Woman in mid fifties, looking in the mirror and applying a bright red lipstick.

46% of women* did not feel prepared for menopause and 44% were unaware of perimenopause until they started experiencing the symptoms (Statistica). In fact, menopause is one of those things (like a lot of things women-related), that just wasn’t talked about, to the point where women had no idea about what it was or what to expect. Fortunately, this is all changing now! With GenX now approaching menopausal age, it seems the conversation has finally started, and people are not just finally talking about menopause, but they’re actually throwing parties for it!

And what’s even better is that even celebrities are being outspoken about menopause, and helping to reduce the stigma associated with it, with the likes of Michelle Obama openly talking about menopause and her experience with it, “I’m going through it, and I know all of my friends are going through it. And the information is sparse,”. Well, we hear you Michelle, so we are here to help provide the much-needed information on perimenopause and menopause, and what you can expect during this time, so when the time finally comes around… You do feel prepared and you want to throw a menopause party too!

*and anyone with a womb (women is used throughout this blog post in a general manner but refers to everyone with a womb and other female anatomy, and/or who might be affected by menopause.

DISCLAIMER: THIS BLOG POST DOES NOT PROVIDE MEDICAL ADVICE

The information in this blog post, including but not limited to the text, graphics and images, are for educational and informational purposes only. None of the material within this blog post is intended to substitute medical advice, diagnosis or treatment. Always seek the advice of a qualified medical professional such as your doctor when you have concerns or questions.

Perimenopause and menopause are inevitable and natural phases (not diseases) in a woman’s life; however, both are often misunderstood, and surrounded with many misconceptions and uncertainties. Both menopause and the transition into it are accompanied with a range of both physical and emotional symptoms that can affect women, and their daily lives, significantly. So, even if you’re no where near that time yet, it can be really helpful to understand it now, to not only help your future self but also to help those around you that may be going through this right now.

What are menopause and perimenopause?

Older woman with eyes closed, crying depicting a woman who is going through emotional changes as part of the transition to menopause.

Menopause is a natural phenomenon that occurs when menstruation permanently stops due to progesterone and estrogen no longer being produced by the ovaries. Generally, menopause takes place when women are older than 45 years old with no apparent pathological or physiological cause, although menopause can occur prematurely due to a disorder known as primary ovarian insufficiency (POI), or because of surgery, radiotherapy or chemotherapy. POI is a condition that is mainly caused by a deficiency in estrogen, although genetic disorders, autoimmune disorders and other factors can also result in this. Menopause does not just happen overnight, there is a transitional phase, called perimenopause, which can last up to 8 years. The defining thing about menopause is that it signals that the fertile, reproductive phase of a woman’s life is over, in that the reproductive system no longer functions in a fertility-related manner. This is only true once menstruation has stopped for a period of 12 months or more, which is when a woman has officially entered menopause.

What causes menopause?

Essentially, menopause is caused by the natural ageing process. As a woman ages, the ovarian follicles and granulosa cells reduce in numbers. *Trigger warning* You know that saying “your biological clock is ticking” – well, this is what it is referring to. Ovarian follicles are small, fluid-filled sacs that each contain an unfertilised egg. Women are born with a certain number of ovarian follicles within their ovaries, and this number only ever declines over time until ultimately, there are none left. The granulosa cells are responsible for the production of both estradiol and inhibin, so as these cells diminish, the level of both of these hormones declines. Inhibin is the hormone that signals the pituitary gland to make less follicle-stimulating hormone (FSH). Because of this, as a woman is transitioning to menopause, the overall hormone balance is shifting towards increase FSH and LH levels, and lower estrogen and progesterone levels. The signs and symptoms, including irregular menstruation and eventually no menstruation, are a result of this shift in the hormonal profile.

What are the main symptoms of menopause?

The obvious sign of menopause is no menstruation, but during perimenopause and sometimes even persisting throughout menopause, there are several symptoms that are experienced. These include vaginal dryness, insomnia, mood swings, decreased focus, hot flashes and night sweats. Hot flashes and night sweats, otherwise known as vasomotor symptoms (VMS), are one of the most common symptoms, affecting around 80% of women during their menopausal phase. These symptoms often begin in perimenopause, but are strongest during menopause and continue even post menopause.

So, what are hot flashes? Hot flashes are basically a feeling of intense heat, causing sweating, predominantly around the upper part of the body. The cause of these is not fully understood, however, they are thought to be associated with low estrogen levels and high luteinizing hormone levels, which are two hormones that have been linked to menopause. Moreover, there is some evidence that body temperature regulation is affected, with even small changes in temperature triggering a response to try to reduce the heat, such as sweating.

