What is menopause?

Menopause is a natural part of life that every woman goes through. Yet it is surprisingly rarely talked about. Many women experience changes in their body without fully understanding what is happening or why. Here is a straightforward overview.

What does menopause actually mean?

Menopause, also called the climacteric, is the period of life when the body gradually winds down its reproductive phase. It involves hormonal changes that affect far more than just menstruation.

Technically, menopause is a single point in time: the date of your last period. But because we do not know it was the last one until 12 months have passed without bleeding, it is a diagnosis made in hindsight. The entire transitional phase stretches over several years, and this is what most people are referring to when they say "menopause".

The three stages

Perimenopause

Perimenopause is the first stage, and it often starts as early as your 40s. For some, it can begin in the mid-30s. During this phase, the ovaries start producing less oestrogen, but the levels fluctuate significantly. It is precisely these fluctuations that create many of the symptoms women experience.

Typical signs include irregular periods that may become shorter, longer, heavier, or lighter than what you are used to. Many also notice hot flushes, night sweats, sleep problems, and mood swings. This phase lasts on average 4 to 8 years, but can stretch over up to 10 years.

Menopause

Menopause is technically just a date. It is the point at which you have gone 12 consecutive months without a period, without other medical causes.

Among Norwegian women, menopause occurs on average between the ages of 52 and 53, typically between 45 and 55. Norway has one of the highest average ages for menopause in the world, and the age has actually increased by nearly 3 years in recent decades. Women who smoke tend to reach menopause about 2 years earlier than non-smokers.

Post-menopause

Post-menopause covers all the years after menopause, the rest of your life. Hormone levels stabilise at a low level. For most women, the acute symptoms gradually subside, but some can experience discomfort for many years.

During this phase it is important to be aware of the long-term health effects of low oestrogen, such as increased risk of osteoporosis and cardiovascular disease. That does not mean you need to worry, but it is wise to talk to your doctor about prevention.

What happens to the hormones?

Three hormones play the leading roles in menopause.

Oestrogen fluctuates dramatically during perimenopause. Levels can vary from nearly undetectable to several times the normal value within a single cycle. It is a bit like a roller coaster, and it is these swings that often cause the most noticeable symptoms. In the final two years before the last period, oestrogen drops sharply.

Progesterone declines because the ovaries release eggs less frequently. In the final years before menopause, 60 to 70 per cent of cycles occur without ovulation, meaning progesterone is barely produced any longer.

FSH, follicle-stimulating hormone, rises because the brain is trying to stimulate the ovaries to produce more. It is the body's way of saying "hello, we need more oestrogen here". FSH begins to rise approximately 6 years before menopause and does not stabilise until 2 years after.

Who experiences symptoms?

Most women notice menopause. According to Norwegian health sources, 8 out of 10 women experience hot flushes and night sweats. About 1 in 4 women have severe symptoms that affect daily life, while 1 in 4 do not notice anything in particular at all. Most fall somewhere in between.

International studies involving over 480,000 women show that the most common complaints are joint and muscle pain (65 per cent), physical and mental exhaustion (64 per cent), irritability (54 per cent), and memory problems (54 per cent). Hot flushes, which many think of as the hallmark symptom, are reported by roughly half.

When should you talk to your doctor?

Contact your doctor if your periods suddenly become very heavy, if you experience bleeding between periods or after intercourse, or if symptoms affect sleep, mood, or daily functioning in a way that is hard to live with.

It is especially important to seek medical advice if you are under 45 and experiencing irregular periods or typical symptoms, and crucial if you are under 40, as this may indicate premature ovarian insufficiency that should be investigated.

For women over 45 with typical symptoms, blood tests are usually not necessary to make the diagnosis. The doctor assesses based on your symptoms.

The key takeaway

Menopause is not an illness. It is a natural phase of life. But that does not mean you simply have to endure it in silence. Good treatment options exist, and it starts with understanding what is happening. The more you know, the better you can look after yourself through this transition.