As women approach their late 30s, their ovaries start making less oestrogen and progesterone — the hormones that regulate menstruation — and fertility declines. In their 40s, during the perimenopausal period, women’s’ menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually, on average, by age 51, the ovaries stop producing eggs and the woman has no more periods.
“Oestrogen plays a role in body temperature regulation, which helps to explain why hot flushes and night sweats occur. Declining oestrogen can explain changes in skin and hair. Loss of oestrogen causes the vaginal epithelium to become redder and thinner, causing dryness,” says Dr David Edwards, a GP and specialist in female sexual dysfunction.
Changing hormone levels may also cause mood swings and other emotional changes. “These hormonal changes occur naturally but can be exacerbated by poor lifestyle choices, smoking, excessive alcohol, poor diet, lack of exercise and so on,” explains Dr Edwards. “Hysterectomy, chemotherapy and radiation can also bring on the menopause and its symptoms. This can be very distressing for the patient as in these situations the menopause occurs suddenly and often at a younger age.”
Most women are aware that the menopause can cause physical symptoms such as hot flushes and aching joints. For many, changes in mood can be just as debilitating.
Research has shown that 61 per cent of women suffer anxiety during the perimenopause. Many, however, are unaware that they may be in the perimenopause, and that changing hormones may be responsible for this change in mood.
Women are affected very differently during the menopause, and there is no way of predicting how the transition from normally functioning ovaries to cessation of function, and hence decline in oestrogen, will affect each individual. “It’s important to remember that every woman will be impacted differently by menopausal symptoms, especially as there are so many variables such as diet, lifestyle and life stresses, that can all contribute to your experience,” explains Dr Heather Currie, founder of Menopause Matters and an associate specialist gynaecologist and obstetrician at Dumfries and Galloway Royal Infirmary.