Upon the start of menopause, a female faces the loss of ovarian follicles, resulting in the cessation of cyclical estrogen and progesterone creation. Menopause refers to the final menstrual period in the persons lifetime. When a person has had no periods for twelve consecutive months, they are then considered postmenopausal.
For most women, this occurs in their forties or fifties, with an average age being around fifty-one. There are various types of menopause, triggered or caused by different reasons. Surgical menopause occurs immediately after a bilateral oophorectomy. “Premature menopause” is any time before the age of 40 and referred to as premature ovarian insufficiency. This can occur for various reasons including ovary removal, chemotherapy, radiation, or after total hysterectomy. Early menopause occurs between the ages of 40 and 45 (CDC).
Women continue to live one-third of their life after menopause, making physical, mental, and overall health a vital aspect of daily life (NIH/Alray).
Perimenopause
Perimenopause is the time prior to menopause beginning, to one year after the menopause. This can be noted by the hormone fluctuation, anovulatory cycles, and irregular cycles. In this transition time there can be changes in flow, length of cycle, PMS-like symptoms. At this time, hot flashes, night sweats, aches and pains, fatigue, irritability, mental strain, sore breasts, and a never-ending list of side effects can also occur (Alray/EI).
While some menstruators may experience irregular menstrual cycles and anovulation, pregnancy can still occur and contraception may be required. Some menstruators can experience menopausal symptoms for five to ten years before their final period (NIH).
Menopause Physical Symptoms and Changes
Symptoms and changes range from person to person, and some people report never having symptoms at all. Some of the more common symptoms reported are hot flushes, night sweats, sleeping difficulties, body aches, dry skin, vaginal dryness and atrophy, loss of libido, urinary issues, along with mood and memory changes. Unwanted facial and body hair, scalp itchiness, thinning of the scalp may also be occurrences one must deal with.
There are other factors that can play a role in the severity or lack thereof of menopause symptoms including age, cause of menopause, psychological and physical health, attitude towards menopause or mindset at the start, ethnicity, and education level. The following information comes from the CDC and NIH.
- Vasomotor symptoms. This includes hot flushes and sweats, the Hallmark calling cards of menopause. More than 75% of menopausal women report suffering from these issues. For many, these symptoms resolve or lessen in two to five years, with the average duration being seven years. A hot flush in a subjective sensation of extreme, uncontrolled heat associated with vasodilation and a drop in core body temperature. Vasomotor instability is the driving force behind disturbed sleep, interrupted quality of life, relationships, careers, and overall wellbeing.
- Genitourinary Syndrome. Urogenital symptoms and vaginal atrophy are common issues that are most often faced in silence by patients. Many women are reluctant to discuss these issues, even though they are some of the most common issues around. Symptoms can include vaginal dryness, burning, irritation, decreased lubrication, dyspareunia, and increased overall risk for repeat urinary tract infections. Thinning of the pubic hair, loss of the labial fat pad, thinning and resorption of the labia minora, reduced vaginal caliber and changes to overall moisture production due to lack of estrogen.
- Psychological and Cognitive Symptoms. This includes hormonal changes, vasomotor symptoms and sleep deprivation, which can then alter the mood, cause anxiety, irritability, forgetfulness, and create trouble concentrating or with decision making. Many complain of “brain fog” which has been proven in many with a decrease in their serotonin levels.
- Skin Changes. Estrogen produces glycosaminoglycans, promotes sebum production, increases water retention, and improves the barrier function of the stratum corneum- all linked to dry skin.
- Muscle and Bone. Menopause and ageing contribute to decline in muscle mass and strength in postmenopausal women. Low physical activity, protein intake, and elevated oxidative stress are often the top contributors of sarcopenia in postmenopausal women. Osteoporosis is also a risk.
- Metabolic changes. A decline in estrogen levels with menopause, combined with other factors such as ageing, can lead to metabolic changes with the increased risk of cardiovascular disease- a leading cause of death in women (all from the CDC and NIH).
If you believe you are in the beginning stages of perimenopause or having menopause symptoms, do not wait to make an appointment with your doctor to get a diagnosis and find out your possible treatment options. So often the symptoms women are facing are undefinable and many doctors do not always quickly acknowledge the possibility of peri- or menopause.
Check out our Empowerment Session with Dr. Yas from Alray Direct Gynecology and Intimate Health Center where we discuss menopause and some of the most common issues, symptoms, and how one can be diagnosed.
Citations:
Centers for Disease Control and Prevention
National Institutes of Health and Human Services
Alray Direct Gynecology and Intimate Health Center