Menopause: Basic Information for Africans

By: Foluke Akinwalere. Freelance Health Writer. Medical review and editorial support provided by the T.N Mungchieng MD and O Oni, MD

 

AI generated image of three African women of menopausal age posed standing in colourful attire with middle one holding a menopause sign. 

 

Highlights

• Menopause is a natural and progressive  process that marks the end of a woman’s menstruation and by extension, reproductive years. It occurs usually between the ages of  45 and 55 years.

• Menopause begins over a period of time and has been grouped into four phases that can last several years before menstruation stops completely.

• Menopause symptoms vary for every woman. Some women experience mild symptoms, while others face intense changes.

• Some women may experience early or premature menopause due to genetics, medical treatments (such as chemotherapy), or surgical removal of the ovaries.

• Menopause increases health risks of a woman as a result of lower estrogen levels, making a healthy lifestyle essential during and after menopause.

• Some African societies see menopause as a sign of wisdom and respect, while others associate it with myths and stigma. These diverse viewpoints  highlight  the need for more open conversations and awareness of the condition.

 

Introduction

Menopause is a significant milestone in every woman’s life.  It is a natural phase that signals the end of childbearing years, and brings a mix of physical, emotional, and social changes in a woman’s life. 

In Africa, menopause is frequently misinterpreted, surrounded by myths, and sometimes viewed through cultural lenses. That is why many African women find it difficult to discuss menopause openly due to the cultural beliefs and societal expectations. The subject matter is covered in silence and misunderstanding, leading to confusion, fear, or feeling of isolation. 

Menopause is not a disease or a sign of failure as regarded by many African communities. It is a transition phase just like getting into the adolescence, adulthood, or motherhood phase. Understanding this natural phase of life is crucial for African women to manage it confidently and live healthily.

This article provides detailed information on menopause, including its phases, types, symptoms, associated health disorders, common myths in Africa, and answers to frequently asked questions.

 

What is Menopause?

Menopause is a natural process that occurs when a woman permanently stops having menstrual periods, marking the end of her ability to have children.  It happens because the ovaries stop producing as much estrogen and progesterone, the hormones that control menstruation. It usually occurs between ages 45 and 55 and is confirmed after 12 months without a menstrual period.

 

Phases of Menopause

Menopause occurs in different phases.  To better understand menopause, you need to understand the different phases as shown in Figure 1 below:

Fig. 1: showing infographic representation of the phases of menopause. Click on image to enlarge.

 

1. PREMENOPAUSE

• This refers to the entire reproductive phase before menopause, when a woman has regular or irregular menstrual cycles and normal hormone levels.
• Estrogen and progesterone levels fluctuate within normal range, supporting ovulation and fertility
• Hormonal changes may begin to occur 8 - 10 years before actual menopause occurs, but these are not evident to women.
• No menopause symptoms
• Begins in woman’s late 30s or early 40s

2. PERIMENOPAUSE

• Often referred to as menopausal transition, this is the build-up to menopause.  It is marked by irregular menstrual cycles, mood swings, and other hormonal changes.
• The perimenopausal phase may last averagely 4 years.
• For many African women, the phase can be confusing as symptoms may feel random or unrelated to menopause.

3. MENOPAUSE

• This is the point at which a woman’s menstrual cycle stops completely for a whole year and doesn’t come back.  It often occurs between the ages of 45 and 55.
• Hormone production in the ovaries (primarily estrogen and progesterone) has significantly decreased.

4. POSTMENOPAUSE

• The years following menopause are often a time of self-discovery, but they may come with increased health risks such as osteoporosis and heart disease due to reduced estrogen levels.

 

Age Association

The age for natural menopause in women worldwide is typically 45 to 55 years. However, some women may experience menopause earlier, before the age of 40.  This early onset of menopause could be due to specific chromosomal abnormalities, autoimmune conditions, or other unknown causes. [1]

Factors that influence the timing include:

• Genetics: Family history often determines the onset of menopause
• Lifestyle Choices:  Smoking, excessive alcohol consumption, or poor nutrition
• Medical Interventions: Surgery (e.g. oophorectomy), chemotherapy, or radiation therapy

 

Types of Menopause

• Natural Menopause

This occurs gradually as a woman ages and her ovaries stop producing eggs causing her estrogen and progesterone levels to reduce. This happens between ages 45 and 55

• Premature and Early Menopause  

This is when menopause occurs before the expected age range. Premature menopause happens before the age of 40 while early menopause occurs between age 40 and 45. Both may be caused by genetic factors , autoimmune diseases, lifestyle factors (like smoking)  or medical conditions.

