Menopause, Perimenopause, and Postmenopause

Postmenopause, menopause and perimenopause are the stages of a woman’s reproductive life after her monthly period ends. This marks the end of a woman’s reproductive years. Perimenopause, which can occur between eight and ten years before menopause, is the first stage of this process. Menopause occurs when a woman stops having periods for 12 months. The stage following menopause is called postmenopause.

What is menopause?

Menopause refers to the time when your monthly period ends. This is a natural part of aging and marks the end your reproductive years. The typical time when menopause occurs is in the late 40s or early 50s. As you age, your hormone levels drop.

Menopause is characterized by the greatest drop in hormone levels. Women who have had their ovaries removed will experience “sudden” surgical menopause.

Natural menopause, which is the onset of menopause in your 50s that isn’t caused by surgery or other medical conditions, is normal and part of aging. Menopause refers to a year without any menstrual bleeding. This is in the absence or treatment of any medical condition, such as hormonal birth control, thyroid overactivity, etc. The reproductive cycles slow down as you get older and set themselves up to end. Since puberty, this cycle has been ongoing. As menopause approaches, estrogen production in the ovaries decreases. Your menstrual cycle (period), begins to change when estrogen levels drop. This can cause it to become irregular or even stop. As your body adjusts to hormone levels, physical changes may also occur. Your body adapts to the changes by displaying different symptoms during menopause.

What hormonal changes occur during menopause?

Menopause, which we refer to as the traditional change we experience, occurs when the hormones produced by the ovaries are low. The reproductive glands known as the ovaries store eggs and then release them. They also produce testosterone and the female hormones estrogen and progesterone. Progesterone and estrogen control menstruation. The body’s use of calcium and blood cholesterol levels are also affected by estrogen.

As menopause approaches, your last menstrual cycle will be due to the fact that the ovaries stop releasing eggs.

What is natural menopause?

Natural menopause refers to the end of menstruation without any medical intervention. The natural menopause process for women is gradual. It is broken down into three stages.

• Menopause transition or perimenopause: The perimenopausal period can last eight to ten years. It is most common to begin in the 40s for women, but it can also start in the 30s. Many women will experience symptoms of menopause at this point. During this stage, women may still experience menstrual cycles and could become pregnant.
• Menopause refers to the end of a woman’s menstrual cycle. This stage is when the ovaries stop releasing eggs and most of their estrogen. A woman who has not had a period for 12 consecutive months is considered to be in menopause.
• Postmenopause is the time period after a woman hasn’t bled for an entire calendar year. This refers to the rest of your life following menopause. Postmenopausal women have a higher risk of developing a variety of health conditions such as heart disease and osteoporosis. This is due to a lower estrogen level. Some of these conditions can be reduced by medication, including hormone therapy and healthy lifestyle changes. Every woman is at risk. Talk to your doctor about the steps you can take.

What is the average length of perimenopause (the menopause transition)?

Each person’s menopause journey can take a different length. Perimenopause lasts approximately four years. While some women will only be in this phase for a few months while others will remain in the transition stage for four years or more, many will experience it for longer periods. It can be difficult to determine the exact stage of menopause transition if you have any medical conditions or medications that could affect your periods.

What is premature menopause?

Menopause is defined as a natural part of aging and occurs between 45 and 55 years of age. Some women may experience menopause earlier than others, due to a surgical procedure (e.g. removal of the ovaries), or because of damage to the ovaries (e.g. chemotherapy). No matter what the reason, early menopause is when menopause occurs before 45 years of age. Premature menopause is when menopause occurs before the age of 40.

SYMPTOMS

What are the signs and symptoms of menopause?

If you experience any of these symptoms, it could be that you are transitioning into menopause.

• Hot flashes: a sudden sensation of warmth that spreads throughout the body.
• Night sweats or cold flashes.
• Vaginal dryness; discomfort during sex.
• Urinary urgency is a pressing need to urinate frequently.
• Insomnia (difficulty sleeping).
• Emotional changes: mood swings, irritability, mild depression.
• Dry skin, dry eyes and dry mouth.

Women in their menopause transition (perimenopause), may also experience the following:

• Tenderness in the breasts
• Premenstrual syndrome (PMS) worsening
• Periods that are irregular or skipped
• Periods that are either heavier or lighter than normal

Women might also experience the following:

• Racing heart
• Headaches
• Aches and pains in the joints and muscles
• Changes in libido (sex drive)
• Memory lapses, difficulty concentrating (often temporary)
• Weight loss
• Hair loss or thinning

These symptoms could indicate that your ovaries are producing less estrogen or increase hormone fluctuation (ups/downs). These symptoms may not be present in all women. Women who experience new symptoms such as racing heart, urinary problems, headaches or any other medical problem should consult a doctor.

