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Pathophysiology of Menopause, Signs and Diagnosis

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Menopause is the permanent cessation of menses for 12 months resulting from estrogen deficiency and is not associated with a pathology. The median age of menopause is 51. Most women experience vasomotor symptoms, but menopause affects many other areas of the body, such as urogenital, psychogenic, and cardiovascular.

Hormonal Changes

Menopause is a normal physiologic process in aging women in which the number of ovarian primary follicles quickly diminishes, such that there are inadequate amounts to respond to the effects of FSH. As ovaries age, their response to the pituitary gonadotropins FSH and LH decreases, initially causing a shorter follicular phase, fewer ovulations, and decreased progesterone production. During menopausal transition, double ovulation and luteal out-of-phase events occur and occasionally cause oestradiol levels to be above normal. The number of viable follicles decreases; eventually, the remaining follicles do not respond, and the ovaries produce very little estradiol. Estrogens are also produced by peripheral tissues (e.g., fat, skin) from androgens (e.g., androstenedione, testosterone).

The decline in estrogen levels leads to increased secretion of FSH and LH by the pituitary gland in a negative feedback loop. FSH levels rise more than LH levels because estrogen inhibits FSH more than LH. The elevated FSH levels stimulate the remaining follicles to produce more oestradiol, resulting in erratic fluctuations of estrogen levels during perimenopause. The decreased progesterone levels cause irregular and heavy menstrual bleeding due to unopposed estrogen stimulation of the endometrium.

Clinical Manifestations

The clinical manifestations of menopause vary widely among women and depend on several factors, such as genetics, lifestyle, health status, and previous use of hormonal contraception or therapy. The most common symptoms are vasomotor symptoms (hot flashes and night sweats), which affect about 75% of women and can last for several years. Vasomotor symptoms are caused by changes in the thermoregulatory centre in the hypothalamus due to estrogen withdrawal. They are characterized by sudden sensations of heat in the upper body, face, and neck, followed by sweating and chills. They can be triggered by stress, alcohol, caffeine, spicy foods, or warm environments.

Other symptoms of menopause include:


The diagnosis of menopause is clinical: absence of menses for 1 year. Hormone variations are common, and it is difficult to diagnose menopause based on hormonal levels. In rare situations specialist may prescribe blood tests to check levels of FSH and estrogen


The treatment of menopause depends on the severity of symptoms and the individual preferences of each woman. The main goals are to relieve symptoms.

Menopause is a natural transition that affects women’s health and well-being. If you want to learn how to care for women around the menopause, you can join our virtual course: Caring for women around the menopause. This is a 4-hour interactive course that covers the basics of menopause and how to help women make healthy choices for their future. It is suitable for primary care nurses, ANPs, and other healthcare practitioners who work with peri-menopausal women.


 What is the menopause and what are the signs? - BBC News. (2019, May 14). Retrieved from https://www.bbc.co.uk/news/health-48258910

What Are The 34 Symptoms Of Menopause? | UK Meds. (2019, October 21). Retrieved from https://www.ukmeds.co.uk/blog/what-are-the-34-symptoms-of-menopause

Menopause - NHS. (n.d.). Retrieved from https://www.nhs.uk/conditions/menopause/