Women can spend almost half their lives either transitioning through Menopause or being Postmenopausal. Yet there’s very little information available about this phase of Womanhood. And the available information is vague and confusing. For instance, what exactly is Menopause? And – the question on every menopausal woman’s mind – how do I know when it’s over?
The Two Stages of Menopausal Transition
Menopause, or the Menopausal Transition as we like to call it these days, is the decade or so when your ovaries begin to wind down before retiring altogether. This major life change has two distinct stages: Perimenopause and Postmenopause.
In fact, what we’ve traditionally called Menopause, and often considered a stage of its own, actually occurs during the first stage, Perimenopause. And it’s the point in time when it’s been exactly 12 months since your final menstrual period.
Once you’ve reached that point, though, Postmenopause starts immediately. Meaning that Menopause is less of a phase itself, and more of a marker signifying the end of one stage and the start of another.
Now, we know that this feels like a completely new way to look at the Menopausal Transition, but we think it makes a huge amount of sense. So here’s how the stages breakdown:
Generally begins in your mid-40s. Characterized by changes in your cycle and periods, as well as physical and emotional symptoms. Also includes the 12 months following your final menstrual period.
Begins 12 consecutive months after your final menstrual period. Your transition symptoms, including hot flashes, night sweats, and fatigue should recede over the coming years.
What is Menopause?
Now, the above might all have sounded a little… brief, so let’s start at the very beginning.
Literally translated, Menopause means when your menses, or monthly cycle, pauses or stops. When this happens, it generally means that you’ve stopped ovulating. When you stop ovulating, there’s no need for your body to thicken your uterine lining in preparation for pregnancy every month. This means you stop getting your period regularly and eventually stop getting your period altogether. Common Menopause symptoms can include:
- Irregular periods
- Insomnia or sleep disturbance
- Vaginal dryness
- Night sweats
- Weight gain
- Brain fog
Generally, women exeperiencing the Menopausal transition are generally 45 to 55, with the average being 51. It is also possible to experience symptoms as early as 40. But if you’re under the age of 40 and experiencing those symptoms, that’s generally known as Premature Menopause.
Menopause is usually talked about as if it’s a final destination or a resting place for all of your monthly period-related woes. But the truth is, you can experience the symptoms of Menopause for anywhere from seven to 14 years! Just let that sink in for a second.
But, as horrendous as that sounds, spending up to 14 years in Menopause is completely normal. And you’re in good company. After all, menstruators account for just over half of the world’s population. And anyone who’s lucky enough to make it to their 40s will go through it.
Premenopause? Perimenopause? Postmenopause? What’s the difference?
Now, when you really start looking into Menopause, loads of other terms pop up. Premenopause? Perimenopause? Postmenopause? And what’s more confusing is that sometimes these words are used interchangeably. It’s incredibly annoying!
The truth is, although medical research was performed as far back as 500 BC, research on Menopause only started to ramp up during the 1930s. Given the social context of that time, in the days before World War 2, you can imagine that even that research may have been ever-so-slightly skewed. And even since then, most Menopause research has been conducted by male physicians, who often have limited hormone knowledge.
Though most people aren’t aware, those different terms all describe completely different stages. And we’re going to tell you about it. But remember that most people – and potentially even your primary healthcare physician – may not use these terms. And even if they do, they probably won’t use them the same way as the next person. So, it’s a good idea to ask for clarification to make sure you’re on the same page.
Premenopause and Perimenopause
The literal translation for Premenopause is before Menopause. Girls and women who experience monthly fluctuations in Estrogen and Progesterone and have a period are considered Premenopausal.
Perimenopause, on the other hand, literally translates to around Menopause. Technically speaking, this stage can be characterized by chills, difficulty sleeping, irregular periods, brain fog, and all of those other fantastic symptoms listed above.
However, you’ll find that many healthcare professionals — and health websites — may not use the term Premenopausal at all, or they’ll use Premenopausal and Perimenopausal interchangeably. Confusing, right?
Well, we’re sorry to say that the confusion doesn’t stop there.
Some people use the word Menopause to describe the transitional time when women start to experience irregular periods, hot flashes, and all those familiar symptoms we discussed earlier.
Hold on a minute? Isn’t that the same as Perimenopause? Well… Yes.
In truth, most people use Menopause as a blanket statement covering both the whole journey. They could mean the part where you can’t sleep at night, are hot one second and cold the next, and never know when your period will come or how intense it will be, i.e., Perimenopause.
But they could also mean the part where you don’t get a period at all but might still have other symptoms, i.e., Postmenopause
But we’re here for the nitty-gritty. And since you’re here, you probably are too.
The distinguishing factor is your period. You wouldn’t be considered to be Postmenopausal until after your period has been MIA for 12 months. And that’s it — there’s no test, no line you cross, nothing to do with symptoms, it’s just 12 period-free months in a row.
