Demystifying Menopause
As you know, this is an important topic for women and their partners, families and friends. We’re all affected by changes in hormones at various stages of life. But, the erratic diminishing of and then final turning off of vital hormones that leads to Menopause, roughly mid-way through the modern lifespan, dramatically impacts the remaining health span of these individuals.
What exactly is Menopause?
The roots of the word Menopause trace back to ancient Greek where “menos” means monthly and related to the word moon, and “pausis” means to cease or stop. So, the time when a woman’s monthly cycles, associated with the moon, end. A functional definition of Menopause is: The day that falls 12 months/ 365 days / 1 year from the last menstrual period, which allows you to look back and know that that was the final monthly cycle or Menopause.
After that day is considered to be Postmenopause, when estrogen and progesterone levels remain close to zero. The 5-15 years before that day, when ovulation may be inconsistent and therefore hormones fluctuating in new/different/ erratic ways are considered to be Perimenopause.
So, with our current definitions and understanding, Menopause is actually just a fleeting moment of recognition that monthly cycles have completely ended. It is most useful to discuss Perimenopause and Postmenopause, as these are the phases when the body is experiencing changes due to the changing levels of specific hormones. Whereas people might say they went through Menopause, the transition time that women go through is actually Perimenopause and starts earlier than you might realize.
What happens during Perimenopause?
Perimenopause is the time “around menopause” or the menopausal transition which can start from the mid-30s to mid-40s. The female body transitions from having menstrual cycles to not having menstrual cycles as the ovaries gradually stop releasing eggs and hormones to support reproduction. It is a natural process, but not a smooth on-off transition.
The menstrual cycle may shorten or lengthen with unpredictable timing, and there may be cycles where there is no ovulation (the ovaries don’t release an egg). There may be heavier or lighter bleeding than before, variable number of days of bleeding, and skipped bleeding. During this time, the levels of estrogen and progesterone are rising and falling unevenly, and are overall lower than before.
We have estrogen receptors all throughout the body – such as in the brain, muscle and skin, not just in the reproductive organs. Estrogen has a role on brain, muscle, skin and hair health, in addition to reproductive health, and more. This is why fluctuating levels of estrogen have broad impact and can lead to variable symptoms. Changes or symptoms during Perimenopause include but are not limited to*:
Irregular periods
Sleep disruption
Hot flashes / night sweats
Brain fog / Trouble concentrating
Headaches
Mood changes that may be related to hormone changes, sleep disruption, or other factors
Vaginal tissue changes like dryness due to decreased estrogen which normally stimulates collagen, elastin and lubrication
Urinary tract infections
Urinary incontinence
Changes in sexual arousal and desire
Dry eyes
Dry skin
Hair loss
Weight changes
Insulin resistance
Heart Palpitations
Joint and muscle aches
Bone loss
Muscle loss
Changing cholesterol levels
Changing gut microbiome
*Perimenopause is a diagnosis of exclusion as these symptoms could be from a variety of other conditions. You need to discuss with your healthcare provider to evaluate your specific situation.
On top of all of that, it is important to note that although cycles may be different and eventually infrequent, it is still possible to get pregnant during this time, until complete cessation of menstrual cycles, that Menopause milestone.
What happens in Postmenopause?
Postmenopause is the time after the cessation of menstrual cycles for more than 12 months, which happens on average around age 52. Estrogen and progesterone levels remain close to zero because the ovaries make very little hormone by this point. Many symptoms that were experienced during Perimenopause may get milder or go away, but sometimes persist. Some, such as bone loss, muscle loss, weight changes, insulin resistance, and changes in cholesterol tend to accelerate in the absence of estrogen. Without support to mitigate these changes, they can lead to increased risk of osteoporosis, diabetes, and heart disease.
So, we have the years leading up to Menopause, with hormones being unpredictable and at variable, generally lower than prior levels. This leads to some degree of changes to the body and metabolism, and potentially some specific symptoms such as vaginal dryness, sleep disruption, or hot flashes, to name a few. And then we have the years after Menopause, when the hormones have completely dropped off the cliff, which accelerates these changes in the body and metabolism.
Why do we have to Demystify Menopause?
Humans did not used to live as long as we do on average in the modern world and there has been a gap in education, research, healthcare, and lifestyle support regarding Perimenopause and Postmenopause and women’s health. Half of the world’s population will go, or have gone through the menopause transition. They do not have to suffer silently, without resources and support to optimize their health span in this phase. In the past 20 years doctors have not been trained in Menopause during Medical school. The education was just left out, largely due to the misunderstanding of and fear generated by the Women’s Health Initiative study, and the absence of training in Lifestyle factors (Nutrition, Sleep, Exercise, Stress Modulation) in conventional medicine. Now we understand a lot more about what that study actually showed, and there are ways for doctors to get training, for example through The Menopause Society and fellowships in Integrative Medicine.
Can we mitigate the changes that precede and follow Menopause?
In short, Yes! There are many things we can do to mitigate these changes and address symptoms to optimize health span during the second half of our lifespan. In an ideal world, we can be proactive and bolster the system before these changes start or early on, and have a better base going into Perimenopause. Realistically there are many reasons why being proactive might not be an option, or possible, or accessible. So, in reality the best time to start really is now, from wherever you are, and be persistent, patient, and consistent.
Menopause and the years leading up to, and after it have many different faces and experiences because after all we are individuals with different bodies, life experiences, hormone levels, genetics, and lifestyle factors. That is the piece that can feel overwhelming, confusing, and lonely as we navigate our own journey. But it is imperative to know that there are some common denominators that most women in this age range, whatever their personal journey looks like, can benefit from, have agency over, and build community around. In upcoming posts we will start digging into specific pearls that you can start applying to your own journey.