As a menopause specialist, I’ve spent years helping women navigate the complex—and often confusing—journey of menopause. One of the most frequent questions I hear is, “Why does this happen?” It’s a fair question. Understanding the science behind menopause can empower you to better manage your symptoms and make informed decisions about treatment. So, let’s break down exactly what happens during menopause, specifically the decline of ovarian function, and why it matters.
The Role of Ovaries in Hormonal Balance
Let’s start with a basic biology refresher. Your ovaries—those two small, almond-shaped organs—have been quietly running the show for decades, producing eggs and hormones like oestrogen and progesterone. These hormones regulate not only your menstrual cycle but also a whole host of other functions, from bone density and heart health to mood regulation and skin elasticity. In short, they’re critical players in keeping your body balanced.
As you approach your late 40s and early 50s, your ovaries start to change. They become less responsive to the signals sent from the brain to release eggs. This process, known as ovarian function decline, is the key driver behind the onset of menopause.
The Science of Ovarian Function Decline
Menopause doesn’t just happen overnight—it’s a gradual process, often spanning several years in a phase known as perimenopause. During this time, your ovarian function begins to decline, and your body starts producing less oestrogen and progesterone. This hormonal shift is what triggers the familiar menopause symptoms like hot flushes, night sweats, irregular periods, and mood swings.
Your ovaries have been responding to signals from the pituitary gland in the brain for decades, releasing eggs during your reproductive years. The hormone follicle-stimulating hormone (FSH) triggers the ovaries to mature and release eggs, and in return, the ovaries produce oestrogen. As the number of viable eggs decreases with age, the ovaries produce less oestrogen. This, in turn, sends your pituitary gland into overdrive, increasing FSH production in an attempt to coax more eggs into maturing.
But here’s the thing: by this point, your ovarian reserves are depleted. The ovaries can no longer keep up, leading to increasingly irregular cycles until menstruation stops altogether. When you’ve gone 12 consecutive months without a period, you’re officially in menopause.
Why Oestrogen Decline Hits Hard
Oestrogen is often the star of the show when we talk about menopause because its decline is responsible for so many of the symptoms that women experience. But oestrogen’s job doesn’t end at regulating your menstrual cycle.
- Bone health: Oestrogen plays a vital role in maintaining bone density. As oestrogen levels drop, you become more susceptible to osteoporosis, which is why post-menopausal women are often at a higher risk for fractures.
- Heart health: Oestrogen helps regulate cholesterol levels and supports cardiovascular health. When levels decline, your risk for heart disease increases, which is something I always discuss with my patients when we’re reviewing long-term health plans.
- Mood and mental health: Oestrogen also affects serotonin levels, the “feel-good” chemical in your brain. That’s why mood swings, anxiety, and even depression can make an appearance during menopause.
- Skin and hair: You might notice drier skin, thinning hair, and even more pronounced wrinkles as oestrogen drops. While these are often seen as “cosmetic” issues, they can take a toll on how you feel about yourself, which is just as important.
The Importance of Progesterone
While oestrogen often steals the spotlight, progesterone plays a key role during menopause as well. As ovarian function declines, progesterone levels drop, leading to irregular and sometimes heavier periods during perimenopause. Progesterone helps regulate the menstrual cycle and prepares the uterus for pregnancy. Without it, the lining of the uterus becomes less stable, which can result in unpredictable bleeding patterns.
For women on Hormone Replacement Therapy (HRT), progesterone is often included alongside oestrogen to protect against the risk of endometrial hyperplasia (thickening of the uterine lining), which can happen when oestrogen is unopposed by progesterone.
What Happens After Menopause?
Once you’re officially post-menopausal (12 months without a period), your ovaries stop producing significant amounts of oestrogen and progesterone. At this point, your body has to adjust to a new “normal” with these much lower hormone levels. While some women find that their symptoms ease after menopause, others may continue to experience hot flushes, vaginal dryness, or sleep disturbances for years afterward.
This is where treatments like HRT can be beneficial. By supplementing the hormones your body is no longer producing, HRT can alleviate symptoms and help protect your long-term health. HRT tablets, patches, and HRT gels can all provide relief, and now, you can even buy HRT online in the UK or arrange for a private menopause consultation to discuss your options.
Should You Consider HRT?
The decline in ovarian function and the resulting symptoms of menopause are natural, but that doesn’t mean you have to just “put up with it.” Hormone Replacement Therapy is one of the most effective treatments for managing symptoms like hot flushes, night sweats, and mood swings. For women dealing with severe symptoms, HRT can be life changing. There are various forms, such as HRT patches or bioidentical hormone therapy, that can be tailored to your needs.
However, HRT isn’t for everyone. If you have a history of breast cancer, heart disease, or blood clots, for example, you’ll want to carefully weigh the risks and benefits with your doctor. But for many women, particularly those under 60 or within 10 years of menopause, the benefits often outweigh the risks. I always recommend speaking to a menopause specialist to explore your options, whether it’s through a private HRT prescription or booking a menopause clinic appointment.
Final Thoughts: Understanding Your Body
The science behind menopause is complex but understanding the role your ovaries play in this process can give you valuable insight into your body’s changes. Menopause marks the end of your reproductive years, but it doesn’t have to mean the end of feeling good in your own skin. Whether it’s managing symptoms through lifestyle changes or opting for HRT, the key is finding what works best for you.
Don’t hesitate to reach out to a menopause specialist or HRT doctor to explore your options. The decline of ovarian function is inevitable, but suffering through the symptoms doesn’t have to be. Whether you’re searching for menopause hormone therapy in London or considering a private menopause specialist in the UK, help is out there—you just need to take that first step.