General bodily and emotional changes occur at the time of the menopause but are not necessarily caused by it or related to it. Cessation of menstruation is therefore only one aspect of the menopause.
The average age for cessation of the menstrual flow is around forty-nine years, though this varies widely among women, depending on hereditary endowment, general health conditions, and variations in climate. There is some evidence, though far from conclusive at the present time, that smoking, especially when excessive, brings on an earlier onset of the menopause.
Early puberty usually means late menopause, and vice versa. Loss of the childbearing function is not an overnight phenomenon, any more than the development of this function at puberty is. It takes several years for the reproductive apparatus to cease its normal functioning, the rate depending on the rate of decline of ovarian functioning. The menopause is regarded as officially over when there has been no menstruation for a year.
During the period when the endocrine interactional system is becoming adjusted to lessened ovarian functioning, certain physical symptoms normally occur. These are the result of the estrogen deprivation which comes from the decline in the functioning of the ovaries. In addition, other symptoms are due partly to estrogen deprivation but are mainly the result of environmental stress and thus are psychological characteristics of the menopausal syndrome are given below:
The Menopausal Syndrome
Cessation of Menstruation
The woman may experience a sudden cessation of menstruation; regular periods with gradual diminution of the menstrual flow; increased irregularity, with the periods coming further and further apart; or shorter cycles with profuse flow.
Generalized Atrophy of the Reproductive System
There is a generalized atrophy of the genital tract, with the result that, neither mature ova nor the ovarian hormones, estrogen and progestin, are produced.
Decline in Feminine Appearance
As production of the ovarian hormones diminishes, the typically feminine secondary sex characteristics become less pronounced. Facial hair becomes coarser, the voice deepens, the curves of the body flatten out, the breasts appear flabby, and pubic and axillary hair become scantier.
Physical Discomforts
The most common physical discomforts experienced during the menopause are flushed, involving the head, neck, and upper thorax; sweating that accompanies or immediately follows the flush; hot flashes, typified by tingling over the entire body; headaches; fatigue; nervousness and irritability; heart palpitations; restlessness; and frigidity.
Weight Gain
Just as many pubescent children go through a “fat” period, many women gain weight during the menopause. Like the fat acquired during puberty, it is concentrated mainly around the abdomen and hips, making the woman seem heavier than she actually is.
Knobbiness
The joints, especially those of the fingers, often become painful with the decline in ovarian functioning. This causes them to become thickened, or “knobby.”
Personality Changes
Many women experience personality changes during the menopause. They become depressed, hostile, and self-critical and have wide mood swings. With the restoration of endocrine balance as the menopause ends, these changes normally disappear.
For a number of years, doctors have used estrogen replacement therapy to slow down the menopausal changes and to ward off the physical discomforts that often accompany these changes. However, recent medical reports of the higher incidence of uterine cancer in women who have received estrogen replacement therapy than in the general population have made many doctors stop using it and have caused many women to wonder if menopausal discomforts and telltale signs of aging are not less serious than the risks of developing uterine cancer.
