You don't know what causes the menopause. Get an overview here.

The natural menopause

The natural menopause is a process in which a woman permanently stops menstruating without medical intervention. This process is usually described in three phases: Perimenopause (premenopause), menopause and postmenopause.

When the ovaries no longer have any functioning eggs, the menopause occurs naturally in women.

At birth, most women have around 1 to 3 million eggs, which decrease over time. By a girl's first period, there are on average about 400,000 eggs, and by the time of menopause, a woman may have fewer than 10,000 eggs. Of these, most die through a process called atresia and a small number are lost through normal ovulation (the monthly cycle).

Normally, the hormone responsible for the growth of follicles (egg cells) in the first half of a woman's menstrual cycle is follicle-stimulating hormone (FSH). The remaining egg cells become more resistant to FSH as the menopause approaches. As a result, the ovaries significantly reduce their production of the hormone oestrogen and the menopause occurs.

The medically induced menopause

Not all women go through the menopause naturally; some women go through the menopause as a result of medical treatments such as chemotherapy, radiotherapy or surgery. This is known as a medically induced menopause.

A surgical menopause occurs when a woman's ovaries are surgically removed before the menopause (so-called bilateral oophorectomy), which leads to an abrupt onset of the menopause and often to more severe menopausal symptoms than with a natural menopause.

The bilateral oophorectomywhich is the surgical removal of both ovaries, is usually performed to treat cancers such as cervical, endometrial and ovarian cancer. However, it can also be performed for non-cancerous conditions such as uterine fibroids, endometriosis or infections.

A hysterectomyin which the uterus is removed may or may not include a bilateral oophorectomy, depending on the case. If the ovaries are not removed, a hysterectomy does not usually lead to menopause and the ovaries usually remain functional.

Other operations in which both ovaries can be removed are abdominal resection for colon and rectal cancer and the total pelvic exenteration for recurrent cervical cancer.

For the abdominal resection usually involves removing the lower colon and rectum. However, the surgeon can also remove part or all of the uterus as well as the ovaries and posterior vaginal wall.

With the total pelvic exenteration the surgeon removes most of the pelvic organs, including the uterus, cervix, ovaries, fallopian tubes, vagina, bladder, urethra and part of the rectum.

In addition, medical treatments such as chemotherapy and pelvic radiation can damage the ovaries and induce menopause, although this is not the case for all women who undergo these treatments.

As a woman, you should be aware that the effects of these medical interventions on the menopause can vary from woman to woman and do not always lead to permanent damage or induced menopause.