All About Menopause

What is Menopause?

Menopause is a definite time in the woman’s life when her periods stop. She is considered to be in the menopause when she has not had a period for 1 whole year.
Menopause happens when the ovarian follicles stop producing estrogen and progesterone, the two main hormones for a woman.

 

What is the average age of menopause?

The average of menopause around the world is 51 years. In Malaysia, the average age of menopause has been found to be around 50.7 years.

Menopause in Malaysia

In 2021, the average life expectancy of a Malaysian woman was 78.3 years. As the average age of menopause in Malaysia is 50.7 years, one third or more of her life is now going to be spent in the post-menopause, a state of estrogen deficiency.

In 2000, a study from an urban menopause clinic in Malaysia showed that hot flushes (56%) and generalized tiredness (49%) were the predominant symptoms in urban menopausal women. More recently, a similar study in a similar urban setting found joint pains (73%) and fatigue (59.3%) to be most prevalent followed by vasomotor symptoms (55%). Malaysian women were also found to underestimate menopause-related problems and there was a lack in seeking treatment

Stages of menopause

The common terminologies used to describe the stages of the menopause are:

1. Menopausal Transition or the Perimenopause
   This is the time before the menopause when the body starts going through changes. During this time, a woman may experience irregular periods, hot flushes, night sweats, tiredness, sleep disturbances mood swings and brain fog. The full range of symptoms are described below. These changes may start 5-7 years before menopause.A woman is in the perimenopause till one year after her last period. She is then in her menopause.
2. Menopause
   A woman is considered in the menopause when she has not had her periods for one full year.
3. Postmenopause
   The period of time from the last menstrual period till the end of her lifespan.
4. Premature Ovarian Insufficiency (POI) is when menopause occurs before the age of 40 years. This may happen naturally, surgically (when both the ovaries are removed) or induced (chemotherapy or radiotherapy for malignancies). There may also be other factors that can cause POI (refer to POI).
5. Early Menopause is when menopause occurs between 40 to 44 years of age.
6. Late menopause is when menses goes on beyond the age of 55 years. Women who menopause late may have an increased risk of breast and uterine problems.
7. Surgical menopause is when both ovaries are removed by surgery before menopause. Symptoms of surgical menopause can be abrupt and more severe.

The Straw +10 Classification

 

What are the hormones involved?

Women are born with all their follicles at birth and do not develop any more as they get older. These follicles are the source of estrogen and progesterone which are active mainly during her reproductive years. These 2 hormones, estrogen and progesterone are vital in controlling the menstrual cycle and fertility issues. Estrogen is also vital in maintaining various organs in the woman including the brain, skin, heart, and bone.

During the menopause, these follicles release less estrogen and progesterone and this is the beginning of menopausal symptoms and changes. When the follicles cease functioning completely, periods stop.

Two other hormones, follicular stimulating hormone (FSH) and luteinizing hormone (LH) are the controllers of estrogen and progesterone. When estrogen and progesterone levels drop, there is loss of control of FSH and LH and these 2 hormone levels start rising. A rising FSH level is the first indicator of impending menopause.

Factors that affect the age of menopause are:

1. Current and past history of cigarette smoking. Smoking makes menopause earlier by 2 years. The age of menopause is also affected by passive smoking.
2. Family history of early menopause.
3. Ethnicity. Menopause occurs earlier in Japanese -American women and Hispanic women when compared to Caucasian women.
4. Low body weight.
5. Surgery on both the ovaries before menopause.
6. Cancer treatment – which include surgery, chemotherapy or radiotherapy.
7. Living in high altitudes.
8. Vegetarianism.
9. Malnourishment in women.