Healthy Living

The Stages of Menopause

The Stages of Menopause

Menopause is a natural transition period where women progress from their childbearing years to a subsequent stage of their lives. The symptoms that come with it shift and appear in overlapping stages.

It is very important for women to understand all the signs and symptoms that accompany menopause, especially if they are approaching middle age.

Premenopause

Premenopause is usually described as the entire life of a woman before menopause. Throughout this time, your menstrual periods occur frequently; you are capable of bearing children, and your sex hormones, progesterone and estrogen, maintain a moderately stable balance. This transition stage often begins when women are in their early forties.

Many years before your last menstrual period, the physical signs of menopause begin. Premenopause refers to the fertile life of women from the first menstrual period to the last. It is a part of the natural aging process. Some experience great relief when they reach this phase, whereas others are unhappy since they have lost their fertile life.

The period of premenopause may vary for each individual. However, the symptoms are the same. Usually, when a woman reaches the age of 45, she may experience this condition. However, women in their twenties may show signs of premenopause; some may even exhibit signs in their late sixties. The period of premenopause lasts for one to five years. Doctors may recommend including certain vitamins in your diet, changing your lifestyle and diet, and doing regular exercise. Many over-the-counter medications are available to provide some relief from premenopause symptoms. However, take these medications only with a doctor’s recommendation.

The following symptoms are common during this period:

These symptoms often occur as a result of hormonal fluctuations related to a woman’s menstrual cycle changes. Most women encounter premenstrual syndrome prior to their monthly periods.

Perimenopause

This is the time when both ovulation and fertility slow down. Hormonal levels drop and unpleasant side effects become more frequent

The drastic changes that take place in the body are fluctuations in hormone levels and menstrual cycle. The ovaries produce less estrogen; there is a decline in estrogen levels; and the menstrual cycle shortens. Women may show different behavior. Some women may miss their periods whereas others may have fewer periods, but longer menstrual cycles.

Women may also experience weight gain, tender breasts, headache, dryness of the vagina, and lack of sleep. Emotional changes also occur, such as irritability, extreme anxiety, depression, and difficulty handling stress. Other common symptoms are hot flashes and mood swings. Less common symptoms are a lack of sexual desire, loss of hair, and an inability to hold urine. Some women enter this phase in their forties whereas others may not experience this phase at all.

Recurring perimenopausal symptoms include:

  • Hot flashes: The most common symptom accompanying menopause is the feeling of instant warmth or heat. These are triggered by the inconsistent fluctuation of hormones that prompt the body to erratically try to contend with them. Hot flashes can occur at any time, day or night. They can cause a lot of discomfort, too. If a woman gets hot flashes at night, she will experience night sweats as well. In this, women wake up drenched in sweat.
  • Vaginal dryness: The sudden reduction in estrogen leads to a significant decrease in natural vaginal lubricant.
  • Mood swings: The fusion of unpredictable hormones and the uncomfortable symptoms can result in extreme mood swings, such as depression and irritability.
  • Night sweats: An increase in body warmth causes excessive sweating on the individual’s body.
  • Loss of libido: A decreased level of estrogen production is associated with menopause, which can cause lower sexual motivation among menopausal women. The sexual desire decreases. Sometimes, couples adjust to the change in sexual activity, so it might not be a problem, however, for others, this situation might lead to tension and problems.
  • Decreased ability to get pregnant: During perimenopause, the ovulation rate goes down, and a woman’s ability to get pregnant reduces. However, if you do not wish to get pregnant, it is safe to use birth control pills until menopause occurs.

It is very hard to understand when your perimenopause period sets in. The most common warning symptom, however, is infrequent monthly periods.

Other symptoms of perimenopause are:

  • Longer or heavier menstruation
  • Shorter length of menstrual periods
  • Irregular periods, wherein the ovaries ovulate, but not in a predictable manner. Sometimes, women may miss their periods, which might cause worry.
  • Sore breasts
  • Unusual menstrual cramps
  • Mid-sleep awakenings or middle-of-the-night insomnia
  • Increased frequency of migraines
  • Noticeable gain in weight
  • Bladder difficulties, wherein the tissue or urethra responds to estrogen. When the estrogen declines, the urethra tissue shrinks, and this can cause incontinence or urine problems. Since the cervix no longer produces cervical mucus, intercourse can become painful as well.

