DEMYSTIFYING MENOPAUSE: SYMPTOMS, DURATION AND EVERYTHING ELSE YOU SHOULD KNOW
Welcome to the complete menopause guide that will equip you with all the essential insights about menopause – its stages, duration, hormonal shifts and associated symptoms. This resource is designed to empower you with the knowledge you need to navigate menopause with confidence and ease.
Successfully navigating the complexities of menopause depends on understanding the physiological shifts that will take place within your body. This guide is dedicated to demystifying these changes, offering you a comprehensive understanding of menopause.
What is menopause? What does it entail? How does it manifest? What are the first signs of menopause? How long does it last? And how do you recognise when you're in its throes?
Empower yourself through knowledge and you'll be better equipped to enhance your overall well-being throughout this transformative journey.
Understanding Menopause: What is Menopause?
In the simplest terms, menopause marks a phase of hormonal transition. While "menopause" is often used as a catch-all term, the medical term is “climacteric” which describes the period of life starting from the decline in ovarian activity until after the end of ovarian function. Menopause refers exclusively to the Final Menstrual Period (FMP). In this article, we define the difference between perimenopause and postmenopause. However, we still use the term "menopause" to as the grouping term, referring to the hormonal changes women experience in midlife.
However, the journey of menopause encompasses much more than the day you have your FMP. It starts several years before your last period. To confuse the matter even more, you can only know with certainty that you’ve had “the menopause” in retrospect, when you have not had a period for 12 months in a row. Menopause, like puberty, is not a sudden event or something that happens overnight. Rather, it unfolds gradually over years or even decades.
Navigating Hormonal Transitions
Puberty triggers the release of the sex hormones oestrogen and progesterone, initiating the menstrual cycle. At birth, our ovaries house approximately 1,000,000 tiny egg cells. By the time we have our first period, around half remain.. Over the years, each monthly ovulation further depletes this egg cell reservoir.
In midlife, you release fewer and fewer eggs and eventually, you stop releasing them altogether. Our hormone production changes because ovulation stops. Initially, progesterone levels decrease, which is followed by a gradual decline in oestrogen.
Phases and Symptoms of Menopause
The journey through menopause does not happen overnight; it happens gradually, much like the transition into puberty. This transformative hormonal journey is characterised by three distinct phases, each marked by specific hormonal shifts.
It's extremely valuable to grasp the different stages of menopause and to comprehend the shifts that happen in each one, as this awareness is crucial due to each phase being linked to distinct symptoms. To truly connect with your body and its cues, it's essential to know which phase you’re currently in.
Perimenopause: Embarking on the Menopausal Journey
Menopause starts with the perimenopause stage. Typically starting in the early to mid-forties, perimenopause lasts anywhere from 4 to 15 years. It can also start as early as the late thirties, though this is rare.
While we usually associate menopause with a decrease in oestrogen, this connection only becomes evident later on in the process. Perimenopause is mainly characterised by a decrease in progesterone, which is caused by irregular ovulation. Substantial amounts of progesterone are only produced after successful ovulation.
Having said that, oestrogen behaves somewhat unpredictably during this phase. It remains stable at times and surges at other times, leading to an excess of oestrogen. In both cases, an imbalance known as oestrogen dominance (also known as high oestrogen or unopposed oestrogen) emerges, disrupting the balance between oestrogen and progesterone. The following graph illustrates the hormone changes during perimenopause:
Changes in Hormone Level Patterns over Six Months // Graph based on data from Dr Nanette Santoro, adapted from Harvard Women’s Health Watch, 1999
It's no wonder these shifts are palpable. Potential symptoms of perimenopause include:
- Shortened menstrual cycles
- Prolonged and/or heavy menstruation
- Heightened premenstrual syndrome (PMS)
- Mood swings / changes in mood
- Irritability
- Tender breasts
As perimenopause nears its end, oestrogen levels usually decrease. During this stage we start to see the first signs of oestrogen deficiency, such as vaginal dryness or reduced libido.
