What is Menopause?
Menopause indicates the end of the monthly periods and the end of a woman’s reproductive life. It is a sign that the follicles in her ovaries have stopped production of estrogen and progesterone, the two main hormones for a woman.
A woman is menopaused when she does not get periods for 12 full months.
The other terminologies for menopause are as follows (according to the STRAW classification).
The time before the menopause when the body begins to prepare itself for its transition. During this time, a woman may experience menopausal vasomotor symptoms along with changes in menstrual cycle.
The exact age the transition begins may vary from woman to woman. Some women start having changes in their mid-thirties whilst many others actually start in their forties.
This phase may also be called the climacteric
- a) Early (Stage -2): The menstrual cycles may vary by + 7 days
- b) Late (Stage -1): Lasts for 1-3 years with intervals of cycles of > 60 days.
This is the period of time immediately around the menopause and the first year after menopause. The endocrinological (hormonal), biological and clinical features of menopause are more obvious
The period of time from the last menstrual period till the end of her lifespan. The post menopause is divided into:
a) Early Postmenopause: The first 5 -6 years since the last menstrual period.
b) Late Postmenopause: after 5 years of menopause till the end of her lifespan.
What are the hormones involved?
Women are born with all their follicles at birth and do not develop any more as they get older. These follicles are the source of estrogen and progesterone which are active mainly during her reproductive years. These 2 hormones, estrogen and progesterone are vital in controlling the menstrual cycle and fertility issues. Estrogen is also vital in maintaining various organs in the woman including the brain, skin, heart, and bone.
During the menopause, these follicles release less estrogen and progesterone and this is the beginning of menopausal symptoms and changes. When the follicles cease functioning completely, periods stop.
Two other hormones, follicular stimulating hormone (FSH) and luteinizing hormone (LH) are the controllers of estrogen and progesterone. When estrogen and progesterone levels drop, there is loss of control of FSH and LH and these 2 hormone levels start rising. A rising FSH level is the first indicator of impending menopause.
What is the average age of menopause?
he average of menopause around the world is 51 years (50-52 years). In Malaysia, the average age of menopause has been found to be around 50.7 years.
Premature Menopause is having menopause before the age of 40 years. This may happen naturally, surgically (when both the ovaries are removed) or induced (chemotherapy or radiotherapy for malignancies).
Late menopause is when menses goes on beyond the age of 55 years. Women who menopause late may have an increased risk of breast and uterine problems.
Factors that affect the age of menopause are:
1. Current and past history of cigarette smoking. Smoking makes menopause earlier by 2 years. The age of menopause is also affected by passive smoking
2. Family history of early menopause
3. Ethnicity. Menopause occurs earlier in Japanese -American women and Hispanic women when compared to Caucasian women
4. Low body weight
5. Living in high altitudes
1. NN Ismael. A study of menopause in Malaysia. Maturitas 1994;19:205-09
2. Premitha D, P Nadkarni, ST Nathan, et al. Malaysian women with regards to menopause and hormone replacement therapy.Abstract.9th Malaysian Congress of Obstetrics & Gynaecology 1999;29