Menopause Causes

Menopause is the permanent ending of your menstrual cycle. Women are considered menopausal when they have not had a period (menses) for a period of 12 months. It is caused by a decline in oestrogen that happens with age. This drop can affect the body in other ways, producing symptoms, such as ‘hot flushes’, night sweats, and mood changes. 

Sometimes menopausal symptoms can appear before your periods have completely stopped, which is considered peri-menopause. Menopause is a natural process and occurs in women usually between the ages of 45 and 55. However, menopause can happen earlier under certain circumstances, such as: 

• Surgery- women who have had both their ovaries (oophorectomy) and/or their uterus (hysterectomy) removed
• Cancer treatment- chemotherapy and radiotherapy have been linked to the ovaries failing to function. The risk is higher if the treatment is targeted towards your brain or pelvis
• Chromosome abnormalities- the most common being Turner Syndrome
• Infections- like malaria or tuberculosis, however, this is a rare occurrence¹

Symptoms of menopause

Menopausal symptoms can last for a few months or a few years, and their nature may change with time. More common symptoms include:

• Changes to your periods - at first, your periods will become irregular, before stopping entirely 
• Low mood, anxiety, mood swings 
• ‘Brain fog’ - problems with memory and concentration 
• Vasomotor symptoms - hot flush, night sweats, palpitations, and migraines.
• Weight gain 
• Hair loss 
• Reduced sex drive
• Vaginal dryness that can cause discomfort during sex 
• Stress incontinence 
• Recurrent urinary tract infections (UTIs)

Women who go through menopause early are more likely to develop osteoporosis and heart disease due to prematurely low oestrogen levels.

Symptoms affect women differently. For some, going through menopause can be difficult to handle, and they may seek treatment to help manage the symptoms. Possible treatment options include: 

• Hormone replacement therapy (HRT) which replaces the hormones in the body that are in low supply
• Testosterone gel which helps improve libido 
• Oestrogen to help with vaginal dryness and discomfort
• Non-hormone medicines (Clonidine, Gabapentin) to help with hot flushes and night sweats
• Antidepressants and therapy to help with depression or anxiety,²³ symptoms which some women experience. 

Menopause is not a disease

A disease is a disorder, or something going wrong in the body. Menopause is not a disease, as it is a natural part of the ageing process and is something that women will go through. 

Reproductive hormones decrease with age

Four main hormones regulate the menstrual cycle:

• Follicle-stimulating hormone (FSH) which triggers the maturation of the egg-containing follicle
• Oestrogen hormone - helps build up the lining of the uterus and prepares the egg for ovulation.  
• Luteinising hormone (LH) - helps with egg maturation and triggers ovulation 
• Progesterone - helps build the lining of the uterus, and maintain this lining if pregnancy occurs.  

FSH and LH are produced by the pituitary gland in the brain, whilst oestrogen and progesterone are produced by the ovaries. As women age, there are fewer and fewer follicles containing eggs. This means that the ovaries will produce fewer hormones. Some oestrogen is produced by the adrenal glands, which may explain why some women are less affected by menopause than others.⁴

However, not all reproductive hormones decrease with age. Oestrogen regulates FSH levels in the body in what we call negative feedback. When oestrogen levels fall, for example at the end of the menstrual cycle when the period occurs, FSH levels rise to trigger the start of the cycle all over again. And conversely, when oestrogen levels are high, FSH levels fall. In menopause, since oestrogen levels decline, this results in FSH levels rising and remaining high. This can be used to help diagnose menopause, however, it is rarely needed due to the characteristic symptoms.⁵

Trans men who began transitioning at pre-menopausal age do not experience menopause

In this article so far, we have only discussed menopause from the perspective of cis-gendered women. Menopause is caused by decreased oestrogen levels in your body. It is not exclusive to only one gender, or those who are assigned female at birth (AFAB) but can also affect trans and non-binary people. Trans women can experience symptoms of menopause (pseudo-menopause) if their HRT is disrupted.⁶ However, some trans women may choose to decrease their dose of oestrogen as they get older. Studies have shown that older trans women are more likely to develop stroke, blood clots, and cardiovascular disorders than cis women.⁷ 

Trans men who started their transition at a pre-menopausal age will never go through menopause. However, this is dependent upon them taking testosterone and altering their hormone profile.⁸ 

It is also important to note that not all trans people take hormones, or undergo gender-affirming surgeries like removing their ovaries and uterus. Trans men can experience surgical menopause if these organs are removed and if they are not taking testosterone. Therefore, trans men can still undergo menopause. Unfortunately, there is limited information available regarding menopause in trans and non-binary people, and only in 2022 were the National Institute of Health and Care Excellence (NICE) guidelines updated to include trans and non-binary people.

Conclusion

Menopause is the permanent end of your menstrual cycle and is marked by not having a period of 12 months. It is not a disease, nor a disorder, and is a natural part of life. It affects not only cis-gendered women but can affect trans men and other non-binary people. If you find yourself struggling with menopause, consult your healthcare provider about ways to help manage your symptoms. For any trans and non-binary people, there are certain websites like queermenopause.com that provide plenty of resources to help guide you through the menopause process.