Menopause: The Final Menstrual Period
Your final menstrual period marks the beginning of the menopause phase. But, as we mentioned before, you can only know with certainty that you’ve had “the menopause” in retrospect when you have not had a period for 12 months in a row.The average age of menopause for most women is 52.
It’s really important to remember that contraception is still necessary until you have gone for a full year (or 12 months) without having a period. As long as you are still menstruating, you can still fall pregnant!
During the phase surrounding the FMP, you might start experiencing some symptoms. Everyone is different but some of the more common symptoms are reduced libido, vaginal dryness, joint pain, hot flushes, mood swings, brain fog and sleep disruptions.
Postmenopause: Embracing The Journey Ahead
If you have gone for a full year without having a period, you are now in the postmenopause phase. Postmenopause becomes your body's new normal state and you will be in this phase for the rest of your life. Your oestrogen and progesterone levels will remain consistently low from now on. Only minimal changes happen as the newly stabilised hormone levels start to find their balance. Over time, your body adjusts to this new hormonal pattern, leading to a reduction in menopausal symptoms or them disappearing altogether. If you take a hormone test now, the result will be very clear. But if you haven’t had a period for 12 consecutive months, it's quite evident that postmenopause has begun.
Although menopause is a natural part of life and not a health problem, it's essential for you to take care of yourself during this time and follow a healthy lifestyle. The reason is that previously, oestrogen shielded us against a variety of conditions. With the decrease in oestrogen levels, the risk of heart problems, osteoporosis, Alzheimer's, diabetes, high cholesterol and different types of cancer increases. Now is the time to implement a healthy diet and lifestyle and go for regular medical check-ups.
When Do Menopause Symptoms Peak?
Many women find the symptoms of perimenopause, such as weight gain, irregular cycles or mood swings, to be quite challenging. Others consider the later stages of menopause to be the most demanding phase thanks to hot flushes.
You might like to try changing your mindset when it comes to postmenopause. Yes, it can be a very frustrating time especially when sleep eludes you at night and hot flushes take over. But menopause is not a disease or a health problem and you’re not going to be in a constant state of distress. Menopause also brings along a plethora of potential for new experiences. It's a transition period – and not just from a hormonal viewpoint.
How Long Does Menopause Last?
On average, the duration of menopause (the full hormonal change starting with perimenopause until things settle in postmenopause) can range from 10 to 15 years, but the exact length varies for each woman and according to their symptoms.
On top of that, there are often differences in the way we define menopause. Is it the 4 to 10 years of perimenopause? The 12 consecutive months without a period that marks the start of menopause? The initial one to two years of postmenopause when our hormone levels are stabilising? Or should we take into account the period during which women experience symptoms? Here too, significant individual differences come into play.
Am I Experiencing Menopause?
You probably already know that this time in our lives can be quite a hormonal roller coaster. Since our hormone levels fluctuate so unpredictably, hormone tests during perimenopause provide a mere snapshot instead of the full picture of what’s going on. Our hormone levels can change significantly shortly after having one done so hormone tests aren't the best method to accurately pinpoint what stage of menopause we are in.
Having said that, there are certain scenarios in which hormone tests make sense, for example if you are thinking about going on hormone therapy. They can also help rule out other conditions like hypothyroidism. A physician will take these fluctuations into consideration, conduct various tests and interpret the results within the context of your symptoms.
Of course, there are alternatives to hormone testing during perimenopause.
The Following Approaches Can Help You Tell What Stage You’re In:
Still unsure? Read our article in which we unveil the five tell-tale signs that you're in perimenopause.
Hormone Testing During Postmenopause
During the postmenopausal stage, hormone tests typically give clear results since hormone levels remain consistently low. At this point, it's usually clear that you're going through menopause because you haven't had a period for more than 12 months. Hormone tests are mainly used in this stage when a doctor prescribes either synthetic or bioidentical hormones as part of hormone therapy.
Body identical refers to HRT products which are licenced, regulated and available from your GP for a usual NHS prescription charge and can be prescribed by both NHS and private menopause specialists. Bioidentical HRT is not licensed or regulated and is only available from private practitioners, who may not always be menopause specialists.