What are hot flashes? How long do they last?

Menopause is characterized by hot flashes. This is a short sensation of heat. There are many reasons hot flashes can occur. Hot flashes may also be caused by heat.

• A flushed, red face
• Sweating
• After the heat, a chilled feeling

Hot flashes can feel different for everyone. They also last for different amounts of time. Hot flashes can be temporary for some women during menopause. Some people may experience hot flashes for their entire lives. Hot flashes tend to get less severe with age.

What causes a hot flash?

You may be unaware of some common things that can trigger a hot flash in your everyday life:

• Caffeine
• Smoking
• Spicy foods
• Alcohol
• Tight clothing
• Stress and anxiety

Hot weather can cause hot flashes, so be careful.

Can menopause cause facial hair growth?

Yes, menopause can lead to increased facial hair growth. Menopause can cause many physical changes in your body. This includes more facial hair. You may have options for waxing and other hair removal methods if facial hair is a problem. Discuss your options with your healthcare provider to ensure you don’t choose a product that could cause skin irritations.

Are you having trouble concentrating and forgetting things?

Menopause can lead to memory and concentration problems. Although it doesn’t occur to everyone, it does happen. Doctors don’t know why it happens. Call your doctor if you have memory problems after menopause.

Remember that anxiety and depression can also affect your memory. These conditions may be related to menopause.

Can menopause cause depression?

Menopause is a time when your body experiences many changes. This could be caused by anxiety, fear, or hot flashes. All these contributing factors may also lead to depression.

Talk to your doctor if you experience any symptoms of depression. Your provider will discuss the different treatment options and check for any other medical conditions that may be causing your depression. Thyroid problems may sometimes be the reason for depression.

Are there other emotional changes that can occur during menopause?

There are many emotional changes that can occur with menopause, including:

• Insomnia and loss of energy
• Lack of motivation and difficulty concentrating
• Anxiety, depression and mood changes
• Headaches
• Aggressiveness and irritability

These emotional changes can occur even if you are not experiencing menopause. You’ve probably experienced them all in your life. It can be hard to manage emotional changes during menopause. Your healthcare provider might be able to prescribe medication (hormone therapy, antidepressant) to help you. Sometimes it can help to know that there is a reason for the feelings you are feeling. Counselling and support groups are helpful tools for dealing with emotional changes that occur during menopause.

What does menopause mean for my bladder control?

Women going through menopause are often affected by bladder control problems (also known as urinary incontinence). This can happen for many reasons, including:

• Estrogen: this hormone has many roles in your body. It controls your period, promotes pregnancy changes and keeps your bladder and urethra hydrated.
• The pelvic floor muscles: these are responsible for supporting your pelvic organs, your bladder and your uterus. These muscles can become weaker throughout your life and can occur during pregnancy, childbirth, and weight gain. You can experience leakage (urinary incontinence) if your muscles become weaker.

You might be suffering from bladder control issues such as:

• Stress incontinence is a condition that occurs when you cough, sneeze, or lift something heavy.
• Urge incontinence is when your bladder contracts at the wrong time.
• Painful urination (discomfort every time you urinate).
• Nocturia is having to get up at night to urinate.

If I have a hysterectomy, will I be able to go into menopause?

Your uterus will be removed during a hysterectomy. After this procedure, you won’t experience a period. If your ovaries are removed (Oophorectomy) then you are menopausal. If left, you will experience hormonal menopause naturally.

DIAGNOSIS

How to diagnose menopause?

Your healthcare provider may be able to diagnose menopause in several ways. First, discuss your last year’s menstrual cycle. You may be postmenopausal if you go more than 12 months without having a period. A blood test to check your Follicle Stimulating Hormone (FSH), level is another way that your provider can determine if you are experiencing menopause. FSH is a hormone that is produced by your pituitary gland. This gland is located at base of your brain. This test can be misleading if your hormone levels fluctuate and your body is in transition. The context of the menstrual cycle and hormone testing should be considered.

A blood test is not required for many women. Talk to your doctor if you have symptoms of menopause or irregular periods. After your conversation, your provider might be able to diagnose you with menopause.

