Menopause is the point of transition from a woman’s reproductive to non-reproductive life stage.
Many of us go through this change in our 40s or earlier (see Premature & Early Menopause section), while others experience it later.
We are born with all of our eggs—around two million of them. They start to deplete from puberty onwards through our menstrual cycles. Once our eggs are gone, the hormonal feedback loop of our cycle is disrupted until it eventually fails.
Perimenopause, Menopause, and Post-menopause
It can take a long time for this cycle to stop altogether, often up to ten years. We use the term peri-menopause or perimenopause to describe the lead-up to the event when periods finally stop.
Menopause occurs after 12 months and one day without a bleed. After that, we call it post-menopause for the rest of our lives.
Perimenopause—the time when we are still experiencing periods—is the most symptomatic phase of the menopausal cycle.
Why Do We Experience Symptoms?
Our body chemistry is a jigsaw that fits together in particular ways. One piece needs the right dimensions of another to join and create a picture that makes sense. When the dimensions aren’t right, the picture is disorganized.
There are gaps and overlaps that are unique to every woman. The presence or lack of symptoms, how long they last, and which treatments are best for us vary from woman to woman.
Some women experience few or no symptoms, while others suffer for many years. But even for those lucky enough to escape symptoms, they must still consider health issues that need to be acknowledged for long-term postmenopausal health.
The average number of years in perimenopause is 3-4 years, though you should not imagine this is the same for all of us as this is merely an average. Many women experience symptoms for much longer but do not recognize them as perimenopause as this is a relatively modern term.
How is Menopause Diagnosed?
If you are 45 years old or over, the diagnosis of perimenopause is usually based on the symptoms a woman may experience.
This is because our hormones fluctuate so much by the time we reach our mid-40s, making hormone blood tests inaccurate. They could differ every day or even every hour.
If you are under 45, a hormone blood test can be taken to test levels of FSH. FSH is tested early in our cycle as it is the first step in the hormonal loop. If levels are high, it can indicate that our menstrual cycle is no longer functioning properly.
It can sometimes be useful to test for another hormone, such as testosterone if libido has dropped significantly during perimenopause. This test can be useful in deciding whether testosterone should be prescribed.
Tests are often repeated at monthly intervals.
Do We Still Need Contraception During Perimenopause?
The hormonal fluctuations leading to menopause can make some women more fertile!
In 2017, conceptions in women aged 40+ increased by 2.6% for the second year running and was the only age group to do so. However, statistics don’t show how many of these pregnancies were planned.
It is important to remember that contraception remains a consideration until you and your doctor are confident your periods have stopped completely for at least 12 consecutive months.
Got any lightbulb moments while learning about menopause? Share them in the comments!
Menstrual Cycle Changes
24/04/2022 / No Comments
Changes to our menstrual cycle are often the first symptoms of perimenopause.
When you approach menopause, falling estrogen and progesterone hormone levels mean that the hormonal feedback loop necessary to maintain your menstrual cycle is interrupted.
Changes can include differences in the length of time that you bleed and the time in between periods. A cycle length is defined as the first day of your period to the first day of your next period.
You may experience heavier or lighter bleeding than normal, causing tiredness and fatigue.
There is often no pattern to the changes. It is important to remember that changes in periods are part of a bigger transition and eventually end.
It is helpful to be aware of what’s normal for you as an individual to monitor what’s happening.
The erratic nature of periods at this phase of life can be annoying, debilitating, and often embarrassing. Not knowing if a period will be light or heavy or when it will arrive can make it difficult to make plans.
If any changes cause concern, you must discuss this with your doctor. Sometimes, abnormal bleeding can signal an underlying problem, such as polyps or fibroids.
Your doctor can check for possible causes of abnormal uterine bleeding using various tests, such as vaginal ultrasound, blood tests, or a referral to a gynecologist.
Don’t Forget Contraception!
Although fertility declines during the menopause transition, it is still possible for a pregnancy to occur. It is important to continue with contraception if you are sexually active.
If you are under the age of 50, then you should use contraception for two years after your last menstrual period. If you are over the age of 50, you should only use contraception for one year after your last menstrual period.
What Can You Do?
Some handy hints to navigate period changes include using a period tracker on your phone to chart when your period arrives.
Having a supply of feminine hygiene products in your bag may be a good idea if you don’t know when to expect your period.
If you have heavy periods, consider specially designed period pants, which can offer more comfort and protection.
If you are experiencing abnormal bleeding or pain, using our symptom tracker may be helpful so you can note when this happens.
Make sure you have a healthy diet and exercise regularly to help you feel less sluggish.
If you are experiencing heavy periods, you do not need to suffer in silence and just put up with it!
Discuss the following options with your doctor:
- Non-hormonal: Tranexamic Acid (as long as it doesn’t interfere with any other medications you may be on)
- Hormonal: the Mirena Coil, which releases progesterone
- Surgical: Endometrial ablation
You can also get your iron levels checked, as low iron levels can contribute to feeling fatigued.
We know that periods are annoying, frustrating, and often downright inconvenient. Many women feel disappointed each month at receiving a period, asking themselves, “When will menopause be here?”
But remember, periods will eventually stop forever. Menopause can be a really good thing to look forward to, especially if you have had a long perimenopause period.