Menopause 101 and FAQs

Your questions answered about perimenopause and beyond.
 

The Three Phases of Menopause

Did you know that there are three very defined phases of menopause?

When most women talk about going through the menopause or ‘the change’, they’re actually describing the first phase, the perimenopause – the phase in which all the ‘games’ begin. The menopause itself is the second phase or to be precise, a single point in time, and phase three is well, the rest of your life.

You may also come across the term premenopause. This refers to the phase of life that precedes menopause.

1. PERIMENOPAUSE – the time leading up to menopause when a woman stops menstruating because of a loss of functioning of her ovaries. Usually lasts 2-7 years

2. MENOPAUSE – The event of menopause is a single point in time when you go a year without menstrual bleeding.

3. POST-MENOPAUSE – the time after the last menstrual period that lasts the rest of a woman’s life.

Amazing women do not have hot flashes. We have power surges. Anon

The typical length of the whole transition is five and a half years. You may be one of a relatively small number of women who hardly notices any changes. For some women, the symptoms of perimenopause can last as long as 15 years.

Many women will start to experience hormonal changes from around 40, but some may notice subtle changes from their mid-30s onwards. The average age for a woman to have menopause is 51.

So there you have it, Menopause 101. And now for some frequently asked questions…

FAQs

Perimenopause

What is perimenopause?
Perimenopause or ‘menopause transition’, begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman’s 40s, but can start in her 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

What are the signs of perimenopause?

As you approach menopause, estrogen levels fluctuate. Some days they spike; other days, they may be low. . This is what causes the common signs and symptoms associated with menopause. However, each woman’s experience is different. Many women who undergo natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stop when they reach menopause.

For those who do experience symptoms, these are some of the most common:

  • Irregular menstrual periods
  • Hot flashes
  • Difficulty sleeping
  • Fatigue
  • Memory problems
  • Mood swings
  • Vaginal dryness; discomfort during sex
  • Lower sex drive
  • Urine leakage when coughing or sneezing
  • Urinary urgency – an urgent need to urinate more frequently
  • Weight gain, especially around the abdomen
  • Breast tenderness

Not all these changes are hormone-related, and some, such as hot flashes and memory problems, tend to resolve after menopause. Maintaining a healthy lifestyle during this time of transition is essential for your health and can even prevent or blunt some of these changes.

Are my perimenopausal symptoms normal or something to be concerned about?

Irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding.

If any of the following situations apply to you, see a doctor to rule out other causes:

  • Your periods are very heavy, or they have blood clots
  • Your periods last several days longer than usual
  • You spot between periods
  • You have spotting after sex
  • Your periods happen closer together

Causes of abdominal bleeding include hormone problems, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.

How is perimenopause diagnosed?
Often your doctor can make the diagnosis of perimenopause based on your symptoms. A blood test to check hormone levels may also help, but your hormone levels are changing during perimenopause. It may be more helpful to have several blood tests done at different times for comparison.
How long does perimenopause last?
The average length of perimenopause is 4 years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends when a woman has gone 12 months without having her period.
Can I get pregnant if I am perimenopausal?

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should use some form of birth control until you reach menopause (you have gone 12 months without having your period).

For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a drop in fertility. If becoming pregnant is the goal, there are treatments that can help you get pregnant.

Are there treatments that can ease the symptoms of perimenopause?

Many women get relief from hot flashes after taking low-dose birth control pills for a short time. Other options that may control hot flashes include the birth control skin patch, vaginal ring, and progesterone injections. Certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.

You may also feel better if you do things that enhance your general well-being, such as:

  • Exercise
  • Stop smoking.
  • Get more sleep and try going to sleep and waking up at the same time each day.
  • Drink less alcohol.
  • Get to a healthy weight and stay there.
  • Get enough calcium in your diet.
  • Ask your doctor if you should take a multivitamin

Talk to your doctor if you are having problems with your sex drive. He or she may be able to recommend a counsellor or therapist to help you and your partner work through this problem. Vaginal lubricants may also be recommended, if vaginal dryness is a problem.

Other treatments available to help with the various symptoms of perimenopause may include antidepressant medications for mood swings.

Talk to your doctor about your specific symptoms and goals of treatment. This will help him or her make a plan that is right for you.

Menopause

What is menopause?

Menopause is not a disease or illness. Menopause is a normal, natural event that a woman’s body is fully equipped to deal with. Menopause is defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months.

Menopause is associated with reduced age-related functioning of the ovaries, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility. Menopause occurs, on average, at age 51. It occurs most often between the ages of 40 and 55. Some women can reach natural menopause in their 30s, and a few as late as their 60s.

