Demystifying Menopause

Part 1: What is Menopause? Perimenopause? Am I having “The Change”?

About half of the world’s population (women) will experience menopause at some point. What is menopause? It is clinically defined as a female stage of reproduction. Menopause begins 12 months after the final menses, or period. In other words, when you are done having periods, which coincides with when your ovaries are out of eggs, you are in menopause. You will not know you have hit menopause, until it has been 12 months without a period for no other reason (like you have a hysterectomy or are using birth control that stops your period). The median age of menopause is 51 years old, and perimenopause typically occurs 4 years prior to menopause (or at about age 47). What is perimenopause? It’s a little like puberty in reverse. It is the stage just prior to menopause when many women start to notice significant changes.

Let’s break it down. Female reproduction is divided into stages. In puberty, women enter their reproductive stage. The late reproductive stage can bring subtle changes in the flow and strength of menses. Also during this time, endocrine (or hormone) changes will happen. Some hormone levels decline (serum inhibin B) while some increase slightly (serum follicle-stimulating hormone or FSH), and others, like estradiol levels, are unchanged. Aside from hormone variations and flow differences, the first half of the menstrual cycle tends to shorten from 14 to 10 days. Women are still ovulating during their cycles in this stage. This time is like the pre-perimenopause.

After the late reproductive stage comes perimenopause or menopausal transition. Perimenopause related changes are more noticeable than in the late reproductive stage. Early perimenopause can have variations in cycle length of 7 days or more. In late perimenopause, there can be over 60 days between cycles. Just for comparison, a standard menstral cycle is 28 days during the reproductive stage. Along with changes in cycle length, most women notice changes in their menses or bleeding - shorter, longer, heavier, lighter. It varies from woman to woman and is related to hormone fluctuations. The hormone shifts are more significant than in the late reproductive stage. The FSH will increase, and estradiol is initially high or normal followed by greater variability later in the perimenopausal stage. Furthermore, during perimenopause, some cycles will not result in ovulation, but don’t count on that for birth control! While it is less likely, you can still become pregnant while perimenopausal.

Are you in menopause? Has it been 12 months since your last period with no other reasonable explanation and are you around 51 years old? If you said yes, then probably. Go ahead and give away those tampons in your cabinet. Are you 47 years old and having more irregularity in your period, then you are most likely perimenopausal.

How can my doctor diagnose if I’m perimenopausal? Maybe surprisingly, there’s no recommended test to traditionally diagnose menopause or perimenopause in women over 45 years old. The diagnosis is made based on symptoms. In women between 40 and 45, it is again based on symptoms, but only after ruling out other reasons for lack of a period - pregnancy or thyroid issues. Women under 40 years old who stop having periods are not considered to be in menopause or perimenopause, but instead are considered to have premature ovarian failure. Anyone under 40 years old with changes to their periods should speak to a specialist for further evaluation.

Bottomline, if you are 40 to 50 years old with increasing irregularity in your periods there is a good chance you are perimenopausal and headed for menopause. If you are under 40 years old, talk to your primary care provider or gynecologist.

What are else can you expect from perimenopause? What can you do about hot flashes? Stay tuned…

Kate Bender is a dual-certified Psychiatric Mental Health and Adult Nurse Practitioner. She knows, firsthand, life is messy and hard. Sometimes people need support and help from a professional. When working with Kate, your mental health will be compassionately addressed in a manner that honors your mind, body, and spirit. She lives with her family on the shoreline in Old Saybrook, Connecticut.