• Surgical and Induced Menopause  

This is a menopause caused by a medical procedure. This happens when a woman undergoes surgery to remove both ovaries (Oophorectomy), or as a result of medical treatment like chemotherapy, radiation, or medications that suppress the functions of the ovaries. Both lead to a sudden drop in hormone levels and immediate menopause symptoms.

 

How Does Menopause Occur?

For many African women, understanding this biology of menopause can feel overwhelming or even unnecessary, especially when cultural beliefs often link this stage of life to myths or spiritual interpretations. But menopause is simply a natural process, determined by the body’s hormonal changes.

Throughout a woman’s life, her body works like a well-coordinated team, with hormones like estrogen and progesterone controlling her reproductive cycle. During her reproductive years, the ovaries release an egg each month, making it available to be fertilized by sperm for the possibility of pregnancy. This process is called ovulation. [2] If the egg is not fertilised, it causes her monthly menstrual period. 

As a woman ages, the ovaries naturally slow down her activity.  This is not a failure or a problem—it’s part of the body’s design.  The number of eggs in the ovaries reduces over time, and so does the production of estrogen.  This hormonal shift is what eventually brings an end to monthly periods and marks the transition into menopause.

Learn more about Ovulation here

It’s important to remember that menopause doesn’t happen overnight.  The body gives signs as it prepares for this transition, though they can be easily missed or misunderstood.

 

How Can I Recognise the Arrival of Menopause?

Fig 2: Infographic: Symptoms of  menopause . Click on imageto enlarge. Image credit Freepik

 

Recognising the signs of menopause can be confusing. Often, the changes begin gradually and may be dismissed as stress, aging, or even in cultural mythical terms.  Some women are hesitant to speak about their symptoms because they fear judgment or misunderstanding, but knowing what to expect can help ease the transition and empower you to seek the right support.

 

Early Signs of Perimenopause

The first signs of menopause often appear during perimenopause.  These changes may feel unfamiliar and even worrisome especially if no one around you talks openly about them.

Here are some early signs: (See also figure 2)

• Irregular Periods: You might notice your menstrual cycles becoming unpredictable—it may be shorter, longer, lighter, or heavier than usual.  This is one of the first clues that your body is preparing for menopause.
• Hot Flashes:  A sudden wave of heat, often felt in the chest and face, which may be followed by sweating.
• Mood Changes:  You may experience irritability, anxiety, or sadness.
• Sleep Problems: Difficulty sleeping, often and hormonal changes, can leave you feeling tired.
• Vaginal Dryness or Discomfort: You may experience itching, dryness, or discomfort during sexual intercourse, which is often misunderstood or left unaddressed.

 

Signs of  Menopause

Once you’ve gone 12 months consecutive without a menstrual period, you have officially entered menopause. [1]  By this point, some symptoms may become more persistent or noticeable:

• Hot Flashes and Night Sweats:  These may continue, sometimes disrupting daily activities or sleep.
• Physical Changes:  You might notice thinning hair, dry skin, or weight gain, especially around the abdomen.
• Emotional Impact:  The emotional toll of menopause, combined with societal pressures or cultural expectations, may lead to feelings of inadequacy or sadness.

For many African women, these symptoms are dismissed as “normal aging” or even spiritual afflictions. Recognising these changes as part of a natural biological process is key to seeking support.

 

Common Health Concerns Associated with Menopause

The changes that come with menopause can increase the risk of certain health conditions (see figure 3):
 

Fig 3: Health effects of menopause

 

1. Osteoporosis (Bone Weakening)

Osteoporosis is a condition marked by changes in bone structure and strength, resulting in decreased bone strength and an increased risk of fractures.  In women, osteoporosis can be caused by hormonal changes, such as low estrogen levels after menopause, absence of menstrual periods in premenopausal women. [3]  Adding calcium-rich foods like milk, fish, and green vegetables into your diet can help to strengthen bones, slow bone loss, and reduce the risk of fractures.

2. Heart Disease

Lower estrogen levels can increase the level of bad cholesterol and the risk of heart disease. Regular physical activity and heart-healthy foods such as beans, nuts, and fruit can help to reduce the risk.

3. Weight Gain and Slow Metabolism

Hormonal changes can lead to weight gain, especially around the abdomen. A balanced diet and exercise are essential to manage these changes.

