Stages of Menopause

Perimenopause

Perimenopause refers to the time around menopause when a woman’s reproductive years are coming to an end. This may occur for a woman as early as her mid-30s and more commonly as a woman enters her 40s. If a woman is not taking any medication for birth control, she may also begin to have menstrual cycles where she does not ovulate (release an egg). Symptoms may include vaginal dryness, problems with sleep, and hot flashes. These symptoms are due to fluctuating levels of estrogen. Be sure to speak to your gynecologist if your symptoms become a problem for you.

Menopause

During menopause, a woman’s menstrual cycles stop and her reproductive years end. This is because the ovaries stop producing estrogen and progesterone and therefore stop releasing an egg every month. This occurs most commonly after the age of 45 for most women. Menstrual cycles change and vary significantly with periods being heavier or lighter, longer or shorter, occurring more or less frequently, and are more irregular. A woman has reached menopause when she has not had a period for 12 consecutive months.

Symptoms in menopause may begin in perimenopause and can include:

Vaginal dryness

Due to dropping levels of estrogen, the vagina becomes drier which can cause sex to be uncomfortable or even painful.  Consider using a water-based lubricant and speak to your doctor if this becomes a problem for you.

Hot and/or cold flashes

Hormonal changes can cause dysfunction in a part of the brain called the hypothalamus that is responsible for temperature regulation. While approximately 85% of women experience hot flashes in menopause, some women also experience cold flashes.

Difficulty sleeping

Hormone changes, hot flashes and cold flashes, and changes in the brain itself during menopause can lead to problems with sleep. Declining levels of progesterone and estrogen may also cause sleep apnea which is 2 to 3 times more common in menopausal women than it is in perimenopausal women.

Mood swings

Declining estrogen is also responsible for a number of emotional symptoms in perimenopause and menopause including:

• Anxiety
• Irritability
• Aggressiveness
• Feelings of sadness and depression
• Problems concentrating
• Memory impairment
• Loss of motivation
• Fatigue

Women should discuss any mood changes that are disruptive for them with their doctor. Medications such as antidepressants are sometimes prescribed for menopause care to help ease these symptoms. Lifestyle changes such as meditation and yoga can also help.

Hair loss

Declining levels of estrogen and progesterone lead to hair loss which varies greatly from woman to woman. When these hormones decline, they trigger the release of male hormones known as androgens and can also cause fine hair to develop on the face and neck. However, there are other causes of hair loss as well such as nutrient deficiency, thyroid dysfunction, and high stress levels. Speak to your doctor if you’re concerned about hair loss and he/she can determine whether further testing including blood work is needed.

Dry mouth, skin, and eyes

Declining levels of estrogen can cause a woman’s mouth, eyes, and skin to be drier. This is because estrogen helps with elasticity of the tissues. Using a good moisturizer on your skin can help. If dry eyes and mouth become a problem, speak to your physician or pharmacist who can recommend medications to relieve these symptoms.

To help with menopause management, your doctor may recommend hormone replacement therapy (HRT), antidepressants, and other prescription medications. However, there are risks with HRT and your doctor can help you decide what’s best for you.

Postmenopause

Postmenopause occurs after a woman has not had a period for one full year. Some symptoms of menopause such as hot flashes may continue during this time but are usually less severe. It is not uncommon for menopause symptoms to last a decade or longer after menopause. Because estrogen levels drop significantly in this stage, women are at higher risk for osteoporosis, heart disease, high blood pressure, and high LDL (“bad”) cholesterol amongst other health issues. Be sure to discuss these issues with your gynecologist if you have a family history of these medical problems or want to know more about how to prevent them.