Menopause - Background

Background

The menopause transition, and postmenopause itself, is a natural life change, not a disease state or a disorder. The transition itself has a variable degree of effects: it can be a difficult time of life.

Menopause is perhaps most easily understood as the opposite process to menarche, the start of the monthly periods. However, menopause in women cannot satisfactorily be defined simply as the permanent "stopping of the monthly periods", because in reality what is happening to the uterus is quite secondary to the process; it is what is happening to the ovaries that is the crucial factor.

As an illustration of the central role that the ovaries play, it is worth pointing out that when for medical reasons the uterus has to be surgically removed (hysterectomy) in a younger woman, her periods will of course cease permanently, and the woman will be incapable of pregnancy, but as long as at least one of her ovaries is still functioning, the woman will not have reached menopause. Even without the presence of the uterus, ovulation and the release of the sequence of reproductive hormones will continue to cycle on, until menopause is reached. In contrast to this, in circumstances where a woman's ovaries are removed (oophorectomy), even if the uterus were to be left intact, the woman will immediately be in "surgical menopause". Surgical menopause is a menopause which is induced both suddenly and totally, by removal of both ovaries prior to the age of natural menopause.

On average, assuming there has been no surgical intervention, the first evidence of the onset of the menopause transition time is slight variations in the length of the menstrual cycle. These variations become more pronounced over time, and eventually lead to cycles that can be considerably longer or considerably shorter than usual, flow that can be significantly lighter or heavier than usual, skipped ovulations, skipped periods, and spans of time of many months with no flow at all, after which menstruation may resume. The transition is considered to be over once a woman has experienced 12 months without any menstrual bleeding at all, even though perimenopause effects may extend well beyond this point in time. The term "perimenopause", which literally means "around the menopause", refers to the menopause transition years, a span of time both before and after the date of the final episode of flow.