4. Mental Health Challenges

Feelings of anxiety, depression, or isolation are common during menopause. In African communities, where mental health discussions are still stigmatised, women may hesitate to speak up.

5. Vaginal and Urinary Issues

During menopause, the vaginal, bladder, and urethral valves tissues may lose elasticity, which can result in sudden, strong urges to urinate or even involuntary leakage.  Simple actions like coughing, laughing, or lifting may also lead to urine leakage, which potentially increases the risk of urinary tract infections. Seeking medical advice can help manage these symptoms.

 

When To Seek Support

The symptoms of menopause can be overwhelming for some women. And this may interfere with their daily life, emotional well-being, and overall health.  Knowing when to seek support is crucial in ensuring you remain healthy, comfortable, and empowered during this phase.

While mild symptoms like occasional hot flashes, or mood swings are common and manageable, certain signs may indicate the need for professional help:
 

• Excessive Bleeding or Prolonged Period During Perimenopause

If your periods become extremely heavy, last more than a week, or occur unusually close together, it could signal underlying health issues such as fibroids, hormonal imbalances, or other conditions.  These require prompt medical evaluation.

• Postmenopausal Bleeding

Any unusual vaginal bleeding after a year without a period is considered “postmenopausal bleeding” and should be investigated by a healthcare professional.

• Severe Hot Flashes or Night Sweats

When hot flashes become so intense that they disrupt your sleep or make it difficult to function during the day, seeking support can help.  Hormonal therapy or alternative treatments may provide relief.

• Unexplained Emotional Distress

If feelings of sadness, irritability, or anxiety become overwhelming or persistent, it may not just be “a phase”.  Depression and anxiety can intensify during menopause, particularly for women who feel isolated or unsupported in their communities.

• Painful Intimacy or Vaginal Discomfort

Vaginal dryness, itching, or discomfort during intimacy is common but often unspoken due to cultural sensitivities.  If these symptoms affect your quality of life or relationships, don’t hesitate to consult a healthcare provider for options like lubricants, moisturisers, or estrogen creams.

• Bone or Joint Pain

Persistent pain or frequent fractures should prompt you to see a doctor for preventive care, like bone density tests or calcium and vitamin D supplementation.

• Significant Weight Changes

Rapid weight gain, especially around the abdomen, or an inability to manage weight despite healthy eating and exercise, could indicate metabolic changes.  A healthcare provider can guide you on diet, exercise, and possible medical interventions.

• Heart Palpitations or Chest Pain

Hormonal shifts during menopause can sometimes mimic heart-related symptoms.  Any unusual chest discomfort, shortness of breath, or irregular heartbeat should be addressed immediately, as they could indicate cardiovascular concerns.

• Extreme Fatigue or Lack of Energy

While menopause can cause tiredness, extreme or persistent fatigue that leaves you feeling unable to carry out daily tasks might signal underlying conditions like anaemia, thyroid issues, or depression.

 

Who To Turn To For Support

• Healthcare Providers: Gynecologists, family doctors, General Practitioner or Nurse, can provide tailored advice, treatments, or reassurance.
• Support Groups or Communities:  Whether online or in-person, connecting with other women going through menopause can help you feel less alone and more understood.
• Family and Friends:  Sometimes, simply talking about what you’re experiencing can lighten the emotional load.  Let your loved ones know how they can support you.

 

Conclusion 

Menopause is a natural part of life that brings changes and challenges, but with knowledge and preparation, it can be a manageable and even empowering phase.  Understanding menopause’s symptoms, health risks, and myths can help African women navigate this transition confidently.

 

References

1.  World Health Organisation (WHO), Menopause, [Internet] 16 October, 2024. Accessed: January 21, 2025. Available from here.

2.  Obialor B. How To Determine Your Fertile Window For Pregnancy: A Guide For African Women. [Internet]. May 06, 2024. Datelinehealth Africa Inc. (Accessed: January 22, 2025)  Available from here.

3.  Onyenekwe V. 10 Common Hormone-Linked Disorder in African Women. [Internet]. September 19, 2024. Datelinehealth Africa Inc.  Accessed January 23, 2025. Available from here

 

 

Related:

• How To Determine Your Fertile Window For Pregnancy: A Guide For African Women
• Demystifying the Menstrual Cycle for African women 
• 10 Common Hormone-Linked Disorders in African Women

 

Published: February 7, 2025

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