Natural menopause – the biology of female midlife
Biologically speaking, the term menopause means the time when a woman’s monthly periods end and she is no longer fertile. Menstruation stops because the woman’s ovaries no longer release eggs.
A baby girl is born with all the eggs in her ovaries that she will ever have. After puberty she releases an egg each month, and if the egg if not fertilised then it is lost during the monthly bleed or period (menstruation). Gradually as she get older and approaches her fifties, the store of eggs gets very low. Eventually the ovaries stop producing eggs altogether and the monthly bleeds end. The last day of the last menstrual bleed ever in a woman’s life, is natural menopause.
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How can I know if my menopause has happened?
It’s impossible for a woman to know that the last day of any particular period is the last bleed she will ever have. For this reason, doctors have agreed that the confirmation of menopause cannot be made until at least 12 months have passed since the last menstrual period.
If a healthy woman over forty years of age, goes 12 months without a period she can consider that she has passed her natural menopause.
Can my doctor do a blood test to confirm that I have had my menopause?
Contrary to popular belief, the answer to this question is NO. There is still no reliable clinical test (blood, urine or anything else) that can say for certain that menopause has occurred. Although blood tests can give an indication, these results can change from month to month so are not definitive. Confirming menopause has to be done in retrospect – looking backwards in time and seeing how long you have gone without any menstrual period.
What signs should I look out for if I think I may be close to menopause?
Before her final ever period, a woman usually experiences a phase in which her normal monthly cycle is disrupted: periods may be shorter or longer than normal and there may be longer or shorter gaps between them. Some women may experience hot flushes, vaginal dryness and possibly some disturbed sleep.
What happens to my hormones at menopause?
In a fertile, premenopausal woman, the female hormones oestrogen* and progesterone, are made in the ovaries. These hormones work together in a kind of cha-cha dance with hormones made in the brain. This is a very complex process but to put it simply, the brain hormones stimulate the ovaries to release an egg each month. In turn the ovarian hormones provide feedback signals during each month that tell the brain when to shut down the release of the stimulating hormones.
As menopause approaches, this hormone balance changes and there is a dramatic drop in the production of the hormones by the ovaries and an increase in stimulating hormones from the brain. After menopause very little oestrogen is made by the ovaries but some is made by fat tissue.
Falling levels of oestrogen are thought to play a role in causing the hot flushes and vaginal dryness that many women experience while their bodies adjust to a new, but equally delicate balance of hormones that will accompany them for the rest of their lives.
But even though lots and lots of scientific studies have tried to really understand what happens at menopause, it’s worth knowing that:
The exact relationship of menopausal hormonal changes to midlife discomforts is still not fully understood by scientists.
(*Note: Oestrogen is spelt with an O in British English and with an E - Estrogen in the USA and Canada.)
What do the terms perimenopause, pre-menopause and post-menopause mean?
You can read about these terms here: Perimenopause explained
What is the official definition of natural menopause?
Here is the definition of menopause given by the World Health Organisation:
"The term natural menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognized to have occurred after 12 consecutive months of amenorrhea, for which there is no other obvious pathological or physiological cause. Menopause occurs with the final menstrual period (FMP) which is known with certainty only in retrospect a year or more after the event. An adequate biological marker for the event does not exist."
World Health Organisation, 1996. (1)
Why do some people say menopause is the big midlife event that never happens?
Germaine Greer has argued that menopause is a non-event because the term refers to:
"the menstrual period that does not happen. It is the invisible Rubicon that a woman cannot know she is crossing until she has crossed it."
Germaine Greer, The Change. (2)
In other words, it's like a boat heading out to sea on a dark night and passing a series of lighthouses: after a while of not seeing a flashing light any more we look back and say "ah yes, that was the last one."
1. WHO Technical Report Series 866. Research on the menopause in the 1990s. World Health Organisation, Geneva 1996.
2. Greer G. The Change. Women, Aging and the Menopause. Hamish Hamilton Ltd. London 1991.
Published September 2012