Perimenopause and Menopause and beyond
We all know that menopause marks the end of female reproduction. No more periods. No more PMS. But you can only know if you are officially menopausal until after the fact! Only after you have gone 12 consecutive months without a period can you be sure.
Although menopause and some of the symptoms that go with it tend to be fairly well known, there are actually different stages within the menopause transition which are important to recognize and understand.
Perimenopause means “around menopause.” It’s also known as the menopause transition because it’s the phase leading up to menopause. Although many women in the 40s think that menopause is a long way off (how could I even be close??), the symptoms can start much, much earlier than the time your period actually stops! Although they’re both part of the same overall life transition, menopause and perimenopause have different symptoms and treatment options.
Image credit of www.cemcor.ubc.ca
PERIMENOPAUSE
Perimenopause usually starts in your 40s, but can even start for some in their 30s and lasts anywhere 4 to 8 years but can even be longer. But what it less known about perimenopause is that this is the time that all of those not-so-fun symptoms that most women associate with menopause (it CAN’T be that! I am still so young!!) begin to surface around this time. And because so many women - and their health providers - aren’t aware of what to look for, we think we could be losing our minds!! Just a few things to look out for!
You can’t remember where you put things, or why you walked into the room (brain fog, lack of concentration)
Your once “like clockwork” cycle has gone haywire (periods get closer together at first and then you start skipping)
You are grumpy, irritable and may experience roller coaster moods
You can’t sleep
Your internal thermostat goes crazy! Hot flashes and night sweats are the most common and most troublesome symptoms experienced by most women.
Cravings, insatiable appetite, incontinence, migraines, weight gain, loss of libido….
Are we having fun yet?
The first step to feeling better is recognition. You aren’t going crazy. And you haven’t woken up in someone else’s body (or with someone else’s brain!). This is a normal (but seemingly unfair!) phase of a woman’s life and there is LOTS you can do to ease the transition.
Why you feel like CRAP!
Excerpted from the 1999 issue of Harvard Women’s Health Watch, Presidents and Fellows, Harvard College
Take a look at the first box. That’s premenopause. Everything is cycling regularly. Even if you do have PMS, most of us would at least know when it was coming! And the third box….that’s menopause. Consistent. Although there are health consequences that come with that permanent reduction in hormones, they do remain stable and predictable.
Now. Take a look at the second box. THIS is perimenopause. It looks crazy, because it is pretty crazy. Symptoms of high estrogen, low estrogen, low progesterone at anytime! Can you stop this from happening? Not really. But it’s kind of like the weather. You hear it’s going to rain (or storm as the case may be!); you can’t change it, but you can prepare for it!
MENOPAUSE
You are officially menopausal when you have gone 12 straight months without a period. Menopause usually occurs naturally in a woman’s 40s or 50s, but can happen earlier in women who have had their ovaries removed, which is considered surgical menopause.
As get older, the reproductive cycle begins to slow down and prepares to stop. As menopause nears, the ovaries stop making as much estrogen. When this decrease occurs, your cycle starts to change. First it becomes irregular and you may experience changes in volume, then they stop altogether. After 12 months, you’ve arrived!
POSTMENOPAUSE
No more pads, no more tampons, no more birth control. No worries about pregnancy and many of us with kids are seeing them leave the nest. Yea! Now you can have sex on the dining room table! But Crap! Sex is the last thing on your mind! Who has time (or the need) for that??? (low libido) And dang. It hurts anyway!
For most women, symptoms like hot flashes begin to ease within 1 to 2 years after menopause. This is a good thing! But the decrease in estrogen has it’s own effects on various aspects of your health.
These include (hold on to your hat!!) almost every system in the body! We’ll go over a few here:
HEART/CARDIOVASCULAR SYSTEM
Estrogen may have a positive effect on the inner layer of artery wall. It keeps blood vessels flexible and helps regulate blood flow. That’s why researchers believe a decline in estrogen after menopause may be a factor in the increase in heart disease among post-menopausal women. So even though heart disease is often thought of as a man’s disease, it is actually the leading cause of death in US women.
Even if a woman is symptom-free, she still may be at risk of heart disease. About two-thirds of women who die suddenly of CHD have had no previous symptoms. Evaluating your risk factors and making positive lifestyle changes (even before the onset of menopause) are super important to prevention!
BONE/SKELETAL SYSTEM
There is a direct relationship between the lack of estrogen after menopause and bone loss. Women who’ve gone through menopause are more likely to develop osteoporosis, a condition that causes bone to become brittle and weak.
Like heart disease, you may be at risk without knowing it. Osteoporosis is often called a "silent disease" because initially bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse.
There are lots of ways you can help prevent osteoporosis. Getting enough calcium and vitamin D, weight bearing exercise, being aware of high risk medications are just a few things you can do to lower your risk.
URINARY SYSTEM
Unfortunately, bladder control issues are common in women going through menopause. No more period pads…just pads for pee! Why? Lower levels of estrogen may cause the urethra lining to thin. This, and the pelvic muscles around the urethra can get weaker as you age or due to vaginal childbirth. This can increase the risk of bladder leakage (incontinence), urinary tract infections, and other problems.
SEXUALITY
As we mentioned above, the freedom to have sex any day of the year! No periods, no pregnancy. But many of us don’t want to. WTF? Estrogen helps keep the walls of the vagina lubricated. Lowered estrogen during menopause causes the vaginal tissues to become thinner and more easily irritated during sex—or dry out. Ok. So this is uncomfortable - to say the least! But it also increases the chance for urinary tract infections and vaginal atrophy.
METABOLISM
Yep. Reduced estrogen may lower your metabolic rate, which prompts your body to store fat instead of burning it. But the cause of weight gain around this time is not so clear cut and menopause alone probably isn’t to blame. Decreased physical activity, lack of sleep, lots of stress, emotional eating among other things are often occuring around this time and may likely contribute to weight gain around menopause.