Women are born with about two million eggs in their ovaries, in an arrested state of development. During the reproductive years, one by one, about four hundred of these eggs are stimulated to develop, mature, and finally be released into the womb, The remainder degenerate and are absorbed. The cells around each egg are important because they produce the oestrogen and progesterone of the female cycle.
Quite simply, all that happens at the menopause is that the ovaries run out of eggs. There are simply no more left to develop, and as a result, two things happen. Firstly, there are no cells able to produce oestrogens, so the level of oestrogen falls; secondly, the brain detects this and tries to stimulate the ovaries by making the pituitary produce ever larger quantities of FSH.
This lack of oestrogen is the principal cause of menopausal symptoms. For reasons that we don’t yet understand, as the oestrogen level falls, the circulatory system becomes unstable and as a result flushing and sweating occur. Other symptoms of the menopause include; woolly-headedness, vaginal dryness, poor memory, back pain, flooding (very heavy periods), depression, a general sense of feeling unwell, and headaches. Sometimes migraine can start or worsen at this time. However, simply providing supplemental oestrogen can bring the woman back to her previously normal state.
Some women get many more menopausal symptoms than others. There are those women who float through the menopause with grace and ease, while others have a wretched time of it, with hot sweats that keep them awake half the night, flushes that make them beetroot-coloured and mental befuddlement that makes them think they’re going mad. It’s unclear why some people have such a difficult time of it, and although in the past many doctors felt that there was a large psychological involvement, it now appears in most cases that any psychological effects of the menopause occur as a result of changes in the hormonal level.
Due to the effects of oestrogen, migraines are more common in women. It used to be thought that the incidence of migraines declined at the menopause, with the decline in oestrogen levels, but it now appears that this is not necessarily so. Some women have fewer migraines after the menopause; but others have more, and a small proportion of women find their migraines start at the menopause. In those whose migraines have worsened, hormone replacement therapy (IIRT) can bring matters back to normal again.
If you’re having headaches and you are also going through the menopause, then your headaches may respond to hormone replacement therapy (HRT). Some doctors believe that HRT should be given to every menopausal woman, to prevent bone-related problems like osteoporosis (thinning of the bones that is increased by oestrogen deficiency in menopause). Others feel that the menopause is a natural phenomenon and shouldn’t be tampered with unless a patient is having severe symptoms. Most doctors probably fall somewhere between these two extremes.
Diagnosis of the menopause is not always easy. Menopausal symptoms may occur at a time when the periods are still relatively regular, and having normal or nearly normal periods doesn’t mean you aren’t entering the menopause. In addition, some women have already had their womb removed (hysterectomy), even though their ovaries may still be in place, so they don’t have periods any longer. Apart from menstrual irregularities, most of the remaining menopausal symptoms can also be caused by non-hormonal circumstances. In other words, it’s not always easy to be sure, from your symptoms alone, of the point at which you’re entering the menopause. Sometimes it’s necessary to do a blood test to be sure if the symptoms are likely to be related to the menopause or not.
There is a further problem in those who’ve had a hysterectomy. Even if your ovaries are left behind, those who have had a hysterectomy have a fifty percent chance of having their ovaries fail within the next five years – in other words, of entering the menopause. Without a womb you may not realise you’re menopausal. A thirty-six year old woman who had a hysterectomy four years earlier might actually be going through the menopause.
It’s easy for a doctor to work out whether or not you’re menopausal. A simple blood test can measure the level of FSH (follicle stimulating hormone) produced by the pituitary. In menopausal women this level is always high because the pituitary is desperately trying to stimulate the production of oestrogen from the follicles in the ovaries.
If some or all of the symptoms mentioned in this chapter seem to fit you, it may be a good idea to go and see your doctor. Certainly, if you are having these symptoms and also getting headaches then hormonal replacement therapy (HRT) may well remove your headaches, as well as the rest of your menopausal symptoms.
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