The chance of becoming pregnant in this phase is still possible. Other forms of contraceptives can be prescribed by your doctor to avoid pregnancy. After your last menstrual cycle, it is suggested to administer birth control, which usually lasts up to one year.

Progestin Therapy

Progestin is a hormone that works similarly to the hormone progesterone. This hormone is used to help regulate a woman’s menstrual period. However, there are some women who cannot tolerate taking progestin because of its unpleasant side effects, which include:

  • Unusual bleeding
  • Spotting
  • Swelling of the breasts
  • Feeling bloated
  • Weight gain
  • Terrible headaches
  • Nausea and vomiting
  • Acne breakouts
  • Unexplained depression

Menopause

If a woman goes for about a year without receiving periods, she has officially reached menopause. Unfortunately, the symptoms experienced in the perimenopause stage can manifest during menopause as well. Technically, menopause refers to the date of your last period. Because of the reduced production of estrogen hormones, a woman may encounter the following:

  • Severe hot flashes (the sensation of extreme heat followed by chills): The face and neck may become red, and the woman may feel sweaty or flushed. The intensity of hot flashes can range from mild to very strong and can last from thirty seconds to ten minutes.Some may experience this symptom a year or two after the first menstrual period. In certain women, hot flashes may continue even after menopause, but over a period of time, it lessens.
  • Urinary tract infections: The low estrogen levels and changes in the urinary tract may make women susceptible to infection. Signs include a persistent urge to urinate, frequent urination, and a burning sensation while urinating. The doctor may ask to do a urine test and give antibiotics.
  • Reduced libido: The low libido experienced during this phase is similar to that of perimenopause. Reduced libido may be due to physical changes brought on by the lower levels of estrogen. The changes include slow or absent orgasmic response and delayed clitoral reaction time.
  • Vaginal atrophy: This is characterized by thinning and inflammation of the walls of the vagina. This may cause painful sexual intercourse. Over-the-counter medications such as localized estrogen therapy, which includes estrogen cream and vaginal rings, are available.
  • Skin hair and other tissue changes: Skin becomes dry due to loss of fatty tissue and collagen. This affects the elasticity and lubrication of the skin near the vagina and urinary tract. Low levels of estrogen cause hair loss or make it brittle and dry. Avoid harsh chemical treatments.
  • Night sweats: These occur due to hot flashes (women may encounter this symptom for more than ten years). During menopause, it is often difficult to fall asleep. Try getting as much rest as possible using relaxation and breathing techniques. Take measures to keep yourself cool while sleeping and avoid foods and drinks such as chocolate, alcohol, and caffeine.
  • Vaginal dryness: Signs include itching around the vulva, stinging or burning, and frequent urination. It may make intercourse painful. Try using a vaginal moisturizer or water-based lubricant. 
  • Anxiety: Menopausal women may feel unusually anxious or irritable at times.
  • Frequent urination: Women may feel a constant urge to urinate.

Usually, women stop having menstrual periods when they reach the age of 50. However, there are women still in their forties who experience menopause as well. Studies have shown that female smokers are more likely to experience early menopause compared to women who do not smoke.

Various menstrual changes happen when women are in the menopausal stage, particularly in the rhythm of their menstrual cycles. They may skip their period for months or experience heavy bleeding for others. These menstrual changes can be experienced by women before they completely stop menstruating.

The symptoms of menopause can last for months or even years and vary from person to person. Check with your doctor regularly so they can monitor your health.

Signs You Should not Ignore

After your period has stopped for a year, if you notice you are bleeding again, visit your doctor as soon as possible to rule out other reproductive system diseases, such as endometrial or uterine cancer.

Seek advice from your healthcare provider if your menopausal symptoms are too overwhelming for you to manage in your everyday life; your doctor can give you prescription medicines to alleviate the symptoms.

Post-Menopause

Once a woman has completed the menopause transition, she is considered to be in the stage of post-menopause. Low hormone levels may bring their own symptoms.

In this phase, the period finally has stopped. The ovaries do not produce much estrogen. Usually, the symptoms lessen, but many continue to have dryness of the vagina.

