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The word menopause means the stopping of cyclical menstrual bleeding and this occurs on average at 50 years of age; however, the normal range can vary from 45 to 55 years.

There is a slow downturn in ovarian activity with resultant hormonal imbalance for as long as five years before menstrual bleeding finally stops. During these so-called premenopausal years, one finds abnormalities of ovarian activity, interspersed with some normal cycles. These abnormalities include short and inadequate cycles with deficient production of progesterone, failure of ovulation with very high peaks in estrogen production and, sometimes, constantly raised estrogen levels. Later still, periods of absent ovarian activity are frequently observed, interspersed with periods of unbalanced hormone production due to lack of ovulation. The menstrual cycle may become irregular and infrequent, and bleeding may be heavy and prolonged at these times due to the hormonal imbalance. During these premenopausal years, many women require a curettage to exclude cancer of the uterus. Also, during these years of severe hormonal imbalance, a large percentage of women will feel generally unwell, physically and emotionally.

Menopause has a physiological or chemical cause, and is not a psychological illness of women in the middle age groups. Doctors are altering their attitudes to the menopause and now regard it as a hormone deficiency disorder rather than, as was often previously the case, merely "a state of mind". It can be compared to other hormone deficiency disorders, for example deficiency of thyroid hormones, disorder of the adrenal gland, diabetes and so on, in which hormone replacement therapy is necessary for the maintenance of normal metabolism and, in many cases, the maintenance of life.

The lack of female hormones causes a disruption in the control of body temperature and this results in hot flushes and sweating, especially at night, which in turn causes disturbed sleep with resultant fatigue the next day. Hot flushes are most intense in the first two years after the menopause and gradually reduce; however, in one third of women they may last up to nine years. Fatter women have less hot flushes because their fatty tissues convert male hormones into estrogen. Hot flushes are usually much worse in very thin women, heavy smokers or women who have had a surgically-induced menopause.

The skin often becomes dry, fragile and itchy, particularly in cold weather when a lot of hot water and soap are used.

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