Definition and Overview

Menopause is not a disease but a natural stage of life that starts twelve months after a woman has had her last menstrual period. After the onset of menopause, a woman will stop having her menstrual periods permanently, which means that she will not be able to bear children anymore.

This natural stage often occurs in women who are between 45 and 55 years old, but the actual age typically varies from individual to individual. Meanwhile, women who have undergone surgical procedures that involve the uterus and/or ovaries might experience menopause earlier in life. Some patients report experiencing symptoms of menopause in their 30’s, while others have said that it started late in their 60’s.

Three stages of menopause

  • Pre-menopause - This stage refers to the couple of years that lead up to the patient’s last menstrual period. During this stage, the levels of reproductive hormones gradually become lower and more unpredictable and the patient might experience symptoms of hormone withdrawal as well as irregular menstrual periods.

  • Perimenopause - The term refers to the period around the menopausal years. During this stage, the patient’s body and reproductive system are transitioning into menopause. Perimenopause can last anywhere from four to eight years (according to the North American Menopause Society), while some organizations, such as the Centre for Menstrual Cycle and Ovulation Research, claim that this stage can occur as early as six to ten years before the patient’s last menstrual period. Estrogen levels typically increase during this stage, averaging at around twenty to thirty percent higher than levels recorded during the pre-menopause stage. However, these levels are known to fluctuate, which can cause physical changes and various symptoms. Perimenopause also ushers in low chances of fertility, but the levels are not considered to be zero, which means perimenopausal women can still get pregnant. This stage ends a year after the last menstrual period. Stressful periods in life can aggravate the symptoms of perimenopause.

  • Post-menopause - This stage refers to the twelve-year period after the patient has had her last menstruation. She will be infertile during this period, but cases have been recorded where a post-menopausal patient became pregnant. At this stage, any vaginal bleeding should immediately be reported to a doctor, as it could be a possible symptom of more serious problems, such as uterine or ovarian cancer.

While menopause is natural, it increases the risk of several medical conditions and diseases, such as osteoporosis, atherosclerosis, osteopenia, and cardiovascular diseases such as acute myocardial infarction.

Cause of Condition

As mentioned earlier, menopause is a natural stage of life for women. Aging is the main cause for the majority of cases; women who are between 40 to 61 years old typically undergo the three different stages of menopause described above. For women living in progressive countries such as the United States and Australia, menopause typically occurs during the individual’s 51st year, but in other parts of the world—including the Philippines and India—the average menopausal age is relatively earlier at 44 years old.

There are some cases when menopause occurs abnormally early in life. Research shows that there are rare cases where patients barely past puberty experience the physical changes and symptoms brought on by menopause. Some of the possible causes are the following:

  • Premature ovarian failure, or POF - With this condition, the ovaries stop functioning normally or have completely stopped working. The lack of menstrual periods can be a sign of premature ovarian failure. In this case, the patient should consult a doctor who can then order a series of monthly lab tests to determine if the levels of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are high. Premature ovarian failure can be caused by a wide variety of factors, such as thyroid disease, undergoing radiotherapy or chemotherapy, autoimmune disorders, diabetes mellitus, or genetic issues.

  • Surgical menopause - Having the ovaries and/or uterus surgically removed leads to early menopause since these procedures cause reproductive hormone levels to drop suddenly. Other surgical procedures performed on parts near the uterus can also restrict or obstruct blood flow to the ovaries.

  • Cigarette smoking - Research shows that cigarette smoking, especially for women with a higher body mass index, can affect the hormonal levels, which also typically leads to early menopause.

There are also other factors that can influence the patient’s probability of experiencing menopause earlier in their lives. Being too thin, being born with a fraternal or identical twin, and belonging to a certain race or ethnicity are known as early menopause factors in the medical research community.

Key Symptoms

One of the most common symptoms of early menopause is the fluctuation in hormone levels and irregular menstrual and ovulation cycles. Other symptoms include:

  • Shorter menstrual cycles, though some patients report that their menstrual cycles actually lasted longer during the early years of menopause
  • Irregular bleeding, which can range from heavy to lighter flows; some patients report spotting. This symptom is caused by hormone fluctuation.
  • Dryness in the vagina
  • Vaginal pain during sexual intercourse
  • Thinning of the membranes in the outer urinary tract, the vulva, the vagina, and the cervix
  • Shrinking and loss of tissue elasticity in areas surrounding the genitals
  • Lack of energy
  • Back pain
  • Abnormal enlargement of the breasts
  • Pain in the breasts
  • Soreness in the joints
  • Itchy, dry skin
  • Tingling sensations in the skin
  • Urinary urgency and incontinence
  • Insomnia or sleep interruptions
  • Hot flashes
  • Headaches and dizziness
  • Abnormal weight gain
  • Heavy night sweats
  • Depressive mood
  • Anxiety
  • Reduced memory and focusing capacities
  • Irritability and mood swings

Who to See and Types of Treatment Available

Every woman will experience menopause later in her life, and as a natural process, it cannot be cured or treated. However, the symptoms that come with it can be managed with hormone replacement therapy, medication (such as selective estrogen receptor modulators), and alternative medicine with the help of an obstetrician-gynecologist (OB-GYN).

References:

  • Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17:25-54.

  • Col NF, Fairfield KM, Ewan-Whyte C, Miller H. In the clinic. Menopause. Ann Intern Med. 2009;150:ITC4-1-ITC4-15.

  • Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial. Menopause. 2010;17:946-954.

  • Freeman EW, et al. Efficacy of escitalopram for hot flashes in healthy postmenopausal women. JAMA. 2011;305:267-274.

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