What causes menopause?
In most cases, menopause is a result of the natural aging process, but it has other causes. Certain surgical procedures, cancer treatments, and rare ovarian conditions can also trigger it.
How is menopause confirmed?

Most women are aware when menopause is approaching—even without a doctor’s diagnosis. This is because menopause has very obvious signs and symptoms.

However, there are tests that can confirm menopause if you’re unsure. Your doctor may test your follicle-stimulating hormone (FSH) and estrogen levels. These blood tests are useful for determining menopause because FSH levels rise and estrogen levels fall during menopause.

How is menopause treated?

There are a number of medications available to treat the symptoms of menopause, three of the most common being hot flashes, bone loss, and vaginal dryness. If you are experiencing the symptoms of menopause and wish to seek help, consult your GP.

If you’re a proponent of alternative therapies, or if your symptoms are mild and don’t warrant mainstream drugs, alternative medicine is an option. There are many natural treatments that may help ease your menopause transition.

Finally, don’t underestimate the power of healthy lifestyle habits. Exercise, a balanced diet, and not smoking all offer major benefits to women going through menopause.

What are the complications of menopause?

The complications below are associated with menopause, though menopause isn’t often the sole cause. Normal ageing also increases your risk of developing these medical problems.

  • Heart disease
  • Osteoporosis
  • Urinary problems
  • Weight gain
Now that my periods have stopped, can I discontinue contraceptives?
Even though menstrual cycles become irregular or even stop, women in perimenopause can still get pregnant unless they have taken steps not to get pregnant. It’s advisable to use birth control until one year after the final menstrual period.
How will I know when menopause is over?
Menopause is considered over with the final menstrual period. However, women don’t know that they’ve had their final period until 12 months later, when looking back they can see that it was in fact their last period. It is uncommon for women to start having periods again after not having them for 12 months. And, although the bleeding may stop, symptoms can go on for months or even years. How long a woman’s symptoms will last cannot be predicted.

Post-Menopause

What is post-menopause?
Post-menopause includes all the years beyond menopause. For many women, it is an optimal time to reassess their health.
How can I prevent vaginal dryness?
Over the counter vaginal lubricants are available to make sexual intercourse more comfortable for you and your partner. If these are not successful, topical estrogen is another alternative which can help other symptoms of menopause and post-menopause like hot flashes. If you are experiencing vaginal dryness consult your GP.
Will I still need to see my gynaecologist now that I am postmenopausal?

Even though you no longer experience a menstrual cycle this does not mean you should skip regular check-ups and screenings with your gynaecologist. Even post-menopausal women should have regular pelvic exams, smears, and mammograms to keep track of any changes in their bodies.

Each woman has a different medical history and the frequency of your exams will depend on your individual needs.

What is postmenopausal bleeding?

Post-menopausal bleeding is any vaginal bleeding which occurs after going twelve months without a period due to menopause. Somewhere between 20 and 30 percent of all women experience postmenopausal bleeding.

In most cases there is nothing to worry about, but no matter how little or brief postmenopausal bleeding is, you should schedule an examination with your GP to ensure that the bleeding is not a more serious problem.

Will I continue to experience hot flashes?

It is possible. Women can experience hot flashes several years before and after menopause, while some women never experience hot flashes at all.

Hot flashes are characterised by intense heat, rapid heartbeat, and sweating, and each occurrence may last as long as thirty minutes. The cause of hot flashes is linked with the decreased levels of estrogen in the body as a result of menopause. When the body doesn’t have as much estrogen, it affects the ability of the hypothalmus to regulate body temperature.

What changes might occur to my body now that menopause is over?

The good news for women who are postmenopausal is that the tiredness will fade and energy will begin to return.

As a woman experiencing bodily changes post-menopause, there are new concerns that you should be aware of. Women in the post-menopause stage are especially at risk for health conditions related to the hormonal changes in their bodies like osteoporosis and heart disease. Women who smoke, drink caffeine and alcohol, and consume excessive salt and sugar are at higher risk for these conditions.

The best way to prevent these diseases, is to live a healthy lifestyle far before menopause; but to decrease your risk you should exercise regularly, eat a balanced diet, and take a dietary supplement with calcium, B and D-vitamins

Can I still get pregnant now that I am postmenopausal?
When you have gone without a period for a year, chances are you will not be able to get pregnant. However, you should always use a contraceptive until you have been tested to confirm you are postmenopausal. A simple blood test, measuring your follicle stimulating hormones (FSH) will determine whether or not you are postmenopausal.
Sources for FAQ information: endocrineweb.com; menopause.org; webmd.com; drayalonobgyn.com

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