The term menopause refers to a woman’s final menstrual period but is often (incorrectly) used as a synonym for the climacteric. These terms refer to the period in which the woman’s estrogen production begins to wane, culminating in the cessation of menstruation, usually between the ages of 40 and 58, with the average age at about 51 (North American Menopause Society, 2003). Smoking, being separated/widowed/divorced, nonemployment, lower educational attainment, and a history of heart disease have all been found to be related to an earlier onset of menopause (Brett & Cooper, 2003; Whiteman et al., 2003).
As women age, their ovaries become less responsive to hormonal stimulation from the anterior pituitary, resulting in decreased hormone production. The first sign of the climacteric is often a menstrual cycle that does not include ovulation, followed by irregular cycles. Amenorrhea may occur for 2 or 3 months, followed by a menstrual flow. In most cases, menstruation does not stop suddenly.
Diminishing estrogen production also results in atrophy of the primary sexual glands. The clitoris and labia become smaller, and degenerative changes occur in the vaginal wall. At the same time, the ovaries and uterus also begin to shrink. Estrogen reduction can also cause changes in the secondary sex characteristics, including pubic hair loss, thinning of head hair, growth of hair on the upper lip and chin, drooping of the breasts and wrinkling of skin due to loss of elasticity, and osteoporosis (ah-stee-oh-po- ROW-sus), resulting in brittle bones.
Decreasing levels of estrogen accelerate bone loss during menopause. It is estimated that 70% of women over the age of 80 will have osteoporosis (Stanford, 2002). Incidentally, “osteopenia” (a thinning of the bones) also can occur in younger women and is a precursor to osteoporosis. If you smoke, use Depo Provera, have an eating disorder or a family history of osteoporosis, you might ask your doctor for a bone-density test. Today, women in their 20s and 30s are advised to get at least 1,000 milligrams of calcium each day and to engage in frequent exercise to maintain bone strength (Lloyd et al., 2004; Manson, 2004).
Many women go through menopause with few problems and find menopause to be a liberating time, signaling the end of their childbearing years and a newfound freedom from contraception. In some women, however, the hormonal fluctuations can cause hot flashes, headaches, and insomnia. Sexual complaints include a change in levels of sexual desire, decreased frequency of sexual activity, painful intercourse, and diminished sexual responsiveness; sometimes this is associated with dysfunction in the male partner as well (Sarrel, 1990). The most prevalent psychosexual problems of older women are not these classic complaints but rather the lack of tenderness and sexual contact with a partner (von Sydow, 2000). In fact, for many menopausal women, life satisfaction is
more closely related to relationship with a partner, stress, and lifestyle than menopause status, hormone levels, or hormone replacement therapy (Dennerstein et al., 2000).
Certain surgeries, such as removal of the ovaries, can result in a surgically induced menopause because of estrogen deprivation. For this reason, surgeons try to leave at least one ovary in premenopausal women to allow these women to enter menopause naturally.