Menopause, the absence of a menstrual period for 12 months, marks the end of menstruation and fertility in a woman.

Menopause Overview

Menopause is a normal physiological process in women that usually occurs after the age of 40. It is marked by the absence of menstrual period for at least 12 months. Although menopause signifies the end of menstruation and fertility in women and may cause stressful symptoms, it is important to remember that it is not an illness.

What causes menopause?

In women, ovaries are responsible for producing the hormones oestrogen and progesterone, which regulate menstruation and ovulation, the release of eggs from ovaries. During menopause, the activity of the ovaries ceases, resulting in a decrease in oestrogen and progesterone levels. This leads to the onset of menopause.

What are the symptoms of menopause?

Menopause affects women in different ways. Some women sail through the transition, while others experience the worst of the symptoms. Some of the symptoms commonly seen during menopause are:

• Irregular menstrual bleeding

• Hot flushes and sweating

• Vaginal dryness and itching

• Mood swings

• Sleep irregularities

• Weight gain around the waist

• Hair thinning

• Loss of breast fullness

Although menopause is not an illness, you should seek advice from a medical professional if your symptoms begin to affect the quality of your life.

What is the treatment for menopausal symptoms?

Menopause in itself requires no medical therapy. The treatments that exist only aim to alleviate the signs and symptoms of menopause.

• Medical therapy: Drugs such as clonidine, gabapentin, and various antidepressants may be prescribed to alleviate mood swings and hot flashes.

• Hormonal therapy: Hormone replacement therapy (HRT) uses oestrogen or a combination of oestrogen and progesterone to treat menopausal symptoms. Oral contraceptive pills can help with irregular bleeding. Vaginal hormone creams can alleviate vaginal dryness.

• Alternative therapy: Phytoestrogens also known as dietary oestrogens that refer to oestrogens occurring in foods such as legumes, flaxseed, whole grains and some fruits and vegetables, Vitamin E, black Cohosh and dietary supplements such as liquorice, chasteberry and wild yam, are known to reduce menopausal symptoms.

What else can help?

The good news is that most of the symptoms of menopause are only temporary in nature. Simple changes in lifestyle along with conventional treatment can help with the transtion.

• Identify the triggers for the hot flashes and avoid them.

• Regularize your sleep pattern.

• Get plenty of exercise through the day and avoid excess caffeine.

• Eat healthy and stop smoking.

• Relaxation techniques such as deep breathing can help alleviate particularly stressful symptoms.

Signs of Menopause and Perimenopause

The term ‘perimenopause’ is used to define the time around the transition into menopause. Even though you are still menstruating, you may begin to experience the signs and symptoms of menopause. Hormone levels tend to fall and rise erratically, and this leads to hot flashes. You could also experience irregular bleeding, vaginal dryness and thinning of the tissues near the vagina and urethra.

Also referred to as climacteric, this condition may last four to five years. If you cross 12 months without a period after your last one, then it means that you are well into menopause.

Predicting the Age of Menopause

Menopause, which occurs around the age of 45-55 years, is that stage in the life of a woman when the ovaries stop producing eggs. The body produces progressively lower amounts of the hormones progesterone and oestrogen, which eventually leads to the end of menstruation.

However, menopause can occur at as early as 30-35 years of age in some women. This has implications for those couples who postpone having a child until the woman is well over 30 years old.

Exciting new research

However, thanks to researchers in the Netherlands, the age at which a particular woman will reach menopause can now be predicted quite accurately. According to their study, the levels of a hormone called anti-Mullerian hormone (AMH) may provide the answer to this question. These researchers say that this hormone can predict a woman’s reproductive capacity better than just her chronological age alone.

By measuring the levels of AMH in the blood, one can estimate the number of small follicles present in a woman’s ovaries. The number of follicles indicates whether monthly ovulation, which allows reproduction, is still possible. If the number of follicles is highly depleted, it means that the woman is nearing menopause. This depletion usually occurs around the age of 40-60 years; but in some cases, it happens much earlier. Thus, information about the level of this hormone can help couples plan their families.

The results of this study, which involved measuring the AMH levels in 144 healthy women, will appear in the Journal of Clinical Endocrinology and Metabolism (JCEM). The data from this study was later extrapolated to estimate the age of menopause in 3,384 women of between 50- 70 years of age.

By analysing the relationship between the AMH levels and age of the women, the Dutch researchers have now developed a model that can predict the age at which any woman would reach menopause.

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