Vaginal dryness, urinary incontinence, pain during sex and lower libido can also be experienced during menopause, because of the decreasing levels of estrogen that also have an impact on vaginal tissue.

Some women may also experience changes in body composition, with weight gain and loss of lean mass, as well as a shift in body fat distribution to a more android pattern where body fat accumulates around the midsection. Menopause also been found to be associated with increased cardiovascular risk factors such as higher diastolic blood pressure, higher total serum triglycerides and cholesterol levels, with menopause being linked to an increased risk of cardiovascular disease in some instances, particularly for women who experience menopause at a younger age.

How is menopause diagnosed?

Blood collection tubes filled with blood.

Clinically, menopause is diagnosed following 12 months of no menstruation (amenorrhea) when there are no other factors that could have caused the lack of menses, such as surgeries or primary ovarian insufficiency. In most cases, perimenopause leading to menopause occurs after the age of 45, however, it can occur prior to this, although below the age of 40 is abnormal and known as POI. Measuring certain hormone levels, including estrogen, FSH and anti-müllerian hormone (AMH), via blood or urine tests, can be carried out in order to observe the changes in these hormone levels over time and therefore give an indication as to whether menopause is occurring or not, or predict when it will. After menopause, follicle-stimulating hormone levels are greater than 30 mIU/mL and estradiol levels are under 30 pg/m.

How is menopause treated?

Well, firstly, it is probably important to point out that menopause itself cannot be “cured” or stopped in anyway. Menopause is not a disease, and is not something that needs to be treated; it is a natural occurrence that happens with age. However, the symptoms that are bought on by menopause, most of which are considered unpleasant and uncomfortable, can be managed or treated to some extent.

Hormone replacement therapy (HRT)

Medically, HRT is one of the main interventions used, which primarily aims to replace the estrogen that is no longer naturally produced by the body. This can be done in various ways, including gels, vaginal creams, skin patches and even consumed orally via pills. HRT is usually prescribed by a medical professional in an attempt to help relieve symptoms such as severe hot flashes, night sweats and vaginal dryness, although notably, it cannot be prescribed for all women and is no longer the “go-to” standard. Recently, an increased risk of blood clots and cancer has been found with long-term use of HRT, therefore use it now cautioned against, and when used, it should be taken for the shortest time needed, at the lowest effective dose. With this being said, HRT is not the only way to help relieve such symptoms.

Supplements and diet for menopause symptoms

Several supplements have also been studied to see if they help reduce menopausal-related symptoms, including botanical and nutritional supplements. Some of these supplements include Vitex agnes-castus, St. John’s wort, evening primrose oil, black cohosh and omega-3 fatty acids. During menopause, both lipid and glucose metabolism can be negatively impacted as a result of the hormonal changes that occur, which can in turn have an effect on cardiovascular health. Therefore, in order to prevent any additional side effects, a healthy diet containing high-fiber whole grains, fruits, vegetables and oily fish is recommended, as well as a diet low in cholesterol, saturated fat, sodium, salt and trans-fatty acids.

Is exercise good for menopausal symptoms?

Elderly woman performing a yoga pose to help relieve her symptoms of menopause.

Exercise has been shown to be beneficial for the vasomotor symptoms of menopause, such as hot flashes and night sweats, as well as the psychological symptoms such as mood swings. Yoga is particularly helpful for relieving such symptoms, with 30 minutes of yoga carried out several times a week shown to have numerous health benefits. The changes in hormone levels during menopause can also increase the risk of osteoporosis, therefore resistance and strength training are beneficial for helping to maintain bone mineral density and muscle mass, as well as high-impact exercises like jogging.

Summary

Hopefully, this article has helped you understand menopause and perimenopause that bit more and given you an insight into what others are experiencing and what you yourself may experience at some point (if not already). Ultimately, menopause is inevitable for every woman and although it can be an uncomfortable period of time, with many unpleasant symptoms and unfamiliar changes, the key is being prepared and knowing what is going to happen and what your options are to help you manage everything to the best of your ability. The number one key message is that the ability for women and everyone to speak openly about menopause is only going to help everyone. Being able to confide in your partner, friends, coworkers, and medical professionals, and being able to just discuss menopause out in the open, is a way that those going through it will feel supported and heard. Menopause is not a disease or anything to be ashamed of, it is a natural part of a woman’s life, just the same as the onset of puberty, and even learning to talk and walk. It’s time we all learned to talk about menopause too!

References and further reading:

Perimenopause and Menopause: An Overview