Our knowledge of menstruation and menopause did not really begin to take shape until the early 20th century. Prior to this, it was thought that ovulation and menstruation were the same thing.
A case study from the late eighteenth century documented a woman who had her last child at 60, at which point her periods stopped. They then started again at the age of 75 and continued until she was 98. They then started again at the age of 104, at which point documentation ceased, possibly because she had outlived her doctor!
The menopause usually occurs between the age of 45 and 54, with the average age of onset being 51. Women who smoke can expect an earlier menopause. Family history can also give some indication as to when you might experience it.
What is the menopause?
The medical profession defines the menopause as 'cessation of periods', its literal translation. It is often heard of women 'going through' the menopause, but it is more accurate to say that a woman 'reaches' the menopause.
The menopause is one point in time, which occurs with the final menstrual period. The time surrounding this point plus the changes that happen to a woman approaching it and the year following the menopause are called the 'perimenopause'.
More specifically, the time prior to the final period, when variability within the cycle is at its greatest, is known as the menstrual transition.
The normal reproductive life of a woman before she reaches this stage is known as 'premenopause', and the years following the menopause, after the initial year, which is encompassed by the term perimenopause, are known as postmenopause.
The Council of Affiliated Menopause Societies (CAMS) defines natural menopause as "the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhea [absence of menstrual periods] for which there is no other obvious pathologic or physiologic cause. Menopause occurs with the final menstrual period, which is known with certainty only in retrospect a year or more after the event."
For many women, the end of fertility, and therefore of the need to worry about contraception, menstruation, pregnancy, etc. brings with it a sense of freedom. It is often viewed as a time when women feel more confident, energised, and positive than in earlier life.
For others, children leaving home, elderly parents and changes in work and personal circumstances can bring additional pressures and emotional turmoil, which may be exacerbated by the physical and psychological manifestations of perimenopause.
How does it affect you?
Although average life expectancy has increased considerably over the past few centuries, the age of menopause has remained fairly constant, currently averaging at 51.4 years in the western world. Most women therefore live between a third and a half of their lives after they have reached the menopause.
By this time, children have usually reached adulthood and lifestyles may have changed. This is therefore often seen by women as an ideal time to concentrate on their own health and well-being. Many of the signs of ageing, such as loss of bone and muscle mass, strength and agility, can be delayed or avoided entirely by adopting an active lifestyle at this time.
A recent study revealed that Japanese women suffered fewer severe symptoms during perimenopause than their western counterparts, as well as having significantly better long-term health in the years following.
It is not known why this particular group showed such differences, but diet is thought to be a strong factor. Many western women incorporate Japanese foods, such as yams and soy, into their diet in the hope that this will ease symptoms.
Male menopause
Men too will experience a menopause - known as andropause. It is similar in some ways to the female in that is it characterised by a decrease in sex hormones: in men's case, testosterone. Such levels begin to decline from the age of 40. This can manifest itself in a number of ways, mostly sexual in nature; for example, erection and ejaculation become more delayed. Other symptoms can be surprisingly similar to those experienced by women, e.g. loss of bone and muscle mass, depression, irritability, and even hot flushes.
Little is known about the reasons for the male menopause, but it is usually seen as the 'end of the first adulthood', after which the most noticeable difference is usually an alteration in sexual attitude.
A changing life
The menopause is not an illness but a natural biological event that can play a major part in some serious health problems, many of which are more common in middle age, such as osteoporosis, heart disease and stroke. There are many elements that contribute to the development of such illnesses, but the biological events occurring around the time of the menopause can put some women at higher risk.
As well as being a risk factor for other illnesses, menopause (or, strictly speaking, perimenopause) often brings with it a set of symptoms of its own.
For most women the cessation of periods is just one of a number of aspects of reaching the menopause. It can be the only thing that two perimenopausal women have in common, since other symptoms can vary enormously, from sleep disturbance to itchy skin.
The hormonal disruptions which are one of the primary characteristics of perimenopause and are the cause of most physical symptoms can also result in emotional difficulties such as anxiety, depression, and erratic moods. In previous years, it was particularly difficult for women to cope with these types of changes, and information was hard to come by due to the taboo nature of the subject.
Recently, reproductive health has become a more openly discussed part of life, and nowadays there is a wealth of information and help available. In fact, many women consider the menopause to be the beginning of a new and fulfilling stage in their lives.
Written by Claire Jackson.
20/05/2009