Menopause

2.1. About menopause

Maria

"The gap between my periods kept getting bigger. But sometimes the gap was shorter. It was completely irregular. Over time the periods got lighter... I had my last period when I was 51."

Baby girls are born with all the eggs in their ovaries that they will have in their lifetime. These eggs are lying in little pockets called follicles. Once puberty starts, hormones ripen the first follicle so that it will release an egg (ovum). That is the beginning of fertility. From then on, hormones ripen a follicle every month. That follicle itself produces more hormones.



As part of the monthly menstrual cycle, the endometrium or lining of the womb prepares for the possibility that an egg might be fertilised. If the egg is not fertilised, it dies and the lining that has built up in the womb to receive an egg leaves the body. This is the monthly period or menstruation. As long as a woman is not pregnant and does not use hormonal contraceptive (like the Pill), the period is a sign that one menstrual cycle has finished and the next one has started.

Somewhere around 50 years of age women have their last period. Menopause is the medical term for this ending of the menstrual cycle [8]. A deciding factor for when the menopause will begin is the number of follicles remaining in the ovaries. From around the age of 40, the number of remaining follicles starts to drop. After that, the number drops quite quickly, until no more follicles ripen at all [8].

The gap between periods becomes irregular. Some periods might be heavier and others lighter. The start of this process can be so subtle that some women do not notice any change at all. For others though, there are very noticeable physical symptoms.

It is only in hindsight that it is possible to know which was the last period. Once there has been no period for 12 months, then a woman can be sure that she has reached the menopause.

The one or two years before the last period is called pre-menopause, and the time afterwards is called post-menopause [8]. During this time the body finds a new hormonal balance. For many women this time of adjustment causes symptoms that will sometimes be very severe. The length of the process varies from woman to woman. For most women, the whole process will take a few years. This phase of life is sometimes called the climacteric. The word climacteric comes from Greek and means something like 'a critical point of life'.

Karin

"It started for me when I was 35. My periods were all over the place. In the beginning, my head would suddenly get hot while I was drinking coffee. It didn't occur to me, that this could be the menopause."

Susanne

"I noticed that my periods weren't as regular. At the time, I thought it was caused by stress or my new life circumstances. Before that I could fairly much count on how regular my cycle was, give or take three days."

Induced menopause

For some women menopause is a side effect of treatment for an illness like cancer. Menopause occurs if both ovaries are surgically removed (ovarectomy). This is called induced menopause. Surgical removal of the uterus (hysterectomy) alone is not enough to cause the menopause if the ovaries are still there and functioning. Women who have induced menopause often experience the same symptoms as women having a natural menopause. But they might be a lot younger. Women having induced menopause have some different and specific questions, but this article deals mostly with natural menopause.

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