Understanding the Menopause

The menopause is a natural process in every woman's life. For us women it is a time of transition, in which our body goes through changes that can be quite challenging both physically and emotionally. But there is good news: we do not have to suffer through this phase. With the right knowledge and support, we women can experience the menopause as a time of self-care and personal growth. The condition for that is understanding what the menopause actually is and what is going on in the body. That is exactly what we will look at in this article. We are laying the groundwork, so to speak, for meeting the challenge of the menopause better in the next step.

To understand the menopause better, let us first look briefly at the monthly cycle. A woman's monthly cycle is a complex process governed by various hormones. These hormones are formed mainly from cholesterol, so a lack of cholesterol can impair the production of sex hormones. Among the most important hormones are progesterone and oestrogen, which have to work in harmonious balance for the cycle to run naturally.

What oestrogen and progesterone do:

• Oestrogen is responsible for cell growth and for thickening the lining of the womb in the first half of the cycle, to prepare the womb for a fertilised egg possibly implanting.
• Progesterone is produced during the second half of the cycle, after ovulation. It prepares the lining of the womb for a fertilised egg possibly implanting. If no fertilisation takes place, the progesterone level falls, which means the lining breaks down and is finally shed with the menstrual bleed.

There are various outside factors that can disturb the hormonal cycle. Among them are:

• The contraceptive pill: it suppresses the natural menstrual cycle by supplying synthetic hormones (oestrogen and/or progestogen).
• Environmental toxins: chemicals in plastics, pesticides and herbicides can act as xenoestrogens and disturb the hormone balance.
• Diet: eating meat carrying hormones and genetically modified food can likewise lead to imbalance.

And not least there is the natural hormonal change of the menopause.

The menopause is the natural transition in a woman's life at which menstruation stops and fertility ends. This phase usually occurs between the ages of 40 and 55 (in some women earlier) and is marked by a clear fall in hormone production, particularly of oestrogen and progesterone. It happens over a period of 10 to 15 years on average. The menopause can be divided into four different phases, which we will now look at more closely.

1. Premenopause

The first phase, the premenopause, is marked by a gradual change in the menstrual cycle as oestrogen and progesterone levels fluctuate. It usually occurs between the late thirties and the mid-forties, though in some women it can start earlier. Periods become more irregular, and both the gaps between cycles and the heaviness of the bleeding change. Symptoms such as premenstrual syndrome (PMS), mood swings, hot flushes, migraine, breast tenderness and sleep problems can occur as well, all indicating that the body is preparing for the menopause.

2. Perimenopause

The second phase, the perimenopause, usually begins from the mid-forties (in some women earlier) and is the most intense phase of hormonal change. This is the phase most women associate with the menopause. Typical complaints such as hot flushes, sleep problems, weight gain and mood swings occur frequently. While some women have only mild complaints, for others the effects are considerably stronger. In this phase it matters particularly that you pay attention to your body and support it.

In the early perimenopause the cycle can fluctuate, shorten, lengthen or stop altogether. Its similarity to the premenopause makes the two hard to tell apart, since the transition is gradual. In the late perimenopause the gaps between periods grow longer, until menstruation finally stops altogether and the menopause is reached.

3. Menopause

The menopause proper arrives when a woman has gone 12 months without menstruating. The follicles no longer produce enough oestrogen to support the building of the womb lining. Ovulation and the period therefore stop entirely. Menopausal complaints can carry on in this phase. Around 50% of women have their last period at 52. For the other 50% the moment comes somewhat earlier or somewhat later.

4. Postmenopause

This phase begins after the menopause. In the postmenopause hormone levels fall further and the sex hormones reach their lowest point. The low hormone level can carry on causing complaints such as hot flushes, sleep problems, incontinence and so on, although most women feel better because the fluctuations are no longer so strong. The hormone balance now has to settle at a new normal and stabilise there. That can take up to 10 years from the last period.

