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    The meaning of the word menopause is ‘the last menstrual period’; however, the word is often used for other terms such as the description of hot flushes.

    It is estimated that 95% of women live long enough to pass through the menopause, with the mean age of the menopause being 50 years plus or minus 1.5 years, and the range of the start of the menopause being from 35 to 60 years. Upon approaching the menopause a woman will undergo changes in the menstruation cycle; these changes include variation in quantity, regularity, frequency and quality of the menses. This goes on for approximately six months after this time when amenorrhoea occurs, at this stage only one in six women will carry on menstruating.

    There is an increase in gonadotrophins at the time of the menopause, with follicle stimulating hormone increasing whilst luteinizing hormone levels remain stable; this leads to an increase in the follicle stimulating hormone: luteinizing hormone ratio. The ovaries fail to respond to the increasing ratio and a resulting fall in the level of circulating oestrogens occurs. The change from ovary function to turning off is a gradual one, with there being a noticeable reduction in the size of the ovaries and a reduction in the number of oocytes and follicles; these are replaced by ovarian stroma. In addition to this a regression of any follicles that do develop occurs.

    When a woman is in her reproductive years ninety percent of oestrogens are synthesized in the ovary, with the principle circulating form being oestradiol; the other oestrogens are produced in the adrenal gland. Following the menopause oestrone becomes the dominant oestrogen; these post-menstrual hormones are mainly produced by the adrenal gland as there is a loss of their production in the ovary. The ability of the body to convert androstenedione increases both with an increase in age and in obese people; this is because the conversion of androstenedione principally occurs in fat tissue.

    The changes in hormone level have a significant effect upon a women's bones and contribute greatly to bone loss and the liklyhood of experiencing osteopenia or osteoporosis.

    Changes that occur during the menopause

    There are many consequences of the change in hormonal levels that occur at the menopause.

    Reproductive system changes. The vagina and uterus becomes smaller during the menopause. There is an associated decrease in secretion of fluids and an increase in susceptibility to infections.

    Somatic changes. These include a thinning of the skin, an increase in bodily hair (due to increased androgens), increased risk of heart disease (due to an increase in cholesterol levels) and an increased risk of chronic diseases.

    Perimenopausal symptoms. These include an increase in hot flushes (usually affecting the face and neck, but can occur all over the body), these typically last for about four minutes and sufferers may experience more than 100 of these per week, it is thought that around 75% of menopausal women suffer from this condition yet the majority never consult a doctor about it, meaning that as few as ten percent of women receive treatment for it. The perimenopause is also connected with insomnia, depression, mood swings and loss of sexual energy.