Menopausal symptoms are caused by the shutting down of the ovaries and the decrease and eventual cessation of the production of the hormone oestrogen. Symptoms are variable from minimal to severe and may precede changes in periods. Symptoms may include irregular bleeding, hot flushes, night sweats, skin changes and itching, vaginal dryness, urinary symptoms, osteoporosis, loss of libido, breast tenderness, tiredness, weight changes, forgetfulness, depression and anxiety.

Menopause is not a permanent state, and post-menopausal women (those who have had no periods for two years) often report an increased vigour and enjoyment of life.

Fertility awareness, by daily charting of cycles and symptoms, helps women understand the changes, monitor their declining fertility and accurately predict menstruation. Charting will tell if a woman is still producing eggs and reassure her that she is not pregnant.

With more understanding of what is happening, women and their partners can meet the challenge of the changes and reduce the stress and uncertainty.

The menopause occurs in all women. It can occur when the ovaries spontaneously fail to produce hormones oestrogen and progesterone, when the ovaries fail due to specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed, often at the time of a hysterectomy. Ovaries naturally fail to produce oestrogen and progesterone when they have few remaining egg cells. At that stage, the ovaries become less able to respond to the pituitary hormones: follicle stimulating hormone (FSH) and Luteinising hormone (LH) and less oestrogen is produced. Levels of FSH and LH subsequently rise and a measurement of FSH is sometimes used to diagnose menopause. The resulting low, and changing levels of ovarian hormones, particularly oestrogen, are thought to be the cause of menopausal symptoms in many women.

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