Menopause

Abstract 

Menopause is a nonpathologic condition experienced by all menstruating women due to a deficiency and production suspension of reproductive hormones such as estrogen synthesised by the ovaries. It signals the end of the menstrual cycle and is formally diagnosed after at least 12 consecutive months of a cessation in vaginal bleeding, spotting and menstrual periods. This article aims to provide a comprehensive overview of the etiology and symptoms of the condition. Moreover , it seeks to explain the pathophysiology of menopause and describe the complications associated with it. Further objectives include presenting and elucidating the treatment options available.

Introduction 

Menopause is a nonpathologic condition experienced by all menstruating women due to a deficiency and production suspension of reproductive hormones such as estrogen synthesized by the ovaries. It signals the end of the menstrual cycle and is formally diagnosed after at least 12 consecutive months of a cessation in vaginal bleeding, spotting and menstrual periods[1]. 

The term was coined by French physician Charles-Marie de Dardanne in 1821 and is a combination of two Greek words: ‘mens’ for month and ‘pausis’ for cessation[2][1]. The oldest references to the condition can be traced back to Aristotle who declared 40 years of age the time when menopause occurs. Over the course of the 1930s, people categorised it as a deficiency disease in colloquial conversations and came up with a variety of concoctions to aid with it such as the crushed ovaries of animals and testicular juice. By the 1970s, the medicalisation of menopause had concluded and subsequently, the International Menopause Society was established. The first global congress on the subject matter was conducted in Paris in 1976, and therefore, it can certainly be argued that the ‘70s saw a massive development in the research done on menopause and the international institutions created for discussion on the topic[2].  

According to the World Health Organisation, most women typically experience menopause between the ages of 45 to 55 years as a natural stage in biological ageing; however, it can be a consequence of surgical procedures and may occur earlier than the above-mentioned ages[3].

Symptoms and Etiology 

A number of symptoms correspond with menopause but the most significant symptomatic features include the hot flush which often results in the individual experiencing insomnia and vaginal dryness. The reason why they are declared the most significant symptom is because they are the most distressing and appear among 70% of women . Such characteristics are directly related to decline in oestrogen levels[4]. 

Other physical manifestations include palpitations i.e. when heartbeats abruptly and unexpectedly become noticeable, headaches and migraines to degrees that are higher and more painful than normally experienced, muscle aches and joint pains, and the skin tends to get more drier and itchier. Moreover, recurrent urinary tract infections (UTIs) become more common, teeth sensitivity increases, and weight along with body shape tends to fluctuate. Mental health symptoms include elevated levels of anxiety, mood swings, and difficulty with concentration or memory, also referred to as brain fog[5]. 

The etiology is concerned with the causes of menopause. The number of ovarian follicles present within the ovaries decreases as age increases and the diminishing is attributed to ovulation and atresia. Granulosa cells of the ovary decrease and consequently, antimullerian hormone levels decline as well as that is the cell’s endocrine function. A decline in oestrogen levels also interferes with the hypothalamic-pituitary-ovarian axis which leads to a failure of endometrial development. This further results in irregular menstrual cycles and an eventual cessation in them completely[1]. 

Other non-natural causes include oophorectomy – a procedure involving the surgical removal of the ovaries. With them being removed, oestrogen and progesterone are no longer being produced and given the fact that these endocrinological agents are responsible for regulating the menstrual cycle, this surgery results in instant menopause. It is to be noted that hysterectomy does not result in this. Furthermore, radiation therapy aimed at the pelvis and lower spine can cause menopause as well[6].

Pathophysiology

Menopause is a normal physiological process in women which is as a result of the number of ovarian follicles decreasing. It reaches such low numbers that alone, in their inadequate amounts, they can not sufficiently respond to the effects of the FSH hormone released by the pituitary gland. Therefore, there is no surge in the luteinizing hormone and no ovulation taking place. Oestrogen production is hampered and this results in a termination of menstruation[1].

Menopausal transition includes a number of endocrine, physical, emotional and psychological changes which tend to be influenced by ethnic, social and cultural factors[7]. The physiological processes can be affected by diet, smoking, medical problems, exercise, social and economic background, ethnicity and general gynecological health[1][7].

