Menopausal symptoms are caused by diminishing oestrogen levels as a result of decreasing ovarian function. When you enter the menopause, your periods end because your ovaries no longer release eggs for fertilisation every month.
As a result, production of the female hormone oestrogen stops. In normal circumstances, egg-cell production stops when the number of eggs a woman was born with has been exhausted, or their quality has deteriorated.
Some women go through perimenopause (the transitional period before entering menopause) and menopause (when your periods stop and you become permanently infertile), without experiencing any typical symptoms like hot flushes, night sweats and mood swings.
But not experiencing these symptoms doesn’t mean you’re immune from the effects that decreased estrogen levels have on the body. That’s because oestrogen helps protect against the external signs of ageing (such as dry skin) and also helps guard against the development of osteoporosis.
Read the section on the role of hormones for more details on the function that sex hormones oestrogen, progesterone and androgen play in menopause.
Natural versus induced
As a normal life event that designates the end of fertility, natural menopause may involve various physical and emotional changes.
Some women experience induced or surgical menopause due to a medical intervention, for example, if there ovaries are removed before they enter their natural menopause. Induced menopause can also occur if the ovaries are damaged by radiation, chemotherapy or certain other drugs.
In such cases, an abrupt hormonal decrease usually results in a sudden onset of menopause-related symptoms.
If you had induced menopause, early menopause (before age 45) or went for a prolonged time without menstrual periods (for example, because of excessive exercising or dieting), you may be at a greater risk later in life for health problems such as heart disease and osteoporosis, since you spent a long time without the protective effect of oestrogen.
Hysterectomy and menopause
Having a partial or sub-total hysterectomy refers to the removal of the uterus and preserving the cervix and does not refer to the ovaries. After a partial hysterectomy, you will usually continue to produce hormones and will therefore not experience early menopausal symptoms unless some nerves and blood supply to the ovaries have been damaged during the procedure.
A total hysterectomy entails having the entire uterus removed, including the cervix. However, it’s important to know that when your gynaecologist mentions performing an oophorectomy, that will mean the ovaries will also be removed.
Symptoms of menopause
Reviewed and updated by Dr Dr Carol Thomas MBChB (UCT) FCOG (SA) MMed (O&G) (UCT), Specialist Gynaecologist in private practice, Cape Town, Secretary South African Menopause Society and Director of the WomanSpace. March 2015. (Previously reviewed by Dr Mike Davey, President of the South African Menopause Society, and Prof B. Schaetzing MD, FCOG (SA), FRCOG, PhD. Part-time Consultant, Dept of Obstetrics & Gynaecology, Faculty of Health Sciences, University of Stellenbosch