MANAGEMENT & TREATMENT

Is it possible to treat menopause?

Your body naturally goes through menopause. Some cases may not require any treatment for menopause. Menopause treatment is about managing the symptoms that cause disruption to your life. There are many treatments available to treat the symptoms of menopause. These are the main types of menopause treatment:

• Hormone therapy
• Non-hormonal Treatments

Talking to your healthcare provider is crucial during menopause in order to create a treatment plan that suits you. Each person is unique and has different needs.

What is hormone therapy?

Your body experiences major hormonal changes during menopause. Hormone therapy is a supplement that can be used if your ovaries don’t produce enough estrogen or progesterone. Hormone therapy can increase your hormone levels and help with some symptoms of menopause. It can also be used to prevent osteoporosis.

There are two types of hormone therapy.

• Estrogen therapy: This treatment uses estrogen alone. It is usually prescribed in low doses and can be taken either as a pill, patch or capsule. You can also get ET as a cream or vaginal ring. This treatment can be used following a hysterectomy.
• Estrogen Progesterone/Progestin Hormone Therapy (EPT): This treatment is also called combination therapy because it uses doses of estrogen and progesterone. You can get progesterone in both its natural and synthetic forms.
• Testosterone Therapy: This treatment replaces testosterone to improve menopausal symptoms.

Hormone therapy may be used to relieve symptoms of menopause.

• Night sweats and hot flashes
• Dryness of the vaginal area
• Irritability, mood swings
• Hair loss

Hormone therapy, is there any risk?

Hormone therapy is not without risks, just like other prescribed medicines. There are some known health risks associated with hormone therapy.

• Endometrial carcinoma (only if you have your uterus intact and aren’t taking progestin with the estrogen) is a serious form of cancer.
• Gallstones, gallbladder problems.
• Blood Clots.

Hormone therapy is a personal decision. To fully understand the risks and benefits of hormone therapy, discuss your past medical history and family history with your healthcare provider.

What non-hormonal treatments are available for women going through menopause?

Hormone therapy can be very effective in relieving symptoms of menopause, but it is not for everyone. Other treatments include lifestyle changes, diet, and over-the-counter remedies. These are good options for women with other medical conditions, or who have just been diagnosed with breast carcinoma. Your provider might recommend the following non-hormonal treatments:

• Changing your diet
• Avoid hot flashes triggers
• Prescription medication, which have been proven to be effective
• Diet

Sometimes changing your diet can help relieve menopause symptoms. Hot flashes can be reduced by limiting the amount of caffeine that you consume each day and reducing your intake of spicy foods. Plant estrogen can be added to your diet. Isoflavones, or plant estrogen, aren’t meant to replace the estrogen your body makes before menopause. Try these foods:

• Soybeans
• Chickpeas
• Lentils
• Flaxseed
• Grains
• Beans
• Fruits
• Vegetables

Hot flashes : Avoiding triggers

Hot flashes can be triggered by certain things in your everyday life. These triggers can be identified and worked around to relieve symptoms. You could do this by keeping your bedroom cool at night, layering clothing, and quitting smoking. Hot flashes can also be helped by weight loss.

Exercising

If you have hot flashes it can make exercising difficult. However, exercise can help with other symptoms of menopause. If you suffer from insomnia, exercise can help you fall asleep through the night. Yoga, a calm and tranquil type of exercise, can help you feel better and ease any anxiety or fears.

My doctor can prescribe non-hormonal medication.

Your doctor may prescribe non-hormonal medication. These medications are often used to treat hot flashes. Talk to your doctor to determine which non-hormonal medication might be best for you.

OUTLOOK/PROGNOSIS

Can I become pregnant while in menopause?

You can still get pregnant during the menopause transition (perimenopause). You can still use birth control if you do not want to get pregnant. Before you quit using contraception, consult your healthcare provider.

Due to a decline of fertility, it can be difficult for some women to get pregnant once they are in their 40s or 50s. If you want to become pregnant, fertility-enhancing techniques and treatments can help. These options should be discussed with your healthcare provider.

What are the long-term health consequences of menopause?

After menopause, there are many conditions you may be more at risk for. The risk of any condition is dependent on your family history, health before menopause, and lifestyle factors (smoking). Coronary artery disease and osteoporosis are two conditions that can affect your health after menopause.