An early menopause

Some women go through an early menopause. When hormonal change and a change in the menstrual cycle set in before the age of 40, we speak of an early menopause. That can have various causes. It can be down to genetics or to conditions such as diabetes or Hashimoto's. Essentially any metabolic or autoimmune condition that impairs how the ovaries work can lead to it. A high, sustained level of stress can bring on an early menopause too. Other causes can be chemotherapy or radiotherapy, or surgical removal of the ovaries and womb. Environmental toxins and heavy metals can also damage the ovaries and bring the menopause forward.

Every person is unique and brings their own genetics, their own vulnerability and resilience, and their own physical and emotional burdens and traumas. Every woman is therefore affected quite individually by the kind and the strength of menopausal symptoms.

Complaints in the menopause can include:

• hot flushes and night sweats
• changes in the menstrual cycle (heaviness and frequency)
• sleep problems
• mood swings
• palpitations
• anxiety
• depression
• weight gain
• muscle and joint pain, muscle loss
• trouble concentrating and memory problems (brain fog)
• changes in sexual function, loss of libido
• vaginal dryness
• dry eyes
• dry, itchy skin
• digestive complaints (heartburn, diarrhoea, constipation, bloating)
• migraine
• dizziness
• breast pain
• tingling all over the body
• problems with the urinary tract

Unfortunately this stage of life also brings a rising risk of cardiovascular disease, diabetes and osteoporosis.

New research has shown that the menopause affects the brain in many ways, which can lead to symptoms such as hot flushes and sleeplessness.

These studies have also shown that brain energy can fall by up to 30% during the menopause. That means the neurons still have access to glucose but no longer burn it as efficiently as before. These changes can lead to symptoms such as memory problems and mental exhaustion.

About two thirds of all women experience memory problems during the menopause. These symptoms are often not recognised as neurological, although they are directly connected to the changes in the brain.

That is a long and frightening list. What matters to me is that you know which complaints can be connected to the menopause, so that you are prepared, can place your physical challenges and respond accordingly. What you can do to ease symptoms or even prevent them, you will find in the articles Through the Menopause with Ease and Hormone replacement therapy (HRT) in the menopause.

If you suspect the menopause is beginning, it can help to have your hormone levels tested thoroughly. A thorough hormone test should cover not only oestrogen and progesterone but testosterone and sex hormone binding globulin (SHBG) as well. Understanding the ratios between these hormones correctly matters a great deal, of course, in making an accurate diagnosis and deciding on effective treatment or support.

Note, though, that a hormone test does not always say much about diagnosing the menopause. Hormone levels, oestrogen and progesterone in particular, fluctuate strongly in this time, which makes finding the right moment to measure difficult. A single test often reflects only the level on one particular day, which does not necessarily show the whole course of the menopause. The symptoms and overall state of health should be taken into account instead, to arrive at a sound diagnosis.

The menopause concerns not only women but has effects on men as well, particularly on their understanding of and support for their partners. Men who know about the menopause can respond better to their partner's needs and so strengthen the relationship. It matters a great deal that men understand what is happening in their partner's body, and above all in her brain, during the menopause, so that they can support and understand her better.

If you would like to go into the menopause in more depth, I can warmly recommend the following books.

The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power and Facts (Dr Mary Claire Haver)

The Menopause Brain: The New Science Empowering Women to Navigate Midlife with Knowledge and Confidence (Dr Lisa Mosconi)

The menopause is a profound stage of life with far-reaching effects on every woman's body and life. By understanding these changes better and adjusting how they live, women can handle this phase better. Research in this field is moving forward and offers hope of new treatment options that can help women lead a full and healthy life during and after the menopause.

This article has given you a basic understanding of what the menopause is. In the articles Through the Menopause with Ease and Hormone replacement therapy (HRT) in the menopause you will find what you can do to prevent and ease complaints during the menopause, so that you can go through this stage of life with strength and with ease.