The Phases of Menopause

“It’s just unconscionable that we are still asking the same questions in 2023 that we asked in 1993” - Dr. Sharon Malone, OB-GYN

It is important that we touch upon a delicate topic. Nope, not menopause. Research on women’s health and menopause in particular. Delicate because it is insane how little funding and information has been evaluated and distributed for something that affects 50% of the world’s population. Women’s health research accounts for approximately 10% of overall research spending within the National Institute of Health (NIH) and only .03% of that is allocated to menopause research.

The scarcity of focus, research and management of this important transition in a woman’s life has resulted in lackluster understanding and representation to support the 55+ million women who have menopause in the US alone.

Basic facts

Menopause is a retrospective clinical diagnosis 12 consecutive months after the final menstrual period.
There are tests to be able to medically diagnose menopause (but not perimenopause) through your physician.
The average age for menopause is 51 in the United States.
Perimenopause can start in your early to mid 30s

Phases of menopause:

Pre-menopause: The time period prior to Perimenopause
Perimenopause: A transitional phase leading up to menopause, lasting 2-8 years
Menopause: The point when menstruation has stopped for 12 months, or as indicated through a follicle-stimulating hormone (FSH) test.
Post-menopause: The years following menopause

Let's talk about Perimenopause a bit more. This is a phase that is significantly more challenging for formally diagnosing as there isn't a key test to identify diagnosis.

Perimenopause refers to the years preceding menopause. The amount of estrogen produced by the ovaries will decline in your 30s and 40s. A change in your period may be the first sign of perimenopause.

Menopausal transition and early menopause may be symptomatic enough to compromise a woman’s quality of life and indicate increased disease risk. Menstrual changes and vasomotor symptoms (VMS) are the most common clinical presentation.*

Each woman’s perimenopausal experience is unique. There may be women who don't have any symptoms or minor symptoms. Other women may experience symptoms that directly impact their quality of life in all aspects.

Symptoms

Hot Flashes - A hot flash is a quick sensation of what can feel like heat on the upper body and facial area. They can occur at any time of day including while sleeping. The frequency and length of time of experiencing these flashes are inconsistent and unique to each woman.

Insomnia - Difficulty falling asleep or becoming wide awake at an undesired time.

Weight Gain - Many women experience unexplained weight gain during perimenopause. There is a hypothesis that the reduction of hormones directly effect metabolism and fat storage.

Hair Loss/Changes - Hair thinning can be common, bu hair loss is possible during the menopause transition because of hormonal imbalances.Women can also experience facial hair from testosterone activity.

Memory Loss/Fog Brain - Memory loss and the feeling like you are "in a fog" during the day are possible side effects of the menopause transition.

Vaginal And Bladder Problems - As estrogen levels drop, the vaginal lining may become thinner, drier, and less elastic. During intercourse, vaginal dryness can cause discomfort. You may be more susceptible to urinary or vaginal infections if your estrogen levels are low. A loss of tissue tone may cause urinary incontinence.

Mood Shifts - Mood swings, impatience, and an increased risk of depression are all possible symptoms of perimenopause. Sleep disturbance caused by hot flashes might be the source of these symptoms. Mood swings can also be induced by reasons unrelated to the hormonal changes in perimenopause.

Health Risks - Before menopause, estrogen generated by women’s ovaries protects them from heart attacks and strokes. Women lose a lot of this protection after menopause because less estrogen is produced. Midlife is also when risk factors for heart disease, such as excessive cholesterol, high blood pressure, and a lack of physical activity, become more prevalent. In menopausal women, the combination of all of these variables raises the risk of heart attack and stroke.

Sexual Function Changes - Sexual arousal and desire may alter during perimenopause. However, if you had adequate sexual intimacy before menopause, you will probably have it during perimenopause and beyond.

When does it stop?

Menopausal symptoms are often transient but may persist in 10% of women who may require life-long treatment. The risks and benefits of pharmacotherapy should be assessed periodically with patients. Further research on menopausal transition and its impact on cognition is a work in progress.