What is the menopause?

From who's affected to what's causing it...
21 September 2021

Interview with 

Imogen Shaw; Dorothy Byrne, Murray Edwards College Cambridge

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We’re going to take a look at something that affects one in every two people on the planet but almost always never gets mentioned in school sex ed - the menopause. First Dorothy Byrne, President of Murray Edwards College, Cambridge, talks us through her experience, then Chris Smith talks to GP Imogen Shaw about what exactly is happening during the menopause...

Imogen - It tends to be between 45 to 55, 80% of women will have some kind of symptoms: flushes, that feeling of rising heat, night sweats, and most women also notice a sleep disturbance. Even if they don't wake hot at night, their sleep pattern changes. Then there's the more psychological symptoms that are not always so commonly known about, the sort of increased anxiety that women feel: general low mood or mood swings, from irritable to tearful. There's the increase in headaches in some women. And then there's the sort of physical changes that women notice: hair loss, skin, and hair drying. A very common complaint is this increased midriff weight gain. The other symptom which is very common, and I think underdiagnosed and undertreated, is genital urinary symptoms: vaginal dryness, pain with intercourse, increased urinary tract infections, overactive irritable bladder with this increased frequency of needing to pass urine. Those are the sort of the main spectrum of symptoms that women notice either all or some of.

Chris - Those are quite common and general symptoms and complaints anyway. So how would a woman disentangle it happening - because she's going into the menopause from it's just one of those things? Is it the frequency with which these things happen?

Imogen - Yes, and the pattern of symptoms because there's no diagnostic test for the menopause. And in fact, we discourage doctors from checking hormone levels because they fluctuate so radically that the levels are inaccurate. So it's a clinical diagnosis, but it's diagnosed on a pattern of those symptoms. But yes, I agree there are common symptoms, but they get worse and more persistent and more intrusive.

Chris - What's actually going on inside a woman though to make her have, or experience, these symptoms?

Imogen - Throughout our adult life the ovaries produce eggs, which then are released once a month and will then go on to produce a period if they're not fertilised. The ovaries have a finite number of eggs, which are determined at birth and are used up throughout our lifespan. And we then tend to run short of eggs around the age of 50, which then decreases their output of hormones, including oestrogen, which then creates the symptoms that I've described.

Chris - In effect, then, there are responses all over the body to these hormones.

Imogen - Absolutely. I mean, every tissue in the body has oestrogen receptors. So our brain, our heart, our blood vessels, musculoskeletal system, breasts, uterus are all oestrogen-responsive to a certain extent.

Chris - Does the body therefore have a process of getting used to a lower level of oestrogen then? Because it's been used to seeing quite high levels when a person is not in the menopause, but then once the menopause has happened and you go into this state of much lower oestrogen, is it that you settle down and then things become normal again for you? Or do people have to experience those symptoms indefinitely?

Imogen - No, it's the fluctuating oestrogen levels that give us symptoms. And in the majority of women, once they're through the menopausal transition and they've now steadied out at a much lower, but stable, oestrogen state, the symptoms disappear. In about 7% of women, these symptoms don't disappear and they still continue flushing well into even... I see 90 year olds who are still flushing, not usually with the same intensity as during the menopausal transition, but they do still have some mild symptoms.

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