Menopause: the symptoms, the systems and existing solutions.

Navigating through menopause can indeed be an overwhelming journey. Surprisingly, over 34% of women have never been formally assessed or diagnosed, and a staggering 73% are not treating their symptoms. (3)

By arming ourselves with knowledge about menopause, its causes, and the signs of this significant life transition, we can make the journey smoother and more manageable. It's always beneficial to understand what to expect so we can be better prepared for this natural phase of life.

When do women hit menopause, and what is it?

Women are born with a finite number of eggs, ranging from one to two million, stored in their ovaries. These ovaries are responsible for producing hormones that regulate menstruation and ovulation. As women age, there's a noticeable decline in both the quantity and quality of these eggs, impacting fertility. (4)

Eventually, hormonal changes lead to menopause, marked by 12 consecutive months without a menstrual period, typically occurring around the average ages of 45 to 55. Instances before this age range, known as early menopause or even premature menopause if before 40, highlight the variability of the menopause age and underline the importance of recognizing early symptoms of menopause.

Menopause symptoms.

During the menopausal transition, women experience many uncomfortable and disruptive physical, psychological, and vasomotor symptoms, including:

Irregular periods.
Vaginal dryness.
Hot flashes.
Night sweats.
Trouble sleeping.
Mood changes.
Weight gain. (5)

The three stages of menopause.

There are three main phases to the menopause transition.

Perimenopause marks a significant transition phase leading up to menopause, characterized by fluctuating levels of ovarian estrogen and progesterone production. Understanding these premenopausal symptoms can help women navigate this period with greater awareness and preparedness.
Menopause is a pivotal stage where the ovaries cease to release eggs, menstrual periods stop, and estrogen levels significantly decrease. The time of menopause is a crucial turning point in a woman's reproductive life with many impacts on daily life.
Postmenopause follows the menopausal transition, a period when symptoms experienced during menopause may begin to diminish or, for some, continue for a decade or more. Recognizing this phase is essential for understanding the long-term changes and managing postmenopausal well-being.

A graph of estrogen levels throughout the stages of menopause. — The Stages of Menopause. (6)

What causes menopause?

The reproductive system's functionality hinges on the intricate cooperation between the hypothalamus, pituitary gland, and ovaries, collectively known as the hypothalamus-pituitary axis. This system plays a critical role in regulating menopause hormones and maintaining hormone levels throughout menopause.

Follicle-stimulating hormone (FSH): Plays a key role in the growth of ovarian follicles, which are crucial for the development of eggs. This hormone's function is vital for understanding reproductive health. (7)
Luteinizing hormone (LH): Stimulates the release of an egg from the ovaries. (8)

A graph of hormone levels in the average menstrual cycle. — Periods are when most hormones’ concentrations are at their lowest and most stable. The rise is when you are most fertile. (9)

Periods are when most hormones’ concentrations are at their lowest and most stable. The rise is when you are most fertile. (9)

The hypothalamus-pituitary axis.

The hypothalamus is pivotal in sending and receiving both electrical and chemical signals within the nervous system, which, in turn, stimulates the production of hormones by the pituitary gland. This process is fundamental to the body's hormonal regulation. (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).
Levels of FSH and LH are crucial in stimulating the ovaries to release sex hormones such as estrogen and progesterone, highlighting the importance of these hormones in the reproductive system.
Estrogen plays a crucial role by binding to receptors in the hypothalamus, effectively inhibiting the system and facilitating the completion of the existing ovarian/menstrual cycle.

The hypothalamus-pituitary axis during menopause.

As women transition into their mid-40s to 50s, a significant change occurs in their hormonal landscape, marking the onset of menopause. The ovaries gradually lose their responsiveness to FSH and LH, leading to less frequent menstrual periods and eventually culminating in menopause. This phase is characterized by a notable absence of ovarian activities such as follicle development, ovulation, and the release of sex hormones like estrogen and progesterone, accompanied by an estrogen crash and the cessation of ovulation. (11)

Health risks and lifestyle changes for postmenopausal women.

Heart disease and stroke.

A woman's risk of health conditions such as 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 result in a higher 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 sex drive declines and changes the body; making it difficult to get aroused and have intercourse. For many women in this stage of life, 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. Weight gain is a normal part of menopause, which 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 hormonal therapy for menopause.

Initiating treatment options such as hormone replacement therapies (HRTs) at the onset of menopausal symptoms can have many possible benefits. Hormone therapy is known to alleviate various menopausal symptoms, offering health benefits and improving quality of life during this transition. (Read more about using hormone therapies to treat menopausal symptoms here!)

Key Takeaways

A woman is born with a finite number of eggs, ranging from one to two million, stored in her ovaries. As she ages, not only does the quantity of these eggs diminish, but the quality of the remaining eggs declines as well, leading towards natural menopause.
Menopause is defined as the point in a woman's life when she has gone through 12 consecutive months since her last period, signaling the end of her reproductive years.
The hypothalamus, pituitary, and ovaries work together for the reproductive system.
When women approach their mid-40s to 50s, a noticeable shift occurs in their reproductive system as their ovaries begin to lose sensitivity to FSH and LH. This leads to less frequent menstrual cycles and eventually progresses to menopause.
The post-menopausal phase brings with it several health risks, including cardiovascular disease, stroke, osteoporosis, urinary incontinence, diminished sexual drive, and an increased tendency for weight gain, highlighting the multifaceted impact of menopause.
Hormone therapy can help relieve some menopausal symptoms and provide some health benefits.