Generally speaking, Postmenopause describes a point in time when you haven’t had a period in over a year, AND most other symptoms have subsided. In other words, it’s the rest of your life. Postmenopause can be the least confusing stage, but it’s not always used in the same context. So, don’t be afraid to clarify and ask questions if you’re ever not sure.
How do I know when Menopause is over?
Ah, the question on everyone’s mind. And it’s a good one.
The official medical answer is this: You in Postmenopause when you haven’t had a period in 12 months and most of your symptoms have subsided. And depending on how your hormones work, that could take up to 14 years. But you’ll notice one little caveat there. Most of your symptoms. Because some women are never symptom-free. And we’re working on an explanation for that.
In reality, then, it’s a question that’s much harder to answer. Hormones are, as regular Hormonas will know, deeply individual. Which means your Menopausal transition won’t be quite the same as the woman’s standing next to you. And coming out of Menopause will be down to a complex, interlocking range of factors that are unique to you.
FSH and Low Estrogen
If you’ve ever had a period, that’s down to the regular release of Follicle-Stimulate Hormone, or FSH, Estrogen, and Progesterone in preparation for pregnancy. Your levels of all three hormones increase and decrease depending on where you are in your cycle, and it’s all done to support baking a new human.
During your menstruating years, FSH helps regulate your cycle. Its main purpose is to stimulate follicles in the ovary so they start growing. These follicles, in turn, produce Estrogen. Eventually, one of the follicles will form an egg, which will be released. This is Ovulation!
In preparation for Ovulation, your Estrogen levels rise – thanks to those follicles – during the first half of your cycle, while Progesterone levels remain low. During Ovulation, your Estrogen levels drop, while Progesterone levels increase to prepare your uterus for a possible pregnancy. But if that doesn’t happen, your uterus lining breaks down, your Progesterone levels drop and you have a period.
So, during Perimenopause, you’d think your FSH levels would be low, but, in fact, the opposite is true. FSH levels are actually higher during this stage.
Why is FSH so high?
Now, as you may or may not know, if you were assigned female at birth, you came into the world with all the eggs you’ll ever have. And as you go through each menstrual cycle, the number of available eggs decreases, until there are no viable follicles left. And as those follicles produce the bulk of your Estrogen, when they stop growing, your levels remain low.
But your brain doesn’t really understand what’s happening, and continues to produce increasing amounts of FSH in an attempt to persuade your ovaries to grow more eggs.
Because of that very specific situation, high FSH levels can sometimes help diagnose Menopausal transition. But they’re unreliable, because levels vary a lot throughout Perimenopause and Postmenopause. And while those levels change, you experience all those wonderful symptoms. Many women report that the symptoms ease over time, but it very much depends on the person.
Should I see my doctor?
If you’re experiencing Perimenopausal symptoms, talk to your primary healthcare provider as soon as you can. They can talk you through options for managing symptoms, as well as checking for any underlying issues, including Thyroid dysfunction. This is particularly important if you’re under 40 — Premature Menopause can have serious long-term health implications, so getting a speedy diagnosis is paramount.
In either case, depending on your age and health history, your doctor may order tests or prescribe medication to help you through the transition.
The most common prescription for the bulk of Menopause-related symptoms is hormone replacement therapy, or HRT. This can mean Estrogen therapy, or a combination of Estrogen and Progesterone, depending on your symptoms. That said, long-term use of Estrogen may come with an increased risk of cardiovascular and breast cancer, so make sure you discuss this with your doctor.
There are, however, lots of other medications, if you’re not sure about hormones, that could help minimize hot flashes. They include low-dose antidepressants for brain fog, depression, and anxiety, and some seizure and blood pressure medications for hot flashes and night sweats.
It is, of course, possible to manage some symptoms without any medication at all. That, though, can depend entirely on their severity and finding the right combination of therapies for you. Here are some tried and tested faves:
- Wearing layers and removing them or adding them as needed
- Carrying a fan with you
- Breathwork to help regulate your temperature and mood
- Identifying any triggers for hot flashes, e.g., eating spicy food
- Maintaining a nighttime routine to improve sleep disturbance
- Regular exercise, including yoga, swimming, and walking
- Not beating yourself up because your hormones are a pain
- Keeping your favorite period products on hand at all times, because you never know. That said, if you’ve not had a period for over a year, and suddenly have one, please tell a doctor immediately.
When Menopause is over…
Menopause is a normal part of every menstruator’s journey. As frustrating as it is, the research on the how and when of the whole extravaganza is still developing. And, unfortunately, it’s not possible to predict when Menopause will begin, or say definitely when it’ll be over. What we can say for sure is that it is — mostly — temporary, that you will start to feel better eventually, and you are most definitely not alone.
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