This stage is characterized by a considerable reduction in symptoms as the body’s hormone levels stabilize. Remember that during this period, the body releases less estrogen, hence, women undergoing this transition are susceptible to contracting serious health problems including insomnia, breast cancer, osteoporosis, heart disease, and urinary tract infections.

Your doctor may request certain tests to determine the levels of the follicle stimulating hormone (FSH) in the blood. The pituitary gland, which can be found at the base of the brain, is responsible for the production of the follicle stimulating hormone. Your FSH level will help your doctor confirm if you are indeed postmenopausal. Moreover, if there is an increased level of FSH in your blood, it means you have a dwindling ovarian reserve (a woman's normal egg supply).

If a year has gone by and you haven’t had your period, the possibility of becoming pregnant is slim. However, you may still continue using forms of contraception unless otherwise advised by your doctor.

Identification of Post-Menopause

  • Frequency: Symptoms occur less often
  • Intensity: Symptoms such as vaginal dryness may become more prominent
  • Duration: Symptoms, if not treated, may last one’s life

Around 7% of women have intense menopause in their sixties. By the age of 58, about 97% of women are postmenopausal.

In the U.S., around one quarter of women die due to heart disease that is likely to develop in post-menopause.

An imbalance of hormones, particularly low estrogen levels, increases the risk of osteoporosis. Other causes include:

  • Genetics: Some women are more sensitive to changes.
  • Diet: If one’s diet is not balanced, the symptoms may become worse and increase the risk of health problems.
  • Habits: Regular exercise and not smoking help to control symptoms.

The symptoms of post-menopause are:

Some less common symptoms may appear which are linked to hormonal imbalance and aging. They include:

  • Follicle stimulating levels are high (over 70 IU /L)
  • Estrogen levels are low (less than 30 pg/ml)
  • Bone density T-score is less than -1
  • Women may not get a period for 12 months.

To determine the transition of menopause, the doctor may perform certain procedures, such as an examination of one’s medical history, a physical, and laboratory tests.

The risks accompanying post-menopause include:

  • Polyps: These are benign or noncancerous growths that can develop in the uterus, cervix, or within the cervical canal. These growths can cause bleeding.
  • Atrophic endometrium: This is also called thinning of the endometrium. The condition usually happens after menopause when the tissue of the uterine lining (endometrium) becomes very thin due to a diminished level of estrogen. For this reason, sudden bleeding may occur.
  • Endometrial hyperplasia: This is described as an abnormal thickening of the uterine lining. The most usual cause for this condition is excessive production of estrogen without progesterone due to the absence of ovulation. As a result, unusual bleeding may occur. Moreover, in some cases, abnormal overgrowth of cells in the uterine lining can also develop into endometrial cancer.
  • Endometrial cancer: This is an illness related to estrogen. The more frequent a woman’s menstrual cycles are, the higher the risk of developing endometrial cancer. Those with tiny body mass indexes are less susceptible to the disease.
  • Osteoporosis: Estrogen is an essential element for healthy bone growth and protection. Thus, when a woman’s body ceases to produce enough of the hormone, the bones have a higher risk of becoming brittle.
  • Coronary artery disease: This is usually described as the sudden narrowing of the arteries bordering the heart due to unnecessary cholesterol. Women undergoing post-menopause are likely to experience excessive cholesterol levels, a phenomenon catalyzed by menopause.

Conditions associated with post-menopause include:

Post-menopause is a natural phase, but its symptoms may interfere with daily routine and cause discomfort. Some may need treatment.

Lifestyle Changes

The good news is that all menopause symptoms are manageable. Postmenopausal women can modify their lifestyles to feel better and healthier. Some of the beneficial lifestyle modifications include:

  • Limiting one’s intake of salt and sugar
  • Avoiding excessive caffeine and alcohol consumption
  • Incorporating nuts, grains, and fresh vegetables into the diet
  • Consuming foods rich in calcium and vitamin D supplements for bone strength
  • Choosing foods that have minimal saturated fat and cholesterol
  • Quitting smoking
  • Exercising daily

Key Takeaways

  • Premenopause is usually described as the entire life of a woman before the menopause
  • Perimenopause is the phase wherein both ovulation and fertility slow down. 
  • If a woman goes for about one year without receiving periods, then she has officially reached menopause
  • Postmenopause is characterized by a considerable reduction in the menopausal signs or symptoms as the body’s hormone levels stabilize.