Menopause

Aug 23, 2021

What is Menopause & Perimenopause? (Part I)

Menopause and Perimenopause bring with them far reaching biological, psychological and physical ramifications, that need care and attention.

This blog is particularly close to our hearts as it sheds light on a topic that is underserved both in information and care, despite having far reaching biological, psychological and physical ramifications. Menopause affects women and people with cycles at a time when they are often juggling multiple roles including upbringing of children, employment, and possibly having to care for aging parents. This can leave them feeling overwhelmed and distressed as they deal with the onset of changes spanning everything from mood to sleep, often without receiving any support or understanding from families. [1]

So, what is Menopause?

Menopause refers to a point in life when a person has not menstruated in 12 consecutive months and ceases to conceive naturally. It typically occurs between the ages of 45 to 55, but can also develop prior to or after this age range. Although menopause is a normal part of ageing, it can be induced by surgery, drug treatments, or medication. 

Natural menopause is usually preceded by a transitory phase called the ‘Perimenopause’, during which the body starts preparing for menopause to take place. On average, perimenopause lasts for 3-4 years, although for some people, it can last only a few months or even span a whole decade. This stage is distinguished by distinct fluctuations in sex hormone levels, and is said to be associated with the “worst menopausal symptom burden”, as it stems from neurochemical changes within the Central Nervous System leading to issues with sleep, depression and severe vasomotor symptoms. [2] 

 Broadly speaking, the gradual process of menopause can be broken down into the following stages: 

  • Early perimenopause, marked by on-going irregularity of the menstrual cycle
  • Late perimenopause, marked by the absence of menstrual periods for ≥60 days in the prior 12 months
  • Early postmenopause, which is the first 12 months following your final menstrual period. During this stage, symptoms such as hot flashes ease for many women, although others continue bearing the burden for several years following the menopause transition. [2]
  • Late postmenopause, which stays for the remainder of your life. Due to lower levels of estrogen, postmenopausal people are at increased risk for a health conditions, including osteoporosis and heart disease. Hormone therapy and/or healthy lifestyle changes could lessen the risk in some of these conditions, but this is best determined in consultation with your medical provider. 

Why does Menopause happen?

Natural menopause is simply a part of aging, characterized by the slowing down of the reproductive cycle. As women hit late 30s to early 40s, their ovaries start producing less and less estrogen — the hormone that regulates menstruation — which in turn causes changes to their menstrual cycles. Periods become irregular, until eventually the ovaries stop releasing eggs altogether, and there are no more periods. 

Induced menopause (“non-natural menopause), on the other hand is defined as “the cessation of menstruation which follows either surgical removal of both ovaries (with or without hysterectomy) or iatrogenic ablation of ovarian function (e.g. by chemotherapy or radiation).” [3] This, in contrast to normal menopause, does not happen as a normal part of aging, but is rather the by-product of a different action.

Is there a right age for Perimenopause and Menopause?

The average age for hitting natural menopause is believed to be around 51-52 years, although anywhere between 45-55 years is considered to be normal. Perimenopause could start 3-4 years prior to menopause (around the age of 47 or 48), but it could also begin several years earlier several months later. 

On the other hand, menopause that occurs between the ages of 40-45 (regardless of whether it is induced or natural) is considered to be “early menopause” and menopause that happens before the age of 40 is known as “premature menopause” or “primary ovarian insufficiency”. .About 1% of women experience natural menopause before the age 40. Premature menopause may result from the inability of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease. But, often no cause of premature menopause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.

Common Signs & Symptoms associated with Menopause

In the months or years leading up to menopause (perimenopause), people experience various biological, physical and psychological changes including irregular periods, vaginal dryness, hot flashes, chills, night sweats, sleep disorders, mood fluctuations, weight gain and slowed metabolism, thinning hair and dry skin. These changes vary in incidence across populations, with individual variables such as medical history, current health (particularly obesity) and socioeconomic status considerably worsening a woman’s experience of menopause. Geographical location and ethnicity can also play a role in the prevalence of certain symptoms.

During perimenopause, skipping periods is typical and anticipated. Menstrual periods frequently skip a month and then return, or skip many months before resuming monthly cycles for a few months. Periods also occur in shorter cycles, making them closer together. It is possible to get pregnant despite irregular periods. Emotional shifts, including loss of energy,  insomnia, lack of motivation, anxiety, depression, mood changes and headaches are also very common and need attention.Support groups and counseling can be useful tools when dealing with these emotional changes during menopause.

Managing symptoms of perimenopause and menopause

We get it. Sometimes, the symptoms can get too much and we need forms of relief. Management of perimenopausal and menopausal symptoms can involve making lifestyle changes, taking non-hormonal medication, opting for hormone replacement therapy or leaning upon alternative therapies and supplements. We’ll cover these in detail in the next part of this series. Stay tuned!

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