Complications 

There are various complications associated with menopause from its adverse impact on an individual’s cardiovascular health to the likelihood of developing osteoporosis increasing. Premenopause, oestrogen levels assist in lowering the risk of heart disease including coronary heart disease (CHD) by decreasing the cholesterol deposition levels in the arteries. However, as a result of the hormone’s levels declining, cholesterol buildup in the coronary arteries increases, body fat accumulates increasingly in regions of the abdominal cavity and one may develop hypertension (high blood pressure). All of these increase the risk of developing cardiovascular disease[8]. 

Osteoporosis is a systemic skeletal disease where the bones become brittle and break easily. Deficiency in oestrogen levels – a characteristic feature of menopause – is associated with increasing risks of succumbing to osteoporosis. A reduction in the levels of the hormone in question results in weakened inhibition on osteoclastogenesis and osteoclast activity which increases osteoclastic resorption activity. Osteoblastic activity on the other hand decreases and with a greater amount of bone resorption as opposed to deposition, a net loss of bone is witnessed. Therefore, a link between menopause, decreased levels of estrogen and osteoporosis can be established[9].

Treatment 

The primary medicinal treatment for menopause is hormone replacement therapy (HRT). This replaces the hormones that are at diminished levels in the body. It includes using oestrogen in the form of skin patches, implants, tablets and a gel or spray applied on the skin to make up for the body’s deficiency during menopause. This is seen to have alleviated the distress and helped relieve hot flushes, brain fog, joint pains and vaginal dryness. Besides HRT, other medicines to help with hot flushes and night sweats include a blood pressure medicine named ‘Clonidine’. A general physician must be consulted to discuss the possible side effects of these medicines before usage [10].

Conclusion 

Menopause is a nonpathologic condition experienced by all menstruating women due to a deficiency and production suspension of reproductive hormones such as estrogen synthesized by the ovaries. A number of symptoms correspond with menopause but the most significant symptomatic features include the hot flush which often results in the individual experiencing insomnia and vaginal dryness. Menopause is a normal physiological process in women which is as a result of the number of ovarian follicles decreasing. There are various complications associated with menopause from its adverse impact on an individual’s cardiovascular health to the likelihood of developing osteoporosis increasing. The primary medicinal treatment for menopause is hormone replacement therapy (HRT). Existing literature however is still extremely limited and further research must be done to understand the condition better. 

Resources

1. Menopause - Kimberly Peacock; Karen Carlson; Kari M. Ketvertis- https://www.ncbi.nlm.nih.gov/books/NBK507826/ 

2. Singh A, Kaur S, Walia I. A historical perspective on menopause and menopausal age. Bull Indian Inst Hist Med Hyderabad. 2002 Jul-Dec;32(2):121-35. PMID: 15981376 - https://pubmed.ncbi.nlm.nih.gov/15981376/  

3. Menopause - Fact Sheet on the World Health Organisation’s Website - https://www.who.int/news-room/fact-sheets/detail/menopause 

4. Symptoms of the menopause- Deborah Bruce MD, MRCOG (Doctor), Janice Rymer MD, FRCOG, FRANZOG (Professor) - Department of Obstetrics and Gynaecology, St Thomas' Hospital, Lambeth Palace Road, London, UK - https://www.sciencedirect.com/science/article/abs/pii/S1521693408001387 

5. Symptoms - Menopause - NHS’s Website - https://www.nhs.uk/conditions/menopause/symptoms/

6. Menopause - Mayo Clinic - https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

7. Talaulikar V. Menopause transition: Physiology and symptoms. Best Pract Res Clin Obstet Gynaecol. 2022 May;81:3-7. doi: 10.1016/j.bpobgyn.2022.03.003. Epub 2022 Mar 16. PMID: 35382992. - https://pubmed.ncbi.nlm.nih.gov/35382992/ 

8. Understanding the Complications of Menopause - Medically reviewed by Stacy A. Henigsman, DO - Written by Deborah L. Nurmi, MS on March 20, 2025 - https://www.healthline.com/health/menopause/menopause-complications

9. Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015 Mar 21;1(1):9-13. doi: 10.1016/j.cdtm.2015.02.006. PMID: 29062981; PMCID: PMC5643776. - https://pmc.ncbi.nlm.nih.gov/articles/PMC5643776/

10. Menopause - Treatment - NHS Website - https://www.nhs.uk/conditions/menopause/treatment/