What to Expect – The Menopause Years

When many women think about menopause, they think of suffering in silence for years with symptoms like hot flashes that culminate with the end of their menstrual cycle. What many women do not know is that this is a critical period for their health and an important time to lay a good foundation for the postmenopausal stage of their life. 

This blog post will detail what to expect during perimenopause and menopause, including hormonal changes, the timeline of menopause, health concerns, how to alleviate menopause symptoms, and how testing hormones can help. 

PERIMENOPAUSE AND MENOPAUSE: DEFINITIONS AND TIMING 

Menopause is defined as having no menstrual cycle for twelve consecutive months. Although hormones are often measured, no laboratory tests are necessary to confirm menopause. 

The average age for menopause onset is 51, and it typically occurs between ages 45 and 55. Early menopause is defined as menopause occurring between the ages of 40 and 45. Menopause that occurs before the age of 40 is defined as primary ovarian insufficiency. 

Surgical menopause occurs as the result of a complete hysterectomy (ovaries and uterus are removed). Although women will stop menstruating with a partial hysterectomy (when they retain their ovaries), and often after a uterine ablation, these procedures do not count as surgical menopause. These women will often still have cycling hormones even without having menses. 

Perimenopause marks the time leading up to a woman’s last menstrual cycle. Most women begin to experience perimenopausal symptoms in their forties. Perimenopause typically lasts five to seven years and is characterized by declining fertility and fluctuating hormone levels. 

HORMONES DURING PERIMENOPAUSE AND MENOPAUSE 

Perimenopause is often referred to as a second puberty or reverse puberty due to the hormonal changes that women experience; many women become estrogen dominant during this stage. During perimenopause, progesterone levels begin to decrease as women begin to have more anovulatory cycles (cycles where no egg is released) and as egg quality also declines. 

At the same time, oestrogen levels can go on a “rollercoaster ride” and start to fluctuate from high to low. Oestrogen levels can be quite erratic during this stage, but eventually, they become low as menopause approaches. These hormonal changes lead to the common symptoms experienced during perimenopause which will be discussed below. 

Menopause is characterized by low levels of oestrogen and progesterone. The ovaries are no longer producing these hormones. The small amount of circulating estrogen in the body is made from the conversion of androgens, mainly in fat tissue. A small amount of progesterone is produced from the adrenal glands. 

Although the ovaries can still produce some testosterone during the postmenopausal years, this production declines with age and most androgens are produced from the adrenal glands. Adrenal health is key to supporting menopausal hormone levels.