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There is a saying that all good things (and not-so-good things too) come to an end. Ditto for woman’s ability to produce babies. Nature puts a cap on how long a female can reproduce. So, females are born with a fixed number of egg cells. As these cells deplete with advancing years, fertility in women goes down, ending finally with a condition called Menopause.

Fertility goes down with age

Nature gifts 6 million eggs to female babies at birth. These are lodged in the organ called ovary. Each egg, subject to fertilization, can produce a new human form. The total number of egg doesn’t increase during a woman’s life time as no new eggs are made in the post-natal life. However, the number consistently declines with age till zero mark and that’s where the countdown to menopause begins. But before this, a growing girl passes through a fertility phase which is controlled by a play of body hormones.

Cyclic preparations to conceive

First sign of adulthood (sexual maturity) in a growing girl is the onset of menstrual cycle. This connotes the bestirring of egg cells that the child was born with. These cells start growing/ maturing in multiple numbers in the form of bubbly outgrowths on ovary, called Follicles. One fully formed egg is then ejected from one follicle (rest of the follicles degenerate), led to fallopian tube, and therefrom to another organ in the genital system, named uterus. Fertilization by male cell (sperm) happens in fallopian tube. There is no question of fertilization unless there is sexual union. If egg gets fertilized it is accepted by uterus which is primed by several hormones to receive it. If no fertilization takes place, egg is rejected and all preparations made in uterus by way of increased blood supply, get trashed. This reflects in the flow of blood (periods) which women must forebear every month except during the pregnancy.

Interplay of hormones is integral to life

Whether pregnancy supervenes or not, women must pass through surges and sags of hormones consistent with her reproductive status. These hormones effect not only the reproductive organs but the entire body and even her thought process. This shows crystal clear in her mood swings from euphoria to stoicism and outright depression and irritability. Thus the psychosomatic status of a woman is challenged all her life by a rise or fall in level of different hormones related to her reproductive organs. This seesaw becomes a way of life for her and crisis begins when this seesaw must come to an end. A bio system conditioned to periodic flux of hormones triggered by developing and disintegrating eggs must change when the store of eggs is totally depleted in a female. Response to this radical change in women is by way of Menopause.

Monthly periods stop in mid life

Menopause is a window for biological transition of women from fertility to infertility. From regular menstruations to total cessation of their monthly periods. Normally this happens from 45 to 55 years of age, average being 51 years. Since the main trigger for this condition is depletion of eggs in ovary, it can even in an earlier age a disease or medical intervention which inhibits natural growth of eggs in ovary.

Menopause implies freedom from pregnancy

Change, be it of any kind, comes with a price tag. So also the menopause. A female bio- system goes on with a kind of inertia even as pushing force, the hormones, is withdrawn. Nature gives a Clarian call that the reproductive phase of the female is over and up. It promises freedom from pregnancy and associated responsibility of birth control precautions. Nevertheless, some physical discomforts are inevitable. Menopause is preceded by Perimenopause, and followed by Post menopause.

A three step closure of fertility

Perimenopause begins from the time of last menstrual flow and lasts for 12 months thereafter. It is characterized by hot flashes, i.e. sudden rise of temperature in facial area. Hot flashes continue for several years even after the end of perimenopause.

After Perimenopause, i.e. when periods have stopped for 12 months in succession, comes Menopause. There is a carry forward of hot flashes into this phase and even beyond. Sweating at night, cold flashes in different parts of the body, dryness of vagina, urinary incontinence, aversion for sex, insomnia and mood swings are also noted.

When exactly the Menopause ends and Post menopause begins can’t be calibrated with precision. On an average the symptoms of menopause prevail for a period of 4.5 years. And life thereafter is postmenopausal.

It’s normal, and not a disease

It is important to remember that Menopause is normal phase of a woman’s life. It is not a disease even as many symptoms ascribed to it seem pathological. It should also be kept in mind that menopause happen in middle age where chances of comorbidity are high. If there are other significant disease problems, menopause is bound to be more problematic because of associated disease burden.

Hormones involved

The countdown to menopause begins at the age of 40 to 50, with ovaries getting less responsive to Follicular Stimulating Hormone (FSH) and Luteinizing Hormone (LH). These 2 hormones are released from the master endocrine gland 'Pituitary’ which is located at the base of human brain. Pituitary in turn is pushed into action by another hormone, GnRH (Gonadotrophin Releasing Hormone), secreted by Hypothalamus located close to Pituitary. As ovaries grow less sensitive to FSH and LH hormones, the process of eggs maturing and getting discharged is hampered. Consequently, the level of Estrogen and Progesterone hormones (which decide whether menstrual cycle will repeat for want of fertilization or stop in face of prospective pregnancy) secreted by developing follicles, also goes down. This effects preparation of the female genital tract to receive or reject mature eggs that are being released from ovary of a middle aged woman. The net result is irregular menstrual cycle and associated health problems.

Why bones go weak

A fall in the level of Estrogen causes Blood-Calcium level to go down. Reason being involvement of Estrogen in Blood-Calcium metabolism. As Blood-Calcium level goes down, nature extracts calcium from bones and directs it into the blood-stream. Bones, consequently, become rarified and weak (osteoporosis) and the person concerned becomes more prone to fracture and dislocation. Thus, health and wellness is affected.

A blessing in disguise

Menopause, thus, is a domino effect of hormonal imbalance in a middle aged woman. Attendant Psychosomatic disorders are generally treated symptomatically. Hormonal Replacement Therapy (HRT) is also tried with limited success. But a more rational approach is to accept it as an inescapable change in life and enjoy the fringe benefit it offers in terms of a carefree conjugal life.