What actually causes menopause?

Women experience menopause in very different ways, with some barely noticing its arrival and others feeling as though the rug’s been pulled from under them.

So what actually causes menopause? In perimenopause, the time shortly before you approach the big event, hormone levels dip and rise more dramatically. “Our ovaries start getting fed up of producing an egg every month – they’ve been at it since puberty,” says Dr Mukherjee, consultant endocrinologist at Spire Manchester Hospital. “And our oestrogen levels drop and drop.”

What actually causes menopause?

Most women experience some symptoms – hot flushes, heavy or irregular periods, deep tiredness, disrupted sleep, mood swings – from their late forties. The average onset of full-blown menopause is at 51, according to Dr Mukherjee.

The pituitary gland in our brain compensates for falling levels of oestrogen. “It produces hormones which try to make our ovaries work harder. Every now and then women experience a surge of oestrogen because of this.” The side effects of oestrogen overload can be challenging.

“That’s why you get mood swings, which can feel horrendous.” There is no fixed time either – some women might be menopausal for years; for others it comes and goes virtually overnight.

But the menopause can be managed, says Dr Mukherjee, and while up to 20 per cent of women use hormone replacement therapy (HRT), which replaces low levels of hormones around menopause, there are lifestyle changes that might be as effective.

 “I used to be a real party girl,” says teacher Vicky Horner, who is trying to approach her menopause as an interested observer. “Now I rarely drink, I eat more vegetables, and I say no – I take time out for myself. I feel it’s about nourishing yourself and living more gently. If I get headaches or feel tired, I try to feel I’m in transition. I think: ‘This is interesting.’”

While she misses the feeling of walking down the street and turning heads, she knows a new phase of life could be liberating. “I have a friend who said she felt as if she had flu for years, but now feels amazing.”

Consultant gynaecologist Eddie Morris says women should ask for more help. A new BMS survey* shows half of women going through menopause do not talk to healthcare professionals.

“Unfortunately the vast majority of women have been trying to cope on their own, but if you can address what’s bothering you. There might be something simple that would change it.”

So vaginal hormonal creams might help any discomfort during sex, for instance. “Or if a woman’s concerned about osteoporosis – perhaps she’s seen her mother suffer – we could offer a bone scan and talk about supplements.”

Sleep is another casualty of this time of life, and disturbed nights can have a hefty knock-on effect on work and relationships. “It might be hot flushes which stop you getting that lovely deep sleep which leaves you feeling refreshed,” says Morris.

But solutions are out there. Some companies even offer double duvets that are thin on one side and thicker on the other, to cater for a chilly partner. And some methods of contraception can help control irregular or heavy periods.

Your skin might feel drier and your hair might feel thinner too, “though some women do say their hair feels nicer”, says Morris, and there are hair products available to help hair feel thicker and healthier.

There is good news for women who feel they have entered what Morris calls the “Post-it note” zone, where they cannot remember anything without a prompt.

“As you enter the menopause, there are changes in the way you store things in your memory. But once you get through that perimenopause and hormones become more stable, your brain function starts to improve again.”

The ‘me’ in menopause

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