What actually is menopause? Why does it even happen? And why is there a silence surrounding it when nearly 50 percent of the population will go through it?

There is a lack of public and cultural knowledge surrounding menopause. In the media, it is mostly viewed in a negative light with references and jokes about hot flushes, mood swings, and decreased sex drive. While there are plenty of movies about puberty (such as Turning Red), there are a limited number of happy coming-of-age stories related to menopause.

Most people with uteruses spend a third to half of their lives postmenopausal, yet it is almost never discussed or taught in school. This lack of communication has resulted in an information vacuum.

“Menopause is like being sent on a canoe trip with no guidebook and only a vague idea where you are headed — although the expectation is it will be awful,” said Jen Gunter in a piece for TED.

But what actually is menopause? Why does it even happen? And why is there a silence surrounding it when nearly 50 percent of the population will go through it?

Normally, humans have one to two million unmatured eggs at birth, encased in the follicles in the ovaries. During puberty, the hypothalamus starts releasing estrogen which wakes up the dormant eggs. Over the next few decades, different hormones begin the dance to help a mature egg leave the follicle and travel down the fallopian tube. This then leads the body to build up the lining of the uterus – and if the egg is not fertilized, the lining is shed, and this results in a period.

Menopause can be thought of as puberty in reverse, typically occurring around the ages of 45 and 55 – although it can be earlier, for example, due to the surgical removal of the uterus and/or ovaries. Technically it is diagnosed one year after the final period, but normally it is referred to as the entire time when the menstrual cycle is changing the length. This process can last several years.

It can cause a cascade of symptoms like irregular bleeding to – finally – no bleeding at all, heart palpitations, migraines, joint pain, change in weight, skin changes, vaginal dryness, and recurrent urinary tract infections. Also, neurological changes like mood changes, brain fog, hot flushes, and difficulty sleeping can occur. These symptoms can last months or years and can last well after your periods stop.

The brain is part of the neuroendocrine system, and the ovaries constantly talk to the brain and vice versa. Estrogen typically starts to fade in midlife. The bad thing is that this reproductive hormone is also needed for brain function – specifically, energy production in the brain. Going down to the nitty gritty details, estrogen pushes neurons to burn glucose to make more energy, and the level declines the neurons start aging faster and start to slow down. Unfortunately, this process can contribute to the formation of structures called amyloid plaques: a hallmark of Alzheimer’s disease. Luckily, not all people who go through menopause develop plaques, and not all people who develop these plaques develop Alzheimer’s disease.

Estrogen affects very specific parts of the brain; the hypothalamus, brain stem, amygdala, and hippocampus. The hypothalamus is key in regulating body temperature, which causes hot flushes. The brain stem oversees waking and sleeping, and when not activated properly by estrogen this causes trouble sleeping. The amygdala and hippocampus are very close together and are the centers for emotion and memory, so changes in this can cause mood swings and forgetfulness. Despite all these changes, there are no differences in cognitive performances between the sexes before and after menopause.

Although, there has been debate about the pros and cons, one treatment that can help during and around menopause is hormone replacement therapy (HRT). This treatment is very effective for treating some menopausal symptoms, like hot flushes. It also seems to reduce bone fracture risk, which is important as osteoporosis and bone fractures can be a problem due to declining estrogen levels affecting bone density. Along with HRT, there are also lifestyle changes often recommended by doctors, such as the Mediterranean diet.

It may seem counterproductive that menopause even occurs, but there are two competing theories for this phenomenon: the grandmother hypothesis (if the reproduction stops then they can care for any existing grandchildren), a fluke of nature, or a combination of both.

Overall, it is something that affects millions of people worldwide every year, and more needs to be done to help public knowledge and care.

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