The Menopause Quiz

See Causes. Option B is correct. Women are born with a fixed number of eggs, and the menopause is the point at which that store is used up and the ovaries stop working. As follicles (the small fluid-filled sacs in the ovary that each contain an egg) fail, the ovary makes less oestrogen and less inhibin (a hormone that restrains FSH). Falling oestrogen disrupts the menstrual cycle and causes the typical symptoms: vasomotor symptoms, meaning hot flushes and night sweats caused by unstable temperature control, as well as vaginal dryness and mood changes. Oestrogen normally holds back the pituitary gland, the small hormone gland beneath the brain, through negative feedback (a signal that shuts down its own source). When oestrogen falls, the brake is released and FSH and luteinising hormone (LH) rise. The usual menopausal pattern is therefore low oestrogen with persistently high FSH and LH, but the raised FSH is a result of ovarian failure and not the cause of the symptoms. Memory aid: the symptoms follow what is lost (oestrogen), while the blood test shows the pituitary shouting for it (FSH).

• Cause: the egg store is used up and follicles fail, so the ovaries make less oestrogen and inhibin.
• Symptoms: they follow falling oestrogen: hot flushes, night sweats, vaginal dryness and mood changes.
• Pituitary: the negative feedback brake is released, so FSH and LH rise.
• Blood test: low oestrogen with persistently high FSH and LH.