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Menopause Age
Menopause - A New Beginning

By Dr. Eva Bell

Menopause Age - The life of a woman is like the cycle of seasons, controlled by the ebb and flow of hormones in her body. They alter not only her physiology, but her emotions and behaviour. Menopause is a watershed. The “Change” has arrived.

It was not until the 19th Century, that scientists discovered and isolated hormones secreted by the ovaries of women. They learnt that these hormones Oestrogen and Progesterone, were regulated by a hypothalamic-pituitary axis, which stimulated ovulation and menstruation, physiologically preparing girls for the role of motherhood. Menopause heralds the end of that reproductive period, and though the hypothalamus sends out more of its hormones, to stimulate the ageing ovaries, it is like flogging a dead horse. The ovaries respond erratically, and finally give up the struggle.

Menopause is a natural biological event and not a disease. But because it has been steeped in myth and superstition, for some women this is a crisis situation. Menstruation has been emotionally tied up with women’s feminity, and is considered important for gender identity, sexuality, and one’s own self concept. There is fear that cessation of periods will make women less feminine, less lovable, sexually dysfunctional, and that their husbands will consider them “old, de-sexed, defective and worthless.” They fear that as a consequence, marital relationships will flounder.

It is therefore important that women familiarize themselves with the functioning of their bodies, and what exactly happens at menopause. Ignorance is always at the heart of illogical fears.

The ageing of the ovaries is a slow and steady process. Most people are unaware that it starts even in foetal life. The maximum number of follicles (oocytes) are present in a foetus of five and a half months (5 million). But at birth, they have dropped to 1 million. By the age of 7 years, only 300,000 follicles remain, and as a woman approaches menopause, just a few hundred can be detected. From the age of 30 years, the size of the ovaries too, begins to decrease.

The human female is one of the few species, in which reproduction ceases, before the end of the natural life span. In fact, 1/3rd of a woman’s life extends beyond menopause. Animals retain the capacity to reproduce, till the end of their lives. This ageing of ovaries causes a drop in the secretion of oestrogen and progesterone, which is responsible for the symptoms one experiences, during menopause. Menopause is the cessation of periods. Provided there is no other pathological cause, stoppage of menses for 12 months, confirms retrospectively, that a woman has reached menopause. The word is derived from the Greek mens (month) and pausis (cessation.) Climacteric on the other hand, refers to the peri-menopausal period, 4-5 years before and after menopause. It is a critical period of transition from reproductive to a non-reproductive phase, with decreased fertility, stoppage of menses, and degenerative changes due to oestrogen deficiency.

Unlike the age of puberty, the age of menopause has not changed over the centuries. It can occur any time between 45-55 years, with an average of about 51 years. Premature menopause occurs in about 1% of women. Here, menses stop before the age of 40. This may be due to a genetic predisposition or premature ovarian failure (0.3%).

Surgical menopause follows removal of ovaries during gynaecological operations. Menopause can also be induced through chemotherapy or pelvic irradiation, in the treatment of malignancies.

Various studies have proved that there is no link between age of menopause and socio-economic conditions, race, marital status, or age of the first menstrual period.However, multiparity and obese individuals are known to have a late menopause, whereas women who have not borne children or suffer from depression, have an early menopause. Smoking hastens menopause by 1.5-2 years.

Those with high cognitive skills in childhood, are also said to have late menopause.

Globally, there are about 470 million women in the 50+ age group. About 30% of these, live till the ripe old age of 80 years. Menopause affects all women, and the numbers reaching middle-age are increasing, which means an appreciable rise in the elderly population. Hence, the management of menopause and its problems, has taken on an urgency like never before.

There are three normal ways in which periods can stop.

• Abruptly. (10%)
• Occurring at long and infrequent intervals before stoppage.
• Cyclical but scanty bleeding which tapers off.All other ways like heavy bleeding, frequent bleeding, or spotting are abnormal, and must be investigated and treated.

Symptoms of menopause are generally due to the interaction of three components.

• Decreased ovarian activity, and low levels of hormones.
• Socio-cultural and environmental factors.
• Psychological factors.

Three main symptoms attributed to oestrogen deficiency must be treated.

About 80% of women suffer from hot flushes, at some time during climacteric. A hot flush is a sudden intense feeling of heat, spreading over neck and body. It may last for 1-3 minutes, and occurs several times a day, making the person self-conscious and uncomfortable. Flushes at night, may be followed by profuse night sweats. However, less than 25% of women suffer acute distress due to excessive and frequent flushes. They seldom persist beyond a couple of years.

Atrophy of the vaginal mucosa leading to dryness, itching, pain during intercourse, and frequent urinary problems are due to oestrogen deficiency. The urethral syndrome is a triad of symptoms of frequency, pain during urination and bladder infections.

The skin loses its elasticity, and becomes dry and wrinkled. Loss of hair and greying also occurs.

By far, the most serious effect of oestrogen deficiency is Osteoporosis. Hip fractures, wrist fractures, and crushing fractures of the vertebrae, causing the typical “Dowager’s Hump,” are more frequent in menopausal women. There may even be a loss of height of about 2 inches. Bones become brittle and lose their density. Osteoporosis literally means “porous bones.” The rate of bone loss is about 1% per year, for about 10 years after menopause.

These three symptoms are known to be relieved by Oestrogen, and so Hormone Replacement Therapy (HRT) has become an important part of menopause management. Some studies have shown that women of 70 years who have been on HRT, show a bone age 10-12 years younger than their chronological age. Oestrogen not only prevents bone loss, but is also beneficial for bone collagen.

Osteoporosis has many causes. Apart from oestrogen deficiency, dietary deficiency or malabsorption of Calcium and Vitamin D, prolonged immobilization, drugs like corticosteroids and anti-cancer drugs, endocrine disorders like hyperthyroidism and hyperparathyroidism, rheumatoid arthritis, are other causes.

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