What is Menopause?
We've all heard about menopause, but what really is it? When does it start? How long does it last? How will I know if I’m in menopause? What are the symptoms? Does everyone have the same symptoms? These are just a few of the many common questions that I’m asked on a regular basis. This natural phase in every woman's life is still a big mystery surrounded by misinformation, confusion, and yes, quite a bit of secrecy. In the next few installments of this series, I will address hormone replacement therapy, alternative therapies, the role of nutrition & physical activity, and any questions you may have. Let's blow the top off this taboo topic - let's talk menopause!
Menopause has morphed from an experience that only a small percentage of women lived through to a natural part of every woman’s life today. At the turn of the 20th century, women were not expected to live past 50. Now, life expectancy for women is 78 years of age. If you’re a woman in your 20’s or 30’s, you might ask yourself: why should I care? I’m way too young for this. Well, I hate to be the bearer of truth but the reality is that you will eventually go through it; so you might as well be educated.
The fact is that 75% of all women will experience hot flashes, night sweats, insomnia, weight gain, and irritability. Menopause symptoms can be debilitating for many women, often appearing before they realize hormonal changes have begun to take place. Women don’t expect to experience these symptoms in their mid-thirties, but it happens all the time. Yet, an alarming number of women still think they don’t have to “worry” about menopause until their 50s. Don’t wait! Educate yourself early on. So let’s start with the basics: what is menopause?
The Menopausal Transition Defined
Menopause is not a singular event but rather a transition lasting on average 3.8 years. It is often described in three phases:
Premenopause: Time when menstruation is normal
Perimenopause: Time when menstruation becomes more infrequent and also includes the one year after the final period
Postmenopause: Is defined as the time in a women’s life when the ovaries stop functioning and menstruation has ceased for at least 12 consecutive months. You’re also considered postmenopausal if the ovaries were surgically removed or were damaged during chemotherapy. (Note: a hysterectomy, where only your uterus is removed, does not affect your ovaries or menopause)
For a more detailed breakdown of the adult female reproductive life, the most recent Stages of Reproductive Ages Workshop (STRAW) is a great resource (Harlow, et al., 2012). It provides guidance on the different stages, their lengths, characteristics, and signs. Although there is no exact test to determine perimenopause, STRAW also provides guidelines for hormone levels that play a role in determining the stages in the menopausal transition. The most common hormone used for determination of perimenopause is the Follicle Stimulating Hormone (FSH), with levels greater than 25 IU/L indicating decline in ovarian function and beginning of perimenopause. As estrogen drops, FSH climbs to kickstart the follicle cycle and make up for the lack in estrogen.
As you will soon find out, I love creating charts and spreadsheets, so here's the first one. I've created an easy-to-read and hopefully just as easy-to-understand overview of the menopausal transition.
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Stay happy & healthy
- Dr. Maria Luque