The Menopause Transition

What does the term ‘menopause’ mean? The term ‘menopause’ refers to the last spontaneous menstrual period in a woman’s life. It is determined if the woman has not undergone surgical removal of the womb (hysterectomy) and is not receiving any hormone therapy that affects the menstrual cycle. Then, the last menstrual period can only be determined retrospectively: the menopause is, by definition, considered to be confirmed when no menstrual bleeding has occurred for a period of at least 12 months in a row.

At what age does the menopause usually begin? On average, the menopause begins in women between the ages of 51 and 52. However, the timing can vary considerably from person to person. Around 1 per cent of women reach the menopause before the age of 40; in approximately 1 in 1,000 women, it even begins before the age of 30. On the other hand, a small proportion of women do not experience the menopause until after the age of 60. In addition to genetic factors, smoking, diabetes, and chronic illnesses in particular can influence the onset of the menopause and may be associated with an earlier start. Family history also plays a role.

What are the reasons for the menopause to occur? Oestrogens, in particular oestradiol, are predominantly produced in the ovarian follicles of women of reproductive age. The level of oestradiol in the blood is subject to considerable fluctuations linked to the menstrual cycle. During menstruation, oestradiol levels in young women are around 25 pg/ml and can reach values of up to 400 pg/ml around the time of ovulation.

With increasing age, the number, and functionality of the follicles in the ovaries steadily decline. When the ovarian follicular reserve is almost depleted, oestrogen production significantly decreases. As a consequence, the hormonal feedback loops between the ovaries, the pituitary gland and the hypothalamus change, ultimately leading to the permanent cessation of menstruation and thus to the onset of the menopause.

Even after the menopause, the ovaries continue to produce small amounts of androgens. They can be converted into oestrogens – primarily oestrone. The ovaries are therefore not completely hormonally inactive after the menopause, but their hormonal function changes significantly. Oestradiol levels after the menopause often remain below 10–20 pg/ml.

What are the stages of the menopause? Pre-menopause often begins between the ages of 40 and 45, though sometimes as early as around 30 years, and is characterized by increasing hormonal changes. Progesterone production decreases, ovulation becomes less frequent, and fertility declines. At the same time, fluctuations in oestrogen levels can lead to irregular periods, changes in the heaviness of bleeding, and breakthrough bleeding or missed periods. Pregnancy is still possible, so contraception remains a consideration.

Perimenopause refers to the actual transitional phase and covers the period of 1 to 2 years before and approximately 1 year after the final menstrual period. It is characterized by significant fluctuations and a gradual decline in oestrogen and progesterone levels, as well as increasingly infrequent ovulation. Typical symptoms may include hot flushes, sleep and menstrual cycle disturbances, mood swings, difficulty concentrating, and vaginal dryness. A loss of energy and fatigue, as well as palpitations, irregular heartbeat or changes in blood pressure, may also occur. Pregnancy is still possible.

Menopause refers to the last menstrual period and is diagnosed retrospectively once twelve months have passed without any further bleeding. However, hormonal changes and symptoms often persist beyond the menopause.

Postmenopause begins after the menopause and is characterized by persistently low levels of ovarian hormone production. Menopausal symptoms may persist initially, but should gradually subside. Prevention and management of risks to bone health, the cardiovascular system and metabolism become increasingly important.

Which hormones are involved? Oestrogens influence numerous bodily functions, including the menstrual cycle, bones, skin, mucous membranes, the cardiovascular system, and mood. During the menopause, oestrogen levels decline, which can contribute to the symptoms mentioned above.

Progesterone is produced in the corpus luteum of the ovary after ovulation and prepares the lining of the womb for a possible pregnancy. During the pre-menopausal period, progesterone production gradually decreases, which can lead to irregular cycles and bleeding.

FSH (follicle-stimulating hormone) and LH (luteinising hormone) regulate the female cycle and are produced in the pituitary gland. As ovarian function declines, their levels tend to rise.

The sleep hormone melatonin and the hormone testosterone also undergo changes in women during this stage of life and can influence or trigger symptoms.

Why do menopausal symptoms occur? During post-menopause, it is primarily the falling oestrogen level that is linked to the symptoms. In perimenopause, even if menstruation is still (irregularly) occurring, fluctuations in oestrogen levels can cause symptoms. As ovarian function declines, the levels of the regulating hormones FSH and LH rise. The initially fluctuating response of the ovaries can lead to significant fluctuations in oestrogen levels, which can contribute to symptoms such as breast tenderness, hot flushes, and night sweats.

Around 8 in 10 women experience symptoms during the menopause, particularly hot flushes and night sweats. For around one third of them, the symptoms are more severe and can significantly impair their quality of life. Symptoms include, sleep disturbances, joint pain, dry mucous membranes, mood swings, palpitations, and tiredness. These symptoms last for an average of around 7.4 years. However, the duration varies considerably: women who experience hot flushes whilst still having periods tend to have a longer average duration of symptoms (around 11.8 years) than those whose first hot flushes do not occur until after the menopause; the latter group typically experience problems for only 3–4 years on average.

In conclusion, menopause is a natural process that requires personalised, evidence-based support.

EXERCISE:

1. All of the following hormones are involved during menopause: Oestrogens, Progesterone, Androgens, and LH. A. True B. False

2. Perimenopause means all phases included menopause. A. True B. False

3. The term ‘menopause’ refers to the last spontaneous menstrual period in a woman’s life. A. True B. False

You’ll find the answer below.

BIBLIOGRAPHY 1. www.ardalpha.de 2. www.ardmediathek.de 3. www.dak.de 4. www.dict.cc 5. www.frauenaerzte-im-netz.de 6. www.menopause-zentrum.com 7. www.msdmanuals.com 8. www.usz.ch 9. www.webster-dictionary.org

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTL. 1998 gründete sie lobitz seminare in Berlin, die Englischseminare für Health Professionals anbieten. Kontakt: mail@lobitz-seminare.de www.lobitz-seminare.de

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Lösung für Exercise:

1. B

2. B

3. A

The Menopause Transition

What does the term ‘menopause’ mean?

At what age does the menopause usually begin?

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The Menopause Transition

What does the term ‘menopause’ mean?

At what age does the menopause usually begin?

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