A woman suddenly realizes that her normal monthly flow has not occurred. Or the thought may not occur to her until she has actually missed more than one. If she is in the 45 plus age range, then she has either reached, or is on the verge of a time in life commonly referred to as the menopause.
Menstruation most commonly ceases about the age of 50. This is also popularly known as the change of life or climacteric. Happily, many women breeze through this particular event with perfect equanimity. Periods stop abruptly; there is little if any outward indication that marked and dynamic changes are occurring inside the body. Nervous stability remains normal, and life seems little different from the usual pattern.
But this is not always the case. Many other women are not so fortunately endowed. For them, the time is fraught with problems, and every day new hazards seem to occur and escalate.
It seems that about 50 percent of women sustain symptoms that are sufficiently distressing to warrant medical attention.
The problem of the menopause is a fairly recent phenomenon. The hard, cold facts are that in past ages, many women failed to reach these mature years that the majority now do.
In Roman days, average life expectancy was about 23 years. By the 14th century, it had risen to around 33 years. Even at the turn of this century, it was only 48 years. So, in those days, the problems of the change-of-life woman seldom occurred.
The reason why symptoms occur is that the ovaries, the small pelvic organs that have been active since the age of 10 – 16 years, producing hormones and eggs on a very regular basis, finally reduce operations.
Gradually the hormonal production winds down, until it finally stops completely. Similarly, the release of the egg each 28 days ceases.
The consequences of this reduction in activity are twofold. First, the chances of pregnancy reduce drastically. If there is no egg present, the chance of its becoming fertilized is nil. Also, no egg means no menstrual period, and these cease. But more dramatically the enormous reduction in circulating hormones also means that the chemical responsible for the general wellbeing and normal operation of the pelvic areas phases out.
Almost inevitably this leads to the production of a new set of symptoms.
Usually the most apparent symptom is cessation of regular menstruation. This may occur abruptly, but more likely it is a gradual process. A period is missed intermittently, or the time between successive periods may be longer than normal, until finally they cease.
We would emphasize again that if bleeding at this time is heavier than normal, then investigation by the doctor is often essential. It may be due to simple hormonal withdrawal from the system. But in this special at-risk age group, uterine cancer must always be considered with bleeding irregularities, particularly heavy bleeding, or bleeding after total cessation of menstruation.
Another very common symptom is the appearance of hot flushes. These may be mild and transient, or they may be marked and distressing. Often they commence in the face. From here they may spread to the neck, shoulders and probably the chest area. The upper part of the body is usually affected most markedly. There may also be a suffocating sensation and the patient may fan herself and gasp for more air. In some, profuse sweating may occur.
The body appearance tends to alter. The breasts may become larger, due to an increase in their content of fat. But in some women the reverse takes place, and the breasts tend to become smaller, less attractive, pendulous and weary-looking. Many women tend to become plump, as fat is deposited on the usual places, usually where it is desired least of all—the midriff, buttocks, thighs and upper arms. This is often associated with a reduction in the desire for activity and exercise.