The menopause is otherwise known as the change of life or climacteric and occurs most commonly at about the age of 50. When one speaks of the change of life one automatically considers the time or age at which a woman has her last period. Just as puberty spans over a number of years in which the onset of menstruation is only one isolated factor, so the true menopause extends over quite a number of years during which the cessation of menstruation is only one particular and dramatic symptom.
The expectation of life in Roman times was about 24 years but by the fourteenth century it had risen to 43 years. At the beginning of this century it had risen only to 48 so that the problems of the menopause have only become really important during the last 70 years.
At a certain time in every woman’s life all the ova which have not been used begin to atrophy and the ovaries themselves gradually cease to function. Menstruation ceases when the cyclic production of the hormones oestrogen and progesterone drops below a critical level.
No one can say for certain at what age the menopause actually begins, because the gradual lowering of hormone levels is so slow that it is initially unnoticed. The majority of women are only aware of the change of life after noting some abnormality of their periods whereas some complain of menopausal symptoms before they notice any alteration.
There arc many horrifying stories associated with the change of life. Few, if any, are true. The menopause does present the average woman with some problems, but most doctors agree that the vast majority can be easily overcome with sympathetic advice or a small amount of treatment.
The changes that occur before, during and after the cessation of menstruation are nearly all due to a fall in the level of oestrogen in the body. This begins three or four years before the periods actually stop, so that the earliest symptoms of the change of life can occasionally be recognized for several years while menstruation is still occurring. It should be emphasized that the majority of women can pass through the change of life experiencing very little or nothing in the way of symptoms and without anyone else knowing or appreciating what is happening.
Several small changes may be noticed in the earlier part of the menopause: an increase of premenstrual tension where this has been comparatively mild or even absent; nervousness and irritability; gradual weight gain and some redistribution of the body fat from the arms and legs to the shoulders, buttocks and abdomen; mild indigestion or change of bowel habit, together with several other very minor symptoms.
The actual cessation of the menstrual periods is gradually occurring at an older age (just as the first period is occurring at a younger age) and the average age is now about 48-5 years. This happens normally in one of three ways:
1. The periods stop suddenly without prior warning.
2. They continue with their normal cycle but the amount of loss gradually decreases until there is none.
3. They continue normally but the time between them gradually increases until after a gap of several months no further menstruation occurs.
Any divergence from the list above is abnormal and a doctor’s advice should be sought. Bleeding between periods, bleeding after intercourse, prolonged bleeding, heavy bleeding, frequent or irregular periods, or blood-stained vaginal discharge, are not symptoms of the normal menopause. Report them to your doctor without undue delay.
The main symptoms of the menopause, apart from the cessation of menstruation, are sweating and hot flushes. These may come at any time of day or night and may vary from once a week to as often as thirty or forty times a day. They may be very mild or sufficiently severe to cause a great deal of distress and discomfort. The feeling of heat and claustrophobia may force a woman to open windows for fresh air; when the hot flush wears off it is followed by a feeling of coldness and she shuts the window and puts on extra clothing or bedclothes. Although the hot flushes feel as though the face is burning like the setting sun, actual flushing of the face is very rare. It is almost impossible to recognize a hot flush from the facial appearance alone. Hot flushes are usually associated with sweating which is often hardly noticeable but which may sometimes be particularly profuse, especially at night, making a woman change her nightdress several times and occasionally her sheets as well. There is no way of knowing if a woman is going to suffer from hot flushes and sweats during her menopause; nor is there any way of knowing how many sweats and flushes she will have.
Neither the first symptoms of the climacteric nor the menopause itself need affect the daily routine, bodily functions or sex life of a woman. There is a tendency to gain weight, more noticeable because of the redistribution of fat over the body, but this can be resisted by moderate but efficient dieting.
The majority of changes in the body after the menopause are nothing to do with hormone levels themselves but are simple processes of ageing which occur in everybody male or female. There are, however, some changes which are specifically related to a fall in oestrogen level. The vagina becomes drier and the muscles of the pelvic floor and perineum become rather wasted. These in turn may lead to problems such as vaginal discharge, difficulty or pain with intercourse, frequency of micturition and even vaginal or uterine prolapse. Nearly all these changes can be reversed by giving small doses of oestrogen. This can sometimes be seen in a post¬menopausal woman who is suffering from depression as well as some atrophic changes in the vagina. If she is given a small and carefully calculated amount of oestrogen, the depression is relieved and the vaginal changes reversed; all this, together with a return to normal sex life, results in a remarkable improvement in disposition and outlook. Oestrogen must always be prescribed by a doctor and never self-administered.
A great controversy rages concerning the advisability of giving oestrogen before, during and after the menopause. Some say that hormones should not be administered, but there is an argument for the administration of small doses of oestrogen in a cyclic regime which off-set the majority of the symptoms of the menopause. If patients who are approaching the menopause are put on a contraceptive pill (which contains oestrogen as well as progestogen) they are relieved of some of the symptoms they might have developed prior to the cessation of their periods.. A woman will know she is entering the menopause because even while taking a low dose of, hormone she will occasionally miss periods despite a lack of other symptoms.
The majority of gynaecologists agree that a woman who has no symptoms or abnormal physical signs does not need hormones, but that treatment should be considered if she has symptoms which can be attributed to the menopause or to a postmenopausal drop in hormone levels.