Menopause, Perimenopause and Postmenopause

Menopause, perimenopause and postmenopause are stages in a woman’s life when her monthly period stops. This is the end of a woman’s reproductive years. Perimenopause is the first stage in this process and can start eight to 10 years before menopause. Menopause is the point when a woman no longer has menstrual periods for at least 12 months. Postmenopause is the stage after menopause.

Menopause is a stage in life when you stop having your monthly period. It’s a normal part of aging and marks the end of your reproductive years. Menopause typically occurs in your late 40s to early 50s. However, women who have their ovaries surgically removed undergo “sudden” surgical menopause.

Natural menopause — menopause that happens in your early 50s and is not caused by surgery or another medical condition — is a normal part of aging. Menopause is defined as a complete year without menstrual bleeding, in the absence of any surgery or medical condition that may cause bleeding to artificially stop (use of hormonal birth control, overactive thyroid, etc.) As you age, the reproductive cycle begins to slow down and prepares to stop. This cycle has been continuously functioning since puberty.

As menopause nears, the ovaries make less of a hormone called estrogen. When this decrease occurs, your menstrual cycle (period) starts to change. It can become irregular and then stop. Physical changes can also happen as your body adapts to different levels of hormones. The symptoms you experience during each stage of menopause (perimenopause, menopause and postmenopause) are all part of your body’s adjustment to these changes.

The traditional changes we think of as “menopause” happen when the ovaries no longer produce high levels of hormones. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone as well as testosterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.

As menopause nears, the ovaries no longer release eggs into the fallopian tubes, and you’ll have your last menstrual cycle.

Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is gradual and is described in three stages:

• Perimenopause or “menopause transition”: Perimenopause can begin eight to 10 years before menopause, when the ovaries gradually produce less estrogen. It usually starts in a woman’s 40s, but can start in the 30s as well. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many women may experience menopause symptoms. Women are still having menstrual cycles during this time, and can get pregnant.
• Menopause: Menopause is the point when a woman no longer has menstrual periods. At this stage, the ovaries have stopped releasing eggs and producing most of their estrogen. Menopause is diagnosed when a woman has gone without a menstrual period for 12 consecutive months.
• Postmenopause: This is the name given to the period of time after a woman has not bled for an entire year (the rest of your life after going through menopause). During this stage, menopausal symptoms, such as hot flashes, may ease for many women. However, some women continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower level of estrogen, postmenopausal women are at increased risk for a number of health conditions, such as osteoporosis and heart disease. Medication, such as hormone therapy and/or healthy lifestyle changes, may reduce the risk of some of these conditions. Since every woman’s risk is different, talk to your doctor to learn what steps you can take to reduce your individual risk.

The length of each stage of the menopause transition can vary for each individual. The average length of perimenopause is about four years. Some women may only be in this stage for a few months, while others will be in this transition phase for more than four years. If you have gone more than 12 months without having a period, you are no longer perimenopausal. However, if there are medications or medical conditions that may affect periods, it can be more difficult to know the specific stage of the menopause transition.

Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention (such as removal of the ovaries) or damage to the ovaries (such as from chemotherapy). Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.

You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:

• Hot flashes (a sudden feeling of warmth that spreads over the body).
• Night sweats and/or cold flashes.
• Vaginal dryness; discomfort during sex.
• Urinary urgency (a pressing need to urinate more frequently).
• Difficulty sleeping (insomnia).
• Emotional changes (irritability, mood swings, mild depression).
• Dry skin, dry eyes or dry mouth.

Women who are still in the menopause transition (perimenopause) may also experience:

• Breast tenderness.
• Worsening of premenstrual syndrome (PMS).
• Irregular periods or skipping periods.
• Periods that are heavier or lighter than usual.

Some women might also experience:

• Racing heart.
• Headaches.
• Joint and muscle aches and pains.
• Changes in libido (sex drive).
• Difficulty concentrating, memory lapses (often temporary).
• Weight gain.
• Hair loss or thinning.

These symptoms can be a sign that the ovaries are producing less estrogen, or a sign of increased fluctuation (ups and downs) in hormone levels. Not all women get all of these symptoms. However, women affected with new symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms.