Menopause: the symptoms, the systems and existing solutions.
Updated: Jul 1
If menopause is anything, it’s overwhelming. And it can really come as a shock.
Over 34% of women had never been formally assessed or diagnosed as menopausal and 73% are not treating their menopausal symptoms. (3) By staying informed, our menopause transition can become smooth and stress-free. Sometimes it helps to know what’s coming so you can brace yourself for impact!
What is menopause?
Women are born with anywhere between one to two million eggs in their ovaries. The ovaries produce hormones that control menstruation and ovulation. As a woman gets older, the quantity and quality of these eggs decrease, which affects fertility. (4)
Eventually, the ovaries stop releasing eggs, and a woman goes 12 consecutive months without a menstrual period. Normally menopause occurs between the ages of 45 to 55. If it occurs between the ages of 41 and 45 years it’s known as early menopause. If it’s even earlier, before the age of 40, it is called premature menopause. (Read more about early and premature menopause here!)
The three stages of menopause.
During the menopause transition, women experience many uncomfortable and disruptive symptoms, including:
Irregular periods.
Vaginal dryness.
Hot flashes.
Difficulty sleeping.
Mood swings.
Weight gain. (5)
There are three main phases to the menopause transition.
Perimenopause: This is a transition phase before menopause. Ovarian production of estrogen and progesterone fluctuates.
Menopause: At this stage the ovaries no longer release eggs, periods stop and estrogen levels crash.
Postmenopause: This is the period following a woman's menopausal transition. Symptoms that occur during menopause may start to fade away or sometimes continue for around a decade.
What causes menopause?
The reproductive system is composed of three cooperating levels: the hypothalamus, pituitary, and ovaries. This pathway, referred to as the hypothalamus-pituitary axis, stimulates the pituitary gland. Here are two important hormones running these systems:
Follicle-stimulating hormone (FSH): Responsible for the growth of follicles that regulate the development of baby ovaries. (7)
Luteinizing hormone (LH): Stimulates the release of an egg from the ovaries. (8)
The hypothalamus-pituitary axis.
The hypothalamus sends and receives electrical and chemical messages within the nervous system to produce hormones to stimulate the pituitary gland. (10)
The pituitary gland produces FSH and LH.
FSH develops our follicles, which maintain our estrogen levels.
LH matures our eggs and triggers ovulation (the release of eggs from the ovary).
FSH and LH levels stimulate the ovaries to release sex hormones such as estrogen and progesterone.
Estrogen binds to receptors in the hypothalamus, inhibiting the system and bringing the existing ovarian/menstrual cycle to completion.
The hypothalamus-pituitary axis during menopause.
When women approach their mid 40’s to 50’s, their ovaries start to lose reactivity to FSH and LH, causing infrequent menstrual periods and eventually menopause. Eventually without reactivity towards FSH and LH, stages 3 - 6 cannot occur. Our follicles do not develop, ovulation does not occur and our ovaries do not release sex hormones such as estrogen and progesterone. So, we enter menopause, accompanied by an estrogen crash and the absence of ovulation. (11)
Post-menopause associated health risks and lifestyle changes.
Heart disease and stroke.
A woman's risk of heart disease and stroke is significantly higher after menopause. Low estrogen levels may cause heart and blood vessels to stiffen and become less elastic. This can increase blood pressure, which can in turn damage blood vessels and increase the risk of stroke, heart disease, and heart failure. (12) There is insufficient evidence that hormone therapy improves cardiovascular outcomes. (13)
Osteoporosis.
Bone loss increases during menopause. Estrogen is involved in calcium metabolism, without it, blood levels of calcium decrease. To replenish the blood, calcium is lost from the bone which may decrease bone density and lead to osteoporosis. Estrogen in the form of hormone replacement therapies (HRTs) can prevent bone loss, but the therapy can have negative side effects. (14)
Urinary incontinence.
Loss of bladder control is more common in women during and after menopause. A decrease in estrogen causes pelvic floor muscles to become weak. Estrogen is the hormone that keeps your bladder and urethra healthy. HRTs are not proven to help urinary incontinence. (15)
Sexual function.
Menopause has a huge impact on your sexual function. After menopause, a person’s sexual desire declines and changes the body; making it difficult to get aroused and have intercourse. For many women, climaxing can become a distant dream. (16) Hormone therapy, can increase sexual interest and drive as balanced hormones can also result in a better overall mood. (17)
Weight gain.
Aging is associated with the slowing of one’s metabolism. Lean body mass (fat-free mass) decreases with age and body fat accumulates. Menopause increases fat in the abdomen while simultaneously decreasing lean body mass. In this case, hormone therapy is not proven to help with weight gain. (18)
Using hormone therapy for menopause.
It’s Ideal to start HRTs as soon as you begin to experience menopausal symptoms. Hormone therapy can help relieve some menopausal symptoms and provide various health benefits. (Read more about using hormone therapies to treat menopausal symptoms here!)
Key takeaways.
A woman is born with one to two million eggs stored in her ovaries. As she ages, the number of eggs decreases, and the quality of the remaining eggs also decreases.
When a woman goes through 12 consecutive months without a menstrual period, it is known as menopause.
The hypothalamus, pituitary, and ovaries work together for the reproductive system.
When women approach their mid-40s to 50s, their ovaries start to lose reactivity to FSH and LH, causing less frequent menstrual periods and eventually menopause.
There are many health risks after menopause such as heart disease, stroke, osteoporosis, urinary incontinence, loss of sexual drive, and weight gain.
Hormone therapy can help relieve some menopausal symptoms and provide some health benefits.
Citations
(1) https://www.yesmagazine.org/opinion/2022/02/15/menopause-shape-shifting-power
(6) https://propelltherapy.com/the-three-stages-of-menopause-and-bio-identical-hormones/ (7) https://www.londonwomensclinic.com/what-are-follicles-and-why-are-they-important-for-my-fertility/ (8) https://medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/ (9) https://helloclue.com/articles/cycle-a-z/estrogen-101 (10) https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/what-are-neuroendocrine-tumours/the-neuroendocrine-system (11) https://courses.lumenlearning.com/wm-biology2/chapter/the-ovarian-cycle-the-menstrual-cycle-and-menopause/ (12) https://herkare.com/blog/low-estrogen-heart-risk/ (13) https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/06/hormone-therapy-and-heart-disease (14) https://www.google.com/url?q=https://courses.lumenlearning.com/wm-biology2/chapter/the-ovarian-cycle-the-menstrual-cycle-and-menopause/&sa=D&source=docs&ust=1658115222941715&usg=AOvVaw1i6H-jjvhlO0F3aDJnpcIZ (15) https://www.nia.nih.gov/health/urinary-incontinence-older-adults (16) https://www.google.com/url?q=https://www.health.harvard.edu/womens-health/yes-you-can-have-better-sex-in-midlife-and-in-the-years-beyond%23: (17) https://coolspringsobgyn.com/hrt-improve-sexual-function (18) https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-weight-and-fat-distribution