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What is the Menopause?

There are several stages of the menopause which may continue for several years.

The menopause, also called “the change of life”, is defined as the end of the last menstrual period
Pre-menopause is the time prior to periods stopping, usually before symptoms start.
Peri-menopause is the time around the menopause when bleeding can be irregular and symptoms may occur.
Post-menopause is the time in a woman’s life after periods have stopped for at least a year.
The menopause will happen to all women, usually between 47 and 52 years old, but can happen outside the age range. The average age is 50 years old. The menopause happens when the ovaries stop releasing eggs, which means fertility comes to an end. There is also a drop in the levels of oestrogen and progesterone in the body (the two female sex hormones produced by the ovaries)

The most common and easy to recognise symptoms of the menopause are
SHORT TERM – hot flushes, sudden sweats, night sweats, insomnia, mood swings irritability.
INTERMEDIATE – Sexual difficulties, vaginal dryness, bladder symptoms
LONG TERM – Osteoporosis, Cardiovascular disease

Natural – Natural menopause is recognized to have occurred after 12 consecutive period free months for which there is no other pathological or physiological cause known. Japanese race and ethnicity may be associated with later age of natural menopause, while those women who smoke may be associated with an earlier menopause.

Surgical – Hysterectomy and Bilateral Oophorectomy (Removal of womb and both ovaries). If you have your ovaries removed at the same time as your womb, your menopause will start immediately. It is recommended starting oestrogen replacement as soon as possible following the operation to relieve symptoms of the menopause.
Hysterectomy without removal of ovaries – Even if you keep your ovaries following a hysterectomy the ovaries may stop producing hormones earlier than would otherwise be expected and the menopause may occur sooner than the time of a natural menopause..

Premature – Whilst it is common for the natural menopause to occur in the late forties or early fifties, some women experience the menopause much earlier.
A menopause prior to age 40 years is described as premature. This may be associated with chromosomal abnormalities or autoimmune diseases affecting the ovaries, and sometimes no cause is found. Menopausal symptoms may or may not be present. For women who are wanting children it is particularly important that a prompt diagnosis is made as implications with regard to their fertility are immense. Women with a premature menopause are usually advised to have hormone replacement therapy until the average age of the natural menopause (51). Women with untreated premature menopause are at increased risk of developing osteoporosis and cardiovascular disease.

Induced – This occurs when ovarian function stops following surgical removal of both ovaries, or when ovarian function is stopped following chemotherapy or radiotherapy treatment. Drugs known as gonadotrophin-releasing hormone analogues (GnRH) for example Zoladex, or Prostap, given on a monthly basis to treat cyclical diseases such as severe PMS (premenstrual syndrome) or endometreosis induces temporary ovarian failure and may cause symptoms associated with the menopause.. The addition of a HRT preparation may be given to alleviate symptoms caused by the “artificially induced” menopause
It is important that women realise and understand the menopause is a normal process and the beginning of a new stage of their life. A period of well-being, a relief that periods have ceased, a better sex life, and the freedom to concentrate on her own requirements.



©2003 - 2011 Dr Paul Fogarty