What is the Menopause ?
The menopause has come of age! For much of society (although sadly, still not all), the menopause is now discussed freely by women both at places of work and in many social situations. Over the past 5-8 years, there has been a huge interest in the menopause by the media (sometimes distorted or inaccurate) and a rapid increase in the number of therapies available to women. Just look in any health food shop and observe the number of packets of pills aimed at ‘midlife women’ or women ‘at the change’. Look in women’s magazines and tabloid newspapers and see how the menopause is widely discussed and debated. But still we meet the stereotypes: menopause is assumed to happen at the age of 50 years, even though many women experience it much earlier – even in their twenties or thirties. The hot flush is assumed to be the worst symptom, yet for some women it will be the psychological symptoms that concern them most. Women hope that by ‘living a healthy life’ they will not encounter problems, but menopausal symptoms may affect even the healthiest of women, and sometimes factors outside her control will influence the health of a woman at the menopause and afterwards.
Women are beginning to understand that there is more to the so-called ‘change of life’ than simply the cessation of periods. Women want information about what happens to their bodies at the time of the menopause. They want to know what to expect in the way of symptoms and experiences. They want to know what they themselves can do or take to make it easier, and they want to know what measures are required to protect their long-term health. Many women want to take responsibility for their health and make their own decisions about whether or not to use medical interventions. They understand that health is more than ‘the absence of disease’ and want to invest time and effort into maintaining their physical, sexual, emotional and spiritual health.
We have all heard and read about ‘the menopause’ but the term often means different things to different people. To some women it is simply an explanation of a physiological change taking place in their bodies. To others, the word itself triggers negative thoughts about middle age and loss of femininity. Most women will recognize that the time of the menopause is a time of hormonal disturbance, but many will not understand precisely what those changes are or what causes them to happen.
Strictly speaking, the term menopause simply means last menstrual bleed and as such cannot be diagnosed until after the event.
The phase of time either side of this last bleed is described as the climacteric and it is during this time that many women experience physical and psychological symptoms, along with the emotional changes that some women will attribute to ‘the menopause’.
In practice, both health professionals and women themselves use the term ‘menopause’ to include all aspects of this phase of life. Women talk about going ‘through the menopause” referring to the months or even years of physical and emotional turmoil that may occur at this time.
A World Health Organization (WHO 1981) report on the menopause uses the following definitions:
- Menopause Permanent cessation of menstruation resulting from the loss of ovarian follicular activity.
- Perimenopause (or climacteric) The period immediately before the menopause with endocrinological, biological and clinical features of approaching menopause, and at least the first year after the menopause.
- Postmenopause The era following the date of last menstrual bleed which cannot be determined until 12 months of spontaneous amenorrhoea has been observed.
In the UK, the majority of women experience the menopause at around the age of 51 years, although it commonly occurs as early as 45 years or as late as 56 years.
Menopause may occur at a very early age in some women, even in their twenties and thirties. This is described as a Premature Menopause and such women deserve special attention, both in terms of physical care and also with regard to emotional support.
Studies have shown a relationship between mother’s and daughter’s menopausal age, suggesting that variation in menopausal age may be determined genetically (Cramer et al 1995, Torgeson et al 1997).
Age of menopause does not seem to be affected by:
- use of oral contraception
- number of pregnancies
- age of menarche.
Smoking, however, does appear to bring forward the age of menopause by 1-2 years (McKinlay et al 1985, Sharara et al 1994).
WHAT HAPPENS AT THE TIME OF THE MENOPAUSE ?