Menopause - Symptoms and Causes

Menopause is the name given to the woman's last period, an event caused by ovarian failure, characterized by stopping ovulation and estrogen production.

It is an inevitable process, irreversible and universal for all women. The term menopause is often used erroneously being confused with perimenopause. In this paper we explain this difference and discuss the main symptoms of menopause and perimenopause.



There is much confusion, especially among the lay public with the terms menopause and climacteric. Menopause, as described in the introduction, is the last period of woman's life. The period that follows the cessation of menstruation is called menopause. Therefore, although it is very common to hear that a woman is in menopause, it would be more correct to say that she had the perimenopause and is now in menopause.

A woman's reproductive life presents two important milestones: menarche, which is the first menstruation, and menopause, her last period. The first is the sign that the woman's fertile life is being initiated, while the second is the signal that the fertile period came to an end.




Menopause is caused by the aging of the ovaries and the depletion of their follicles, which are an aggregate of cells that give rise to ova. Women are born with about 450,000 potential eggs stored in follicles. Ova begin to be eliminated from the body before birth, a gradual process which is completed in average when a woman reaches 50. In fact, 90% of women have their menopause between 45 and 55 years. About 5% can have it closer to 40 years and another 5% over 60 years. This continues and slow degeneration of ovarian follicles is called follicular atresia.

Several factors influence the age of menopause. The most important are:

• Genetics
• Ethnicity: Menopause usually occurs later in Latin and Asian women
• A history of smoking, women who smoke have a menopause, on average, two years before nonsmokers
• Reproductive history: Women who have never been pregnant have menopause earlier

Obviously, women who have their ovaries removed surgically show immediate menopause. The treatment with radiation or chemotherapy may also lead to an early menopause.


The woman in the climacteric period, i.e., after menopause, no longer ovulates and is also no longer able to produce her sex hormones, especially estrogen and progesterone.

Menopause is not an event that occurs abruptly just after the last follicle undergoes atresia. Long before menopause women's body begins to change. From the age of 35 still viable ovarian follicles show signs of aging, becoming less responsive to hormonal actions that stimulate ovulation, such as increased blood concentrations of follicle-stimulating hormone (FSH).

Without going into complex hormonal mechanisms, it is worth explaining that the FSH produced by the pituitary gland within the central nervous system, is the hormone responsible for producing estrogen and progesterone, and maturation of ovarian follicles, which ultimately leads to ovulation.

As the ovaries over time become increasingly less responsive to FSH the pituitary needs to increase its production to keep the woman ovulating and producing estrogen and progesterone. After menopause, when all follicles have undergone atresia, the ovaries are so old that while the pituitary produces FSH in large quantities, there is no longer producing estrogen.

Climacteric women, therefore, exhibit high levels of FSH and absence of estrogen.


When the time of the menopause approaches, menstrual cycles are becoming irregular and may be higher or lower than usual. Bleeding time is usually shorter, but the amount of blood loss can be increased. It is common to spend two or more months without menstruating, making it very difficult to know in advance what will be your last menstrual period. To set the date of menopause and say that the woman entered the menopause it has to be at least twelve months (one year) without menstruating.

Hot flashes

The famous hot flashes of menopause, also called hot flushes, are the most common symptoms of menopause. They start when menopause approaches and remain for the first years of menopause. Hot flashes usually last from one to five years, but there are some unfortunate women, who have hot flashes up to 70 years.

Hot flashes usually begin with a sudden feeling of warmth in the chest and face that quickly becomes generalized. The burning sensation lasts from two to four minutes, often associated with profuse perspiration and occasionally palpitations. Often the heat wave is followed by chills and shivering, and sometimes anxiety attacks. The hot flashes typically occur several times per day and are particularly common in the evening.

Urogenital symptoms

The layer of tissue that covers the vagina, called vaginal epithelium, is very sensitive to estrogen. After menopause, estrogen deficiency leads to thinning of the vaginal epithelium, resulting in atrophy of the vagina (also called atrophic vaginitis), which leads to symptoms of vaginal dryness, itching and pain during intercourse.

The absence of estrogen also causes a reduced blood flow to the vagina and the vulva. This decrease causes a reduction of libido and vaginal lubrication. The lack of estrogen can also reduce the elasticity of the vaginal wall, making the vagina shorter and narrower.

The urethra, the tube that drains urine from the bladder, also suffers from low production of estrogen after menopause. The atrophy of the urethra can lead to urinary incontinence.

Recurrent urinary tract infections are also a problem for many menopausal women. Estrogen deficiency can increase the vaginal pH and change the bacterial flora, eliminating the natural bacteria in the vagina that protect women from urinary tract infections.

Depression and mood swings

During the transition from reproductive period to the menopause, some women may develop depression, mood changes, sadness, irritability, difficulty concentrating and lack of interest in normal activities. Sleep disorders are common, the woman may have a feeling of sleepiness or have other problems starting and / or staying asleep.

Long-term problems

The dramatic reduction in estrogen production after menopause also causes long-term consequences. Among the most common are the loss of skin elasticity, increased incidence of osteoporosis and increased incidence of cardiovascular disease.

Other common changes in the body due to menopause are loss of elasticity of breasts, loss of strength and luster of hair, reduction of healthy teeth and gums, and back pain in some joints.