Osteoporosis

Osteoporosis is a disease that causes bones to become thinner, making them more susceptible to breaking. Testosterone and estrogen are an important part of maintaining bone mass.

After menopause and by age 60, women lose on average 25% of their bone mass. This is due to the loss of estrogen. This loss of bone can eventually lead to fractures. Your healthcare provider might want to assess the strength of your bones. The bone density test, also known as a bone scan , can quickly show how much calcium is in your bones. This test can be used to detect osteoporosis or osteopenia. Osteopenia, a condition in which bone density decreases, can lead to osteoporosis later. Your treatment options for osteoporosis and osteopenia include estrogen therapy.

Coronary Artery Disease

Coronary Artery Disease refers to the narrowing of or blocking of the arteries around the heart muscle. Atherosclerosis is a condition in which fatty plaque builds up within the artery walls. This is linked to high blood cholesterol levels. Your risk of developing coronary artery disease after menopause increases due to several factors, including:

• Loss of estrogen is also a contributing factor to healthy arteries
• An increase in blood pressure
• An increase in physical activity
• Bad habits from your past catch up to you (smoking and excessive drinking)

To prevent heart disease, eat a healthy diet and get regular exercise.

Hormone therapy can help to prevent long-term health problems

Hormone therapy has many benefits, but the risks and benefits will vary according to a woman’s age as well as her personal history. Hormone therapy is more beneficial for women in their 50s than it is for women in their 60s.

How can I tell if my period’s change is normal?

Perimenopause is a transition period in which irregular periods are normal. Other conditions can also cause irregular menstrual periods. To rule out other causes, consult a doctor if any of these situations are true:

• Your periods may become very heavy or accompanied with blood clots
• Your periods can last up to three days longer than normal
• You spot or bleed after your period
• You experience spotting after sex
• Your periods are closer together

There are many possible causes for abnormal bleeding: hormonal imbalances, hormonal treatment, pregnancy, fibroids and blood-clotting issues.

Can menopause affect sleep?

Women may have trouble sleeping through the night or experience insomnia during menopause. Insomnia refers to the inability to fall asleep, or stay asleep at night. It could be a side effect of menopause, or another symptom. Menopause is often characterized by sleepless nights due to hot flashes.

Try these remedies if you are suffering from hot flashes that keep you awake at night.

• Loose clothing is a great way to keep cool at night
• Make sure your bedroom is well-ventilated
• Avoid certain foods and behaviors that can trigger hot flashes. Avoid spicy foods before going to bed if you are sensitive to spicy foods.

Will menopause affect my sex life?

Your body produces less estrogen after menopause. Your sex life can be affected by this major shift in your hormone balance. Women who are menopausal may feel less easily stimulated. Women may also be less sensitive than before menopause to touch and other physical contact.

This, along with other emotional changes, may lead to a decrease in interest in sex. Remember that menopause is a time when your body goes through significant changes. Other factors that could contribute to a decrease in sex drive include:

• Problems with bladder control
• Trouble sleeping through the night
• Feeling stressed, anxious or depressed
• Dealing with other medical conditions or medications

These factors can cause disruption in your life and tension in your relationships. These changes can also lead to a decrease of blood supply to your vagina. Dryness can result. If there isn’t enough lubrication in your vagina, it can become dry, thin, and pale. This can cause painful intercourse.

Talk to your doctor about any changes in your sex drive. Your provider can discuss ways to make you feel better. You can treat dryness in the vaginal area with water-soluble, silicone, or over-the-counter lubricants. To treat vaginal tissue, your healthcare provider may also recommend estrogen or non-steroidal hormones. You may receive this treatment in a cream, pill, or vaginal band.

Does every woman who goes through menopause experience a decline in sexual desire?

Not all women feel a decrease in sexual desire. It could be that there is no fear of becoming pregnant. This allows many women to have sex and not worry about their family planning.

If you are not married, however, it is important to protect yourself (condoms) during sex. You can’t become pregnant after your doctor diagnoses you as having reached menopause. You can still get pregnant if you are in the menopause transition or perimenopause. You must also protect yourself from sexually transmitted diseases (STIs). An STI can happen at any point in your life.

Can I still have sex after menopause?

After menopause, you should still be able enjoy sex. Some women experience a decreased ability to enjoy sex after menopause. This can be due to uncomfortable intercourse. Many women can regain intimacy after addressing the root cause of their discomfort. Many women can also benefit from hormone therapy. Talk to your doctor if you have difficulty having sex after menopause.