Menopause marks the end of the reproductive years of a woman’s life, occurring usually between 45 and 60 years of age, with an average age of 51 years. Menopause occurs as the number of oocytes a woman carries reaches their end point and the ovaries decrease their production of oestrogen and progesterone. The transition into menopause, called peri-menopause, commonly lasts for 2-3 years, where common signs of change include irregular menses, skin changes, mood changes, depression, memory loss, insomnia, fatigue, vaginal dryness and atrophy, changed libido, night sweats and hot flushes, which may be moderate to debilitating in their effects. During peri-menopause ovarian sex steroid synthesis slows and ovulation becomes unpredictable, causing fluctuating monthly patterns until menses ceases completely. Menopause is confirmed with the cessation of periods for 12 months with consistently elevated serum FSH levels and low serum oestradiol.
Whilst there may be a decline in plasma levels of oestradiol in menopause, serum levels of oestrogen and progesterone (and the ratio between them) do not reflect the oestrogen and progesterone content in various tissues. For example, postmenopausal women may have a relatively high serum oestrogen levels despite declining ovarian oestrogen, as adip
ocytes (fat cells) become a major source of oestrogen biosynthesis. One of the most common reasons women seek treatment is for menopausal hot flushes which can range from mild to severe. The drop in oestrogen is a significant catalyst, but not the only cause.
Essentially hot flushes are a heat loss mechanism initiated by short term vasodilation near the skin to allow the blood to cool and lower core temperature. However menopausal women do not experience higher core temperatures, but they have a narrower thermoneutral zone. Contributing factors to loss of thermoregulation include low DHEA as a result of chronic stress, with accompanying neurotransmitter imbalances, including depleted GABA and serotonin with increased noradrenaline and corticotrophin-releasing hormone (CRH). CRH may also contribute to elevated mast cell degranulation, augmenting the vasodilatory response and hot flush severity.
Stress management and adrenal support during the peri- and post-menopause years is therefore vital.

Factors that may hasten the timing of menopause and worsen the symptoms experienced include:
• Premature ovarian failure
• Hysterectomy retaining the ovaries (thought to advance menopause by approximately 2 years)
• Bilateral oophorectomy (immediate menopause)
• Smoking (hastens follicular depletion)
• Radiation and/or chemotherapy used to treat a malignancy
• Hypothyroidism
• Chronic or acute stress, leading to adrenal insufficiency.
• Toxicity (pesticides, smoking, alcohol, heavy metals)
• Certain medications

Signs and Symptoms:
Common signs and symptoms of menopause include the following:
• Absent menstruation for at least 12 months. (Irregular periods occur throughout peri-menopause)
• Hot flushes; of the face, neck, and upper trunk, which may be accompanied by palpitations, dizziness, headaches.
• Night sweats, which may contribute to depression and irritability from insomnia.
• Cold hands and feet.
• Vaginal atrophy and dryness may lead to painful intercourse and/or post-coital bleeding.
• Vulvar pruritis.
• Urinary tract atrophy, resulting in increased frequency, burning, nocturia, incontinence, and infection.
• Sleep disturbances and insomnia.
• Mood changes such as depression, irritability, tension.
• Memory impairment and loss of ability to concentrate.
• Skin changes including loss of skin tone/integrity leading to wrinkles.
• Weight gain and increased central adiposity.
• Breast tissue atrophy
• Increased sensitivity to stimulants such as alcohol and caffeine.