Menopause: A Time of Profound Change
The changes that happen in your body during menopause might seem overwhelming and confusing at times. You might not be able to pinpoint specific symptoms or fully grasp the situation. This is completely normal, natural and very common. You likely also have a lot going on like caring for young children, teenagers going through puberty, wanting to fall pregnant, a career change, a new relationship, ageing parents that need care – and sometimes all these challenges at the same time.
We’re here to tell you that you’re not alone. And here's the silver lining – there's no need to worry. Menopause marks a period of significant transformation. Yes, your body will change. Yes, you are growing older. Yes, new challenges will arise. But you are capable of handling all this. Remember that not every woman experiences every menopausal symptom and the impact of these symptoms varies from person to person. The most exciting part is that there are effective strategies to support you in leading an active, vibrant and positive life throughout menopause. This lays the foundation for healthy ageing and staying fit in your golden years.
Our Perception and Mindset Matter
The physical changes are just one aspect of the journey during and after menopause. The way we perceive and interpret these profound changes greatly influences how we experience menopause and, consequently, how we feel. When you understand the physical changes that are happening and what to expect, you’ve already taken the first crucial step in preparing for the road ahead and you can take proactive steps to enhance your well-being.
It's your time to shine!
That’s right. This journey is all about you and putting yourself first. So prioritise self-care and fill up your cup every day! Taking care of your diet, health and fitness gives you the power to navigate through menopause while nurturing your body as you grow older. Remember, you're never alone – every woman goes through menopause.
Concluding Thoughts on Menopause
Phew... that was a lot of information to absorb. But to be fair, menopause is a multifaceted, complex subject. That’s why we created the following graphic to give you a nifty visual summary.
Sources and References
- Clinical manifestations and diagnosis of menopause UpToDate
- Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging Menopause. Author manuscript; available in PMC 2013 Apr 1.
- Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system. J Clin Endocrinol Metab. 2007 Aug;92(8):3060-7. Epub 2007 Jun 5.
- A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to menopause Human Reproduction, Volume 23, Issue 3, March 2008, Pages 699–708
- Perimenopause: The Complex Endocrinology of the Menopausal Transition Endocrine Reviews, Volume 19, Issue 4, 1 August 1998, Pages 397–428
- Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. 1992 Nov;7(10):1342-6.
- Perimenopause: From Research to Practice J Womens Health (Larchmt). 2016 Apr 1; 25(4): 332–339
- Menopause Nature Reviews Disease Primers volume 1, Article number: 15004 (2015)
- Perimenopause: The Ovary’s Frustrating Grand Finale Cemcor - Centre for Menstrual Cycle and Ovulation Research
- Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS): A cohort profile Maturitas 107 · October 2017
- A Practitioner ’ s Toolkit for Managing the Menopause Climacteric, Volume 17, 2014 - Issue 5
- Change in follicle-stimulating hormone and estradiol across the menopausal transition: effect of age at the final menstrual period. J Clin Endocrinol Metab. 2011 Mar;96(3):746-54. doi: 10.1210/jc.2010-1746. Epub 2010 Dec 15.
- The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample. J Clin Endocrinol Metab. 1995 Dec;80(12):3537-45.
- How can I Tell I am in Perimenopause? CeMCOR - The Centre for Menstrual Cycle and Ovulation Research
- Puberty and perimenopause: Reproductive transitions and their implications for women's health Social Science & Medicine, Volume 132, May 2015, Pages 103-112
- Perimenopause lost - reframing the end of menstruation Professor Jerilynn C. Prior, Pages 323-335, 23 Jan 2007
- Routledge International Handbook of Women’s Sexual and Reproductive Health Oktober 2019, 10.4324/9781351035620-4
- The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN) Menopause. 2019 Oct; 26(10): 1213–1227, doi: 10.1097/GME.0000000000001424
-
Onset of the Menopause Transition: The Earliest Signs and Symptoms Gracia CR, Freeman RW, Obset Gynecol, 2018, 45(4), 585-597
-
Menopause transition: Physiology and symptoms, Talaulikar V, Best Pract Clin Gyn, 2022, 81 ,3-7
