As a facilitator in health talks in churches and social organisation, I have found that most questions asked centred on middle age challenges. The most commonly asked are on arthritis, diabetes, hypertension and menopause. I had promised on various occasions that I would populate my column with menopause on a convenient time and inform them. That promise is what I intend to keep today.
Diagnosis wants to make it clear that menopause is by no means a disorder or disease condition. It is part of the aging process and naturally occurs in women from late 40s to early 50s. In our environment, about the seventies of last century the average menopausal ages were between 38 and 42 years. This has changed a great deal and we are beginning to see menopause in older ages. MENOPAUSE by definition is the cessation of a woman’s ability to have babies. It is not a sudden occurrence but series of events over of a couple of years that is as a result of chronological or biological aging. It is common place to define menopause by the state of the womb (UTERUS) and the absence of periods or menstrual flow.
The reality is that this actually is the permanent cessation of the primary functions of the OVARIES. The ovary is the organ where potential eggs to be fertilized ripen and are released. The ovary after the release of eggs also continues its job as hormone producing organ or an ENDOCRINE GLAND. The hormones that the ovaries produce during the active reproductive years are OESTRADIOL/OESTROGEN, TESTOSTERONE, and POGESTERONE in a cyclical pattern under the control of FOLLICLE STIMULATING and LUTEINISING hormones, which are in turn produced by the PITUITARY gland. This is a small peanut shaped structure situated under the front lobe of the brain. For reminders, hormones are biochemical substances that are produced in one organ but have their physiological effects in another distant organ.
The main function of oestrogen and progesterone is the increased proliferation of cells and blood vessels in the inner lining of the womb known as the ENDOMETRIUM in readiness for the implantation of fertilized egg. It is when there is no fertilization that this lining is shed off as menstrual flow and the cycle is commenced again.
The DNA (deoxyribonucleic acid) is the genetic material that powers reproduction and expression of individual characteristics. During reproduction the DNA undergoes what is known as reduction division or MEIOSIS. That is why each egg or spermatozoa in completion of the process 23 genetic material each instead of 46 which is compatible with life. This process is enhanced by an enzyme repair system known as HOMOLOGOUS RECOMBINANT REPAIR. This basically involves putting together broken parts of the DNA molecule into single strands. This whole process is powered by four GENES in the body. During menopause there is age related decline in this process leading to depletion off eggs (OOCYTES) in the ovary.
This is what leads to the manifestation of certain effects and signs that are related to the derangement and fluctuations of reproductive hormones in the body especially Oestrogen (Oestradiol) and Progesterone. This would include the inability of the body to regulate body temperature, which in some clime is described as HOT FLUSHES but in our environment what you often hear of women complaining of internal heat, which is a misnomer. Night sweats and mood changes are very common features in menopause. Before we proceed to extensively mention some of the other signs of menopause, it is necessary to explain some of the terms used in describing this natural event.
These are PREMENOPAUSE, PERIMENOPAUSE and POSTMENOPAUSE. In reality these entities have a way of having very thin lines separating them and most of the time it is easy to just simply say menopause. Starting with menopause, this is defined as complete cessation of menstruation for a period not less than 12 months from the last menstrual flow. The pre (before) menopausal period refers to the years leading to the last MENSES. During this period the depletion of oocytes has started and the levels of reproductive hormones have become erratic and low with the effects of hormonal withdrawal manifesting. This period takes some time before the monthly period becomes noticeably unpredictable.
PERIMENOPAUSAL is often referred to the period of time around menopause peri being derived from the word periphery. This is usually regarded as the time interval between both before and after the date of the final flow. This, in this case, is the commencement of menopause proper. This is determined retrospectively by counting back at least 12 months. During this period there is a slight increase in the blood level of OESTROGEN with an accompanying wide fluctuation. This fluctuation leads to many physical changes noticed like vaginal dryness or atrophy, inability to hold urine or incontinence, bone demineralisation or osteoporosis and heart challenges. The ability to achieve conception is greatly reduced but not zero.
Around this time a lot of women tend to be very distracted. This also tends to coincide with many life events like children leaving home, caring for the elderly and bedridden and death of aged parents. A sense of loss with respect to fertility, especially if one is still childless tends to worsen the psychological burden and cause sleepless nights. POSTMENOPAUSE is used to describe women who have not experienced menstrual flow for at least 12 months. This is applicable if the woman still has her uterus intact, not pregnant and not breastfeeding! In reality post menopause is the period in life when the ovaries stop functioning till the end of life.
It is not surprising that the differentiation of these phases of menopause is strictly for academic purposes. Most people are not interested in distinguishing them but would rather be bothered about the physical and psychological impacts of this aging process. They would rather refer to the whole gamut of experience as menopause. In our environment the most disturbing realization is the gradual loss of reproductive potential. In one of my outings a woman once asked me: “What do we tell our husbands when this time comes?” I simply told her to tell him that time is gone and that another time has come. And besides men also have their menopause. It is known as ANDROPAUSE.