THE menopause is a natural event that occurs in all women. It is the permanent cessation of periods (menstruation) as a result of the loss of activity of the ovaries and can only be said to have occurred only after 12 months without spontaneous menstruation.
Physical and other changes occur in the years leading up to the menopause. Most of the changes are normal and are related to the menopause. Others are more related to ageing and may, in some women, be associated with illness, as many conditions that are not related to the menopause e.g. hypertension; diabetes, obesity, etc. are diagnosed about the time of the menopause.
Each woman’s experience of the menopause is unique. For some, the end of menstruation brings about freedom from concerns about fertility. For others, it is a time of coping with social changes that are inevitable during this time when the children begin to leave home.
For a few, it is about dealing with illness. For the vast majority, the menopause is a new part of life when they report empowerment, increased confidence and renewed vigour than when they were younger. It is also an opportunity to improve the quality of life with improved health practices.
Every woman is born with a finite number of eggs (oocytes). In every menstrual cycle, at least one oocyte is released under the influence of follicular stimulating hormone (FSH) and luteinising hormone (LH) produced by the pituitary gland in the brain.
The FSH and LH act on the ovary in the first half of the cycle and stimulate an oocyte to develop into a follicle, which produces a large amount of oestrogen. The increase in FSH and LH prepares the uterine lining (endometrium) for pregnancy and causes the release of the follicle at about the middle of the cycle. The ovulated follicle changes into the corpus luteum, which produces progesterone to maintain the endometrium.
If fertilisation does not take place, the follicle degenerates and the decrease in progesterone causes the endometrium to shed (menstruation).
With repeated ovulation, the number of oocytes is reduced until there is none left. The oestrogen levels decrease and the body produces more FSH and LH in an attempt to stimulate the ovaries. The menstrual cycle is disrupted and eventually the pattern of low oestrogen and increased FSH and LH is established.
There are several terms about the menopause which need to be defined.
The perimenopause can be confirmed by a detailed medical history and an exclusion of other causes for the symptoms. In almost all instances, hormone estimations are not necessary.
If there is doubt, an estimation of the blood level of the follicle-stimulating hormone (FSH) will provide a reliable test. When the ovarian production of oestrogen declines, the brain increases the production of FSH in an attempt to stimulate the ovaries to produce more oestrogen. When the FSH is persistently above 30 to 40 mIU per ml, it is accepted that the woman has reached menopause. As the perimenopausal production of oestrogen fluctuates daily, the estimation of FSH more than once is needed to confirm the menopause.
Dr Milton Lum is the Chairperson of the Commonwealth Medical Trust. This article provides general information only and is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation that the writer is associated with.
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