An Introduction to Menopause and Perimenopause:
Signs, Symptoms and Treatments
What is Menopause and Perimenopause?
Menopause is defined as the cessation of menstruation as a result of the normal decline in ovarian function. Technically, you enter menopause following 12 consecutive months without a period. Menopause has become increasingly medicalized, which means it is viewed as something that requires intervention and treatment rather than as a natural life transition that may benefit from support. Menopause signals the end of fertility and the beginning of a new and potentially rewarding time in a woman's life. Part of the stigma of menopause is its association with aging, but we age no more rapidly in our 50s than in any other decade of life.
When Does Menopause Happen?
For most women, natural menopause occurs between the ages of 45 and 55, with the average age of onset being 51.4 years of age. In rare instances, menopause can occur as early as the 30's or as late as the 60's. Menopause is considered premature if it occurs before the age of 40, or artificial if radiation exposure, chemotherapeutic drugs, or surgery induces it. Other factors that may contribute to the early onset of menopause include a history of smoking, poor nutrition, a co-existing medical condition, or even a traumatic experience.
Until a woman is technically considered menopausal (aka postmenopausal), she's considered to be premenopausal, also referred to as perimenopause. It's during the perimenopausal phase that most women experience the worst symptoms.
Menopause (or postmenopause) occurs when a woman hasn't had her period for 12 consecutive months. Once hormones have levelled off, most of the symptoms experienced during perimenopause will disappear -- although some women have occasional hot flashes, anxiety, bouts of depression, et al, for a few years after they become postmenopausal.
The Physiology of Menopause
To best understand what occurs at menopause, it is helpful to know about the physiology of menstruation and the hormones that are involved in our monthly cycle. Hormones are substances in our bodies that act like messengers. They travel throughout the body and can bind to specialized areas of cells known as receptor sites, where they then initiate a specific chain of events. The first half of the menstrual cycle is dominated by estrogen, whose role is to build the lining of the uterus in preparation for a potential pregnancy. At approximately day 14 of the cycle, or two weeks prior to menstruation, an egg is released from the ovaries. This is referred to as ovulation.
As a result of ovulation the ovary begins producing progesterone. It is during this second half of the cycle that progesterone is dominant. Progesterone's role is to change the character of the uterine lining to prepare for pregnancy, and to prevent further buildup of the lining by estrogen. At the end of the cycle, if the egg is not fertilized, estrogen and progesterone levels drop, causing a sloughing of the uterine lining, or menstruation. The body goes through this cycle every month to ensure a fresh uterine lining in preparation for a potential pregnancy.
If a woman fails to ovulate, however, she does not produce progesterone, and this may result in the experience of symptoms of hormonal imbalance. Women are born with a finite number of eggs that eventually runs out. At birth, a woman has close to a million eggs, by puberty a mere 300,000. In the 10 to 15 years prior to menopause, this loss begins to accelerate. Perimenopause is the term used to describe the time of transition between a woman's reproductive years and when menstruation ceases completely. Typically perimenopause occurs between the ages of 40 and 51 and may last anywhere from six months to ten years. During this time, hormone levels naturally fluctuate and decline, but they do not necessarily do so in an orderly manner. Shifts in hormones are a major contributor to that sense of physical, mental, and emotional imbalance that may characterize a woman's experience of menopause.
Eventually estrogen levels decrease to the point that the lining of the uterus no longer builds up and menstruation ceases. This is menopause. After menopause, estrogen levels off at approximately 40 to 60% of its premenopausal levels and progesterone falls close to zero. Although there are similarities in what happens hormonally, each woman's experience can be very different. Genetics may play a role in the timing, but lifestyle can certainly influence a woman's experience of menopause. Many women find that the right combination of herbs, exercise, nutritional support, and natural hormones helps them to manage most of their symptoms. Others find they may need some medical intervention and pharmaceutical agents. This site will help guide you in making the decisions that best support your individual needs.
How long does perimenopause last?
It varies. Women normally go through menopause between ages 45 and 55. Many women experience menopause around age 51. However, perimenopause can start as early as age 35. It can last a few months to quite a few years. There is no way to tell in advance how long it will last OR how long it will take you to go through it. Every woman is different.
I've been depressed in the past. Will this affect when I start going through perimenopause?
It could. Researchers are studying how depression in a woman's life affects the time she starts perimenopause. If you start perimenopause early, researchers don't know if you reach menopause faster than other women or if you're just in perimenopause longer.
What should I expect as I go through perimenopause?
Additional Reading: The 34 Signs/Symptoms of Menopause.
