MENOPAUSE CONSISTS OF 3 STAGES:
Perimenopause - meaning “around menopause” or the “menopause transition”
Natural Menopause – the spontaneous and permanent stop to menstruation, not caused by any medical treatment or surgery
Post-Menopause – the time that follows menopause
This is the beginning stage of menopause for most women and can last from 4 to 6 years before the final menstrual period. The balance of female hormones including oestrogen, progesterone and even testosterone start to change and levels can fluctuate greatly within a single menstrual cycle. This results in menstrual irregularity, longer and heavier periods and increased period pain. Symptoms of menopause including hot flushes, vaginal dryness and irritation, mood swings and memory disturbance can also be reported during this time.
Some women are still able to conceive during this menopause transition, so use of contraception is still recommended until at least 12 months after the final period, if pregnancy is wished to be prevented.
Menopause can hold different meanings for individual women and interpretation of symptoms can vary depending on cultural background.
As a woman gets older, the number of eggs within her ovaries begins to decrease. The activity of oestrogen and progesterone is also reduced and falls below the level needed to stimulate ovulation or shedding of the lining of the uterus. This results in the permanent cessation of menstruation.
Natural Menopause is confirmed by 12 consecutive months after a woman’s last menstrual period. In Western cultures, it is also associated with the symptoms of hot flushes and night sweats. For other cultures, body and joint aches and pains are the most troublesome symptom noted.
When Menopause Comes Early
Menopause in women younger than 40 years of age is defined as premature menopause or premature ovarian failure. It has long term physical and psychological consequences, and so women with early ovarian failure need ongoing emotional support and medical follow-up. The onset of symptoms can be sudden or gradual but result from oestrogen deficiency. Hot flushes, sleep distur
bance, mood change, dry vagina, poor lubrication, decreased libido, joint aches and further symptoms of menopause are experienced. Women can often experience emotional effects related to their fertility and possible loss of sense of femininity and there may be an increased risk in long-term medical consequences such as osteoporosis (bone loss), cardio-vascular disease and stroke.
When Medical Treatment or Surgery Plays a Part
Sometimes menopause is caused by medical or surgical treatments. Common examples include:
- Surgically-Induced Menopause
- Therapeutic Oophorectomy (removal of ovaries) for treatment of ovarian cancer, pelvic inflammatory disease affecting the ovaries, endometriosis involving the ovaries.
- Prophylactic Oophorectomy – a preventative procedure for patients at high risk of ovarian or breast cancer. Women opting for this procedure usually have a strong family history of either breast and/or ovarian cancer or may carry the predisposing BRCA-1 or BRCA-2 gene.
- This surgery may also be offered as part of active breast cancer treatment.
- It causes immediate and permanent menopause.
- When the ovaries are removed, levels of oestrogen, progesterone and testosterone fall, as they are no longer produced by the process of ovulation. This can occur just 24 hours after surgery and symptoms of menopause can be reported within just 2 days following surgery.
- Actress, Angelina Jolie, has recently shared her personal experience of her prophylactic oophorectomy and resultant symptoms of menopause.
- Hysterectomy alone, without the removal of the ovaries, should not cause induced or surgical menopause.
- However, it has been reported that 10-12% of women may experience menopause up to 4 years earlier than expected following hysterectomy.
- Chemotherapy-Induced Menopause
- Not all chemotherapy medications will cause menopausal symptoms.
- However, treatment regimes can cause early menopause due to toxicity to the ovaries resulting in destruction of ovarian tissue and the loss of eggs.
- This form of medical menopause may be temporary or permanent.
- Radiation-Induced Menopause
- Radiotherapy can also cause damage to the ovaries and cause failure of ovarian function and therefore early menopause.
- Usually results in permanent menopause.
- Hormone Therapy Medications used in Cancer Treatment
- Such as Tamoxifen and Aromatase Inhibitors, used in conjunction with the treatment of Breast Cancer.
- Some treatments may not lead to menopause but can cause menopause-like symptoms such as hot flushes.
- Hormonal therapies can also stimulate menopausal symptoms in women who were already considered post-menopausal prior to their diagnosis of breast cancer.
- Post-Cessation of Hormone Replacement Therapy (HRT)
- Women using HRT to treat or alleviate symptoms of natural menopause or premature menopause can experience rebound symptoms upon cessation of treatment.
- This is usually the result of a sudden lowering of hormone levels.
This is the time following complete cessation of periods. During this stage and for years following, women can still continue to suffer from Menopause Symptoms – hot flushes and sweats, vaginal and urinary symptoms, loss of libido, mood changes and sleep disturbance.
There is no reliable method of predicting how long menopausal symptoms will continue. Most of the vasomotor symptoms such as hot flushes and night sweats tend to resolve within 3 years. Vaginal dryness and its associated symptoms of itching, burning, dyspareunia (painful intercourse) and urinary frequency can continue well beyond the cessation of vasomotor symptoms. In fact, vaginal dryness is one symptom that never improves without treatment.
In addition, the depletion of oestrogen levels can result in increased risk of heart disease, bladder weakness and incontinence, osteoporosis and change in body fat distribution. It is important to continue caring for all areas of your health during this time.
How is Menopause Diagnosed?
The diagnosis of Menopause is usually a clinical diagnosis made after 12 months has lapsed since a woman’s last menstrual period. This is usually also in association with the clinical onset of Menopause Symptoms.
Blood tests can be used to help with diagnosis, but may not be a reliable measure of whether a woman has attained menopause. Hormone levels can fluctuate on a daily basis or be affected by medications such as the oral contraceptive pill or hormone replacement therapy.
- Follicle Stimulating Hormone (FSH) is expected to rise with menopause.
- Oestradiol, an oestrogen, is expected to decrease by up to 90% with menopause.
Anti-Mullerian Hormone (AMH) is another blood test which is often used to measure ovarian egg activity and can be used in predicting menopause within a 2 to 4 year period. Nevertheless, this is not yet a recommended, routine investigation for menopause.
Saliva Testing – Once again this test is based on testing levels of hormones, which again can fluctuate depending on time of day and position in menstrual cycle.