Hormonal Changes: From First Menstruation to Menopause
As a woman, you will encounter hormonal changes. Although hormones play a significant role from birth, you only start to notice them during puberty when you have your first period. Women experience various hormonal changes throughout their lives. In this blog, we will explain the hormonal changes that occur from your first menstruation to menopause. We will also explore some common hormonal complaints.
Puberty and the First Menstruation
The average age at which girls begin menstruating and enter puberty is between 9 and 16 years. Most girls have their first period between 11 and 14 years old. The first menstruation is also known as menarche. During puberty, hormonal changes begin that lead to the development of secondary sexual characteristics, such as breast development, hair growth, and menstruation. Oestrogen is the primary hormone involved in this process. Oestrogen stimulates the growth of breast tissue and the development of female reproductive organs.
When you reach reproductive age as a woman, you experience a monthly menstrual cycle. This cycle is regulated by a complex interplay of hormones, including oestrogen, progesterone, follicle-stimulating hormone (FSH), and luteinising hormone (LH). These hormones stimulate egg cell growth and ovulation. Want to know more? Read all about female hormones here.
Hormonal Balance and Well-being
Between the ages of 18-45, you are in the prime of your life physically, and your hormones should have found a good balance. A balanced hormone level helps regulate the menstrual cycle, supports healthy reproductive function, and maintains overall physical and emotional balance. Additionally, a good hormonal balance can help reduce symptoms like mood swings, fatigue, and sleep problems when these are caused by hormonal fluctuations. Our body is a complex system where hormones can sometimes disrupt things, especially in women. You may experience unpleasant symptoms due to a hormonal imbalance, such as menstrual disorders like PMS or PCOS.
Hormonal Imbalance and Menstrual Disorders
During the different phases of the menstrual cycle, natural hormonal changes occur. These fluctuations can lead to physical and emotional symptoms in women, such as mood swings, fatigue, tender breasts, and changes in appetite.
Additionally, hormonal changes can also lead to menstrual disorders, such as amenorrhoea (absence of menstruation), dysmenorrhoea (severe menstrual pain), PMS (premenstrual syndrome), and PCOS (polycystic ovary syndrome).
What is Amenorrhoea?
Amenorrhoea is a menstrual disorder where menstruation is absent for several months while a woman is not pregnant or in menopause. Amenorrhoea is caused by a low level of Gonadotropin-Releasing Hormone (GnRH). This hormone is crucial for regulating the menstrual cycle. When GnRH levels are low, it can lead to low levels of FSH and consequently low oestrogen levels. Various factors can suppress the production of GnRH:
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Psychological stress, weight loss, or excessive physical exercise: Psychological stress disrupts the hormonal balance and affects the hypothalamus, a part of the brain, resulting in reduced GnRH production. Weight loss and excessive physical exercise can also affect the function of the hypothalamus and lead to decreased GnRH production.
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A slow-functioning thyroid (hypothyroidism): Hypothyroidism causes a deficiency in thyroid hormones, leading to increased levels of thyroid-releasing hormone (TRH). Elevated TRH levels suppress GnRH production.
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Medications such as antipsychotics, antidepressants, and antihypertensives: These medications inhibit the release of dopamine in the hypothalamus. Reduced dopamine release leads to increased prolactin levels, which in turn suppress GnRH production. Prolactin is a hormone produced by the pituitary gland and plays a crucial role in stimulating milk production in the breast glands and suppressing ovulation in women.
What is Dysmenorrhoea?
Dysmenorrhoea is also known as menstrual pain. It is not just mild cramps, but menstrual pain so severe that it disrupts your daily life. With dysmenorrhoea, you experience pain in your lower abdomen or severe abdominal cramps just before and during menstruation. This pain can radiate to your lower back and legs. Additionally, you may experience symptoms such as nausea, diarrhoea, constipation, headaches, excessive sweating, and nervousness. Dysmenorrhoea is particularly common among young women aged 12 to 24. There are two types of dysmenorrhoea:
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Primary dysmenorrhoea is the type that most women with severe menstrual pain suffer from. In this form, no clear cause can be identified.
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Secondary dysmenorrhoea is the type where identifiable causes are present. About a quarter of women have this form of dysmenorrhoea. Causes include endometriosis, fibroids, pelvic infection, or a narrowed cervix.
What is PMS?
PMS, or premenstrual syndrome, is a recurring monthly problem for many women. There are no specific characteristics, tests, or lab results that can diagnose PMS. Symptoms that women often experience during the period leading up to menstruation include:
- Tension and irritability
- Fatigue and general malaise
- Mental issues such as depression and anxiety
- Migraine, headaches, dizziness, fainting
- Back pain, sore muscles and joints
- Hives, boils, acne
- Tender, painful breasts
- Binge eating
- Bloating, digestive problems
During the second half of the cycle, after ovulation has occurred, progesterone production increases, while oestrogen levels gradually decrease. Significant hormonal fluctuations can disrupt metabolic and biochemical processes, leading to PMS symptoms. Read more about PMS and what you can do about it here.
What is PCOS?
PCOS stands for polycystic ovary syndrome. Literally, this means that there are multiple (poly) fluid-filled sacs (cysts) in the ovary. PCOS occurs in five to ten percent of all women.
PCOS is a condition where the ovaries produce abnormally high levels of certain hormones, such as testosterone. This disrupts the normal maturation process of follicles, resulting in the formation of cysts on the ovaries. A characteristic symptom of PCOS is an irregular menstrual cycle, where menstruation may sometimes be completely absent. Moreover, women with PCOS may experience excessive hair growth in unwanted areas, such as the face. Other symptoms include acne, weight gain, and enlarged ovaries with multiple cysts. This condition can also lead to fertility issues, as ovulation may be irregular or absent. Symptoms vary from woman to woman, and not every woman experiences all symptoms. Want to know more? Read all about PCOS and what you can do about it here.
Pre-menopause and Recognising the Transition
Menopause is a natural phase in a woman's life where fertility declines, and menstruation stops due to hormonal changes. The transition is the overarching term used to describe the different phases around menopause. There are three phases:
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Perimenopause: This is the phase before menopause, usually beginning around the age of 40. It is characterised by changes in menstruation, such as irregular cycles, heavier or lighter bleeding, and the absence of ovulation. FSH production increases, while oestrogen production decreases.
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Menopause: This is the last menstrual period in a woman's life. It is officially reached when a woman has not had a period for 12 months. The ovaries produce almost no oestrogen and progesterone, leading to the end of fertility and the cessation of menstruation.
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Post-menopause: This is the period from a year after the last menstruation. In this phase, the ovaries no longer produce hormones, and the body reaches a new hormonal balance. It can take several years for the body to adjust to these changes. Symptoms of the transition may still be present as the hormonal balance is restored.
Want to know more? Read about what exactly happens in your body during the transition here.
