At the time of puberty, the inactive ovary throttles into activity following stimulation from brain-derived hormones resulting in menstrual flow and regular ovulation.
The ovary is an organ that produces a multitude of hormones that control reproduction and play a role in other functions such as wellness, and heart and bone health.
Hormone and oocyte production from the ovary is not infinite and these processes are closely controlled by an individual’s genes and environmental influences.
Human female reproduction is a well-orchestrated process starting at puberty through adulthood and concludes with menopause. It is a process that is mirrored in body changes.
At the time of puberty, the inactive ovary throttles into activity following stimulation from brain-derived hormones resulting in menstrual flow and regular ovulation. Data shows changes in timing with earlier onset in recent times.
The ovary is an organ that produces a multitude of hormones that control reproduction and play a role in other functions such as wellness, and heart and bone health.
Hormone and oocyte production from the ovary is not infinite and these processes are closely controlled by an individual’s genes and environmental influences.
The ages of 20 and 35 years correspond to the highest reproductive potential.
However, these biological processes may be modified to suit individual preferences using modern lifestyles, but the biological clock is always ticking in the background.
It is not always the case that this is easily noticeable, especially with the use of modern contraceptive.
Technological advancement makes it easy for cycle tracking applications to inform us of certain events, for instance, when to expect a period flow or optimal time for fertility.
Changes in cycle patterns could reflect important functional activities within the ovary. Though not accurate in predicting the biological clock, it may give cues that certain milestones.
Final menstrual period
In 2001, a team of experts convened the stages of the reproductive ageing workshop (STRAW) to propose that the female adult life is distinguishable into three broad phases; reproductive, menopause transition, and post-menopause.
These three stages are hinged upon the final menstrual period and are not necessarily age-dependent, though most women have the final menstrual period at the age of 51.
There appear to be important biological changes that happen during the menopause transition period.
It is a time when reproductive potential declines, menstrual cycle changes manifest, and variations in hormonal activities become noticeable.
The menopause transition is closely linked to the ovarian functional potential that is measurable through ovarian reserve testing. When ovarian reserve starts to decline, hormonal outputs change and there may be cycle variations.
Individual women have a near-constant menstrual cycle. During menopause, cycle lengths begin to shorten.
Sexual drive
It is during the menopause transition also that women notice the onset of certain symptoms such as hot flushes and night sweats, tiredness and mood changes, vaginal dryness, and to some extent urinary symptoms.
There may also be changes in sleep patterns and sexual drive and desire.
At the heart of these symptoms is a decline in production of the hormone oestrogen by the ovaries.
Oestrogen is also important in maintaining bone and heart health. It is therefore important to pay more attention to the menopause transition than waiting for the final menstrual period.
How to cope
As the final menstrual period occurs on average at the age of 51 and the menstrual transition could take anywhere between 5 and 10 years, it appears sensible that after 40, health professionals and women should focus on wellness.
—Maintain a healthy lifestyle
— Screening for breast and cervical cancer
—Make enquiries into symptoms of the menopause transition. There are no tests that are undertaken to establish this important time in reproductive ageing.
—In addition to the quality of life and wellness, there is mounting data that indicate heart health protection when replacement of oestrogen is offered earlier in the menopause transition based on what is known as the threshold hypothesis.
— Be keen on healthy dietary practices including adequate intake of calcium and vitamin D.
—Consider hormone replacement. We advocate body identical hormone replacement. These are hormones similar to what the body produces naturally and are safe. It is important that prescription and monitoring of hormone replacement are undertaken by properly trained and experienced health professionals.
There is no limit to the duration of use of hormone replacement, however, a review should be made and an agreement reached on when it could be stopped depending on symptom relief.
Dr Muteshi is a consultant obstetrician gynaecologist and fertility expert at Aga Khan University Hospital, Nairobi
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