Some women have symptoms during this time that can be very difficult. Some of these symptoms include:
- Changes in your menstrual cycle - i.e., longer or shorter periods, heavier or lighter periods, or missed periods
- Hot flashes (power surges -- sudden rush of heat from your chest to your head)
- Palpitations, skipped heartbeats
- Internal shaking / tremor-like feelings
- Night sweats
- Vaginal dryness
- Dry skin and skin changes
- Formication (feeling like ants are crawling on your body)
- Insomnia and other sleep disturbances
- Mood swings
- Allergies, sinus problems
- Wheezing, respiratory problems, coughing
- Panic attacks
- Crying for no apparent reason
- General irritability and/or anger
- Hair thinning or loss
- Pain during sex
- More urinary infections
- Urinary incontinence
- Decreased or non-existent libido
- Increase in body fat, especially around your waist
- Forgetfulness, brain fog, problems with concentration and memory
Additional Reading: The 34 Signs/Symptoms of Menopause.
There are numerous articles addressing all of these issues and more in Power Surge's 'Educate Your Body' Library.
Excellent suggestions for coping with menopause in Power Surge's Menopause Survival Tips
I don't understand why I get hot flashes. Could you tell me what's going on with my body?
Read What's A Hot Flash? We don't know exactly what causes hot flashes.
It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger the hot flashes.
I feel so emotional. Is this due to changes in my hormones?
Your mood changes could be caused by a lot of factors. Some researchers believe that the decrease in estrogen triggers changes in your brain causing depression. Others think that if you're depressed, irritable, and anxious, it's influenced by menopausal symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue, and/or by issues you're dealing with that aren't strictly related to hormonal changes. It could also be a combination of hormone changes and symptoms. Remember, menopause doesn't happen in a vacuum. All the issues you came into menopause with are only exacerbated by your changes.
Menopause doesn't happen in a vacuum. It's part of the bigger transition of "aging." Other things that could cause depression and/or anxiety include:
- Having depression during your lifetime
- Feeling negative about menopause and getting older
- Increased stress (look at the world we're living in)
- Having severe menopause symptoms
- Children growing up and leaving home - empty nest syndrome
- Being sedentary - not being physically active
- Not being happy in your relationship or not being in a relationship
- Not having a job, or being unhappy in your current job
- Continuing working during a difficult menopause
- An unfulfilling marriage / marital problems
- Financial problems
- Low self-esteem (how you feel about yourself)
- Not having the social support you need
- Feeling isolated
- Not having anyone to talk to (Use our message boards)
- Regretful that you can't have children anymore
What can I do to prevent or relieve symptoms of perimenopause?
- Read the Power Surge Recommendations for treating various menopause symptoms.
- Read Power Surge's Menopause Survival Tips
- Keep a journal for a few months and write down your symptoms, like hot flashes, night sweats, and mood changes. That can help you figure out the changes you're going through
- Record your menstrual cycle, noting whether you have a heavy, normal, or light period
- Find a physical activity that you'll enjoy doing
- If you smoke, try to quit.
- Keep your body mass index (BMI) at a normal level. Figure out your BMI by going to www.nhlbisupport.com/bmi/bmicalc.htm
- Network with other women who are in perimenopause or menopause. Most likely, they're going through the same things you are!
- Do something new: start a new hobby, do volunteer work, take a class
- Learn meditation and breathing exercises for relaxation
- Use a vaginal lubricant for dryness and pain during sex Read the article on Midlife Sexuality / Vaginal Dryness for more information.
- Dress in lighter layers (preferably cotton), so if a hot flash comes on, you can peel away the top layer (without getting arrested!)
- Try to figure out (and avoid) those triggers that may cause hot flashes, such as spicy foods, caffeine, or being outside in the heat.
- Talk with your health care practitioner if you feel depressed, or have any other questions about how to relieve your symptoms
- Educate yourself about what tests you need when entering perimenopause. Oftentimes, doctors won't prescribe them unless YOU ASK for them!
- An excellent resource for your questions about menopause -- Ask Power Surge's Experts!
I'm going through perimenopause right now. My period is very heavy, and I'm bleeding after sex. Is this normal?
Irregular periods are common and normal during perimenopause, but not all changes in bleeding are from perimenopause or menopause. Other things can cause abnormal bleeding.
Talk to your health care provider if:
- The bleeding is very heavy or comes with clots
(although clotting isn't uncommon during perimenopause)
- The bleeding lasts longer than 7 days
- You have spotting or bleeding between periods
- You're bleeding from the vagina after sex
Can I get pregnant while in perimenopause?
Yes. If you're still having periods, you can get pregnant. Talk to your health care provider about your options for birth control. Keep in mind that methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don't provide complete protection against STDs and HIV. The only sure protection is abstinence (not having sex of any kind). But appropriate and consistent use of latex condoms and other barrier methods can help protect you from STDs.
For perimenopausal women, it is essential that you continue some form of birth control while your periods are erratic -- even if you've been without a period for six or seven months -- you can still get pregnant. For women whose periods have stopped for twelve consecutive months, it is still recommended that you practice some form of birth control for approximately one year after entering menopause.