a suitable treatment as the benefits outweigh the risks. However, for women taking HRT on a long-term basis, to prevent osteoporosis for example, HRT should only be prescribed if other treatments are inappropriate or have proven unsuccessful.
For women who have experienced a premature menopause, HRT may be used until the age of 50, when treatment should be reviewed.
What are the complications?
The main complications of estrogen deficiency are osteoporosis (see article on Osteoporosis) and rapid progress of the effects of atherosclerosis.