By Dr Anita Sturnham, GP
An internationally renowned doctor specialising in dermatology and anti-ageing medicine.
Menopause is a natural stage of life that all women will go through. Many women are left to navigate this transitionary period alone and can often feel overwhelmed and unsupported. Menopause marks the time where the ovaries stop releasing eggs each month and periods stop, meaning that women are no longer able to conceive. The average age that this occurs is 51 years but there is a period leading up to menopause called ‘perimenopause’ where women start to notice the impact of declining hormones on their mental and physical wellbeing. This can start up to ten years before menopause. With improvements in average life expectancy, women can expect to live a third of their life after menopause. Menopause can occur earlier as a result of surgery to the ovaries or as a result of illness or genetic factors. In these cases, it can be called induced menopause, surgical menopause, or primary ovarian insufficiency, depending on the cause.
The support services to guide women through this transition are often very limited. According to a study published by the British Menopause Society, 50% of women aged 45-65 years, will go through menopause without consulting a medical professional and 50% also reported that menopause negatively impacted on their life. These findings reveal a huge need for support and education to help women to navigate their menopause journey.
During the perimenopause transitionary stage, the ovaries, which are the powerhouses that make our sex hormones, start to slow down their function. The rate of ovulation declines and the cells that line the follicles gradually produce less hormones, such as oestrogen, until they eventually stop completely, when we run out of follicles.
During perimenopause women often see a more chaotic picture when it comes to their menstrual cycles. Most women are used to having a regular cycle which consists of a follicular phase, where we see a gradual increase in Oestrogen levels during the first 14-16 days of the cycle and then an increase in another hormone called Progesterone on days 16-28 in the luteal phase, which is the stage post ovulation. If a pregnancy is not conceived this will result in a period, or menstrual bleed, at the end of the luteal phase. The average cycle length is around 28 days but in perimenopause you may have a cycle lasting 14 days one month and 60 days the next. Things become very unpredictable.
As well as the fluctuating hormones causing irregular periods many women also experience other signs such as mood changes, loss of libido, low energy, dry skin, breakouts, sleep disturbance, memory loss, hot flashes and fatigue. These signs are related to declining hormone levels, particularly Oestrogen.
Oestrogen is our dominant female sex hormone and plays an important role in pretty much every organ in the body. For example, we have receptors for oestrogen in our brain, digestive system, cardiovascular system, bones and skin. Declining hormone levels can therefore impact all of these bodily systems. During perimenopause, the production of oestrogen falls until menopause has occurred.
After menopause, our oestrogen levels do not go down to zero but we do have much smaller amounts of it in the body. We can still produce a type of oestrogen called estrone, a less potent form of oestrogen that is converted in the fatty tissue in our bodies by a process called aromatisation. We can also convert some of our androgen hormones such as Testosterone to Estrone too. Many women gain weight in this period of their life, and it is thought that one of the reasons this happens is the body’s protective way of making more of its own Oestrogen in the fatty tissue. Perimenopausal and menopausal women are also more prone to Insulin resistance, meaning that they do not metabolise their sugar well and this also adds to the weight gain.