Menopause is a natural stage in a woman's life, which occurs when the ovaries slow down and then stop production of the hormones oestrogen and progesterone. Natural menopause usually occurs around the age of 50, although women will usually notice signs that they are going through 'the change' some years before. Menopause can occur earlier, either through being 'induced' (by the removal of the ovaries, or due to their damage during certain medical treatments), or as a result of a genetic pre-disposition to premature menopause, or an autoimmune disorder. An autoimmune disorder is when the immune system creates antibodies against molecules and cells normally found in your body. A healthy immune system only creates antibodies against foreign invaders, like bacteria and viruses.

Symptoms

For most women, the greatest change brought about by menopause is the cessation of their periods, and the ending of their natural childbearing life. Notable symptoms of approaching menopause include:

• Menstrual cycle variations - irregular or missed periods, or mid-cycle 'spotting', are often the first-noticed signs of the onset of menopause. Women have been known to become pregnant without realising, assuming the irregularities in menstruation are caused by 'the change'. Conversely, women have believed themselves to be pregnant, only to find that they are in fact entering menopause.

• Hot flashes - the majority of women experience these. They start in the centre of the body, and 'flash' to the extremities, causing the face, neck and arms to flush red, and feel warm to the touch. They can last a matter of seconds, or go on for up to thirty minutes, leaving the woman feeling tired and cold afterwards.

• Night sweats - similarly, these cause a woman to feel overheated and to sweat in bed, waking her often, and leading to general daytime tiredness, due to the disturbed sleep pattern.

• Feeling emotional - the emotional fluctuations that a woman experiences are sometimes the most noticeable to partners and family, who think they are having a tough time of it. Short-temper, irritability, anxiety, depression and sudden mood swings are the result of fluctuating hormone levels.

• Lack of libido - because the ovaries are also responsible for producing testosterone (the sex-drive hormone), the production of this also slows and stops. Many women lose interest in sex, although some women are able to produce the small amount of testosterone needed through their adrenal glands. Often, freedom from the worry of unplanned pregnancy can make a woman feel more relaxed about sex, and some claim that their sex-life has notably improved after menopause.

• Vaginal and urinary tract changes - thinning of the tissues around the vagina and urethra are another result of the decline of oestrogen. The vagina may become dry, making sex painful, and may lead to inflammation and irritation. The urinary tract becomes prone to infections, and women often experience the need to urinate more frequently, or with sudden urgency, and the need to get up several times during the night.

Premature Menopause

Where menopause occurs before the age of 40, this is considered to be premature menopause. Some women are genetically predisposed to early menopause, and others may reach menopause early due to autoimmune disorders or other medical causes.

Medical intervention, through treatments such as chemotherapy or radiation therapy, may damage the ovaries, inducing early menopause. The removal of the ovaries for medical reasons will also induce menopause. Occasionally, ovaries are removed at the same time as a hysterectomy is performed, where the consultant feels there is a risk of ovarian cancer or other medical indication.

Health Matters

The slow-down and eventual stop in the production of oestrogen has a number of other implications. Oestrogen offers protection against heart disease, osteoporosis, ovarian and colon cancer, may also help to prevent Alzheimer's disease, gum disease and cataract formation, and helps maintain a healthy cholesterol level.

Some women are prescribed the birth control pill to help regulate their menstrual cycle while their bodies tackle menopause. However, this is discontinued after ovaries cease oestrogen production, and other options are then considered.

Oestrogen Replacement

In use since the 1940s, Hormone Replacement Therapy (HRT) is a long-standing method of treating menopausal and post-menopausal symptoms. Administered through either a pill or skin patch, HRT can combat the health implications described above, however it does carry some risks of its own. In addition to side effects, such as weight gain, bloating, nausea and breast tenderness, there is believed to be an increased risk of uterine and breast cancers, blood clots, and gallbladder disease.

Relief of Other Symptoms

Creams containing oestrogen are available for the relief of vaginal dryness and soreness, and a slow-release vaginal ring, placed in the upper vagina and lasting for around three months, is another source of potential relief. As these only contain low doses of oestrogen, they are not considered to pose the same health risks as HRT, but are also unlikely to offer the same benefits.

Other treatments are available which combat individual symptoms of menopause, such as osteoporosis. These are generally used to treat women who do not use HRT, and are five years or more past menopause.

Natural remedies may also alleviate symptoms or protect against menopausal related diseases. As women's lives have dramatically increased in length over the last 100 years or so, research into alternative treatments is relatively new, and it is always advisable to seek your doctor's advice before embarking on a particular course of treatment.

Recent research suggests that soy protein (found in soy beans, and foods containing soy, such as many vegetarian alternatives) can also help combat menopausal symptoms, and may even work as well as oestrogen replacement in lowering cholesterol and combating heart disease, and could also reduce the risk of Alzheimer's disease.

Lifestyle Changes

With 21st Century women typically living well beyond the age of 50, they may spend at least one-third of their lives in the post-menopausal phase, so it makes sense to prepare for these changes.

We are all aware of the benefits of eating a healthy diet, but limiting fat and cholesterol intake is particularly important for menopausal and post-menopausal women. Low-fat dairy products, lean meat or vegetarian alternatives, and at least five portions of fruit and vegetables per day should be minimum requirements.

Exercise also plays a crucial role in preparing for, and coping with, the physical changes brought about by menopause. Cardiovascular exercise, such as walking, jogging and cycling, will help to keep your heart in peak condition, and combat heart disease. Weight-bearing exercises, such as weight training, will increase bone density, and protect against osteoporosis. In addition to the physical benefits, the mental lift of keeping fit will help you to enjoy life to the full, and not feel so much like you are 'over the hill', and on a rapid decline down the other side! Life begins after menopause!