Menopause

Menopause is the permanent cessation of menstrual periods for 12 consecutive months, marking the end of a woman’s reproductive years. It typically occurs between ages 45 and 55 but can vary. Menopause is a natural biological process, not a medical condition, but it comes with hormonal changes that affect physical, emotional, and mental health.

Perimenopause

Perimenopause is the transitional phase leading up to menopause, during which a woman’s body begins to produce less estrogen, and menstrual cycles become irregular. This phase can last anywhere from less than one year to 10 years, and women typically start experiencing symptoms such as irregular bleeding,  hot flashes, sleep disturbances, and mood swings.  It ends when menopause occurs. Remember that until you have fully achieved menopause, you can still get pregnant.

Postmenopause

Postmenopause refers to the years after a woman has experienced menopause, defined as having gone 12 consecutive months without a period. During this phase, menopause symptoms like hot flashes and night sweats may decrease over time, but the long-term health effects of menopause, such as the risk of osteoporosis and cardiovascular disease, become more significant.

Premenopause (Reproductive Years)

Premenopause refers to the years before a woman enters perimenopause, when she is still having regular menstrual cycles and is capable of conceiving. This stage typically encompasses the years from puberty to the early 40s or whenever the transition to perimenopause begins.

Menopausal Transition

The menopausal transition is another term for perimenopause, describing the period when the body begins to shift from its reproductive phase to the post-reproductive phase. It includes the fluctuations in menstrual cycles and the onset of menopause-related symptoms.

Early Menopause

Early menopause refers to menopause that occurs before age 40, often due to medical conditions, treatments (such as chemotherapy), or genetic factors. Women who experience early menopause may have more pronounced symptoms and health risks, such as osteoporosis, and may be offered hormone therapy or other treatments to manage their symptoms. If you are experiencing menopausal transition between 40 -45 y of age, please also consult a health care professional about risk assessment and possible supports.

Surgical Menopause

Surgical menopause occurs when a woman has both ovaries removed (oophorectomy), often due to conditions like ovarian cysts, endometriosis, or cancer. This procedure causes an immediate cessation of menstruation and the abrupt loss of estrogen, leading to the onset of menopause-like symptoms, even if the woman is younger than the typical age for natural menopause.

Vaginal Atrophy (Genitourinary Syndrome of Menopause)

Vaginal atrophy refers to the thinning and drying of the vaginal walls due to decreased estrogen levels after menopause. This can lead to symptoms like vaginal dryness, irritation, itching, and discomfort during intercourse. It is part of the broader condition known as genitourinary syndrome of menopause (GSM), which affects the lower urinary and genital tracts.

Osteoporosis

Osteoporosis is a condition characterized by weakening of the bones, increasing the risk of fractures. It is more common in postmenopausal women due to the decline in estrogen, which helps protect bones. Women are advised to engage in weight-bearing exercises, strength training and ensure a well balanced diet high in protein to help maintain skeletal muscle and bone health during and after menopause.

Menopausal Hormone Therapy (MHT – formerly Hormone Replacement Therapy)

MHT involves the use of hormones to relieve menopause symptoms, such as hot flashes, vaginal dryness, and night sweats. MHT can also protect against bone loss but carries uncommon potential risks, such as an increased risk of breast cancer and blood clots, depending on the woman’s health history.  Risk assessment for the use of MHT is unique to each person as it is is based on personal and family history. In women determined to be low or acceptable risk, menopausal hormone therapies’ benefit may outweigh the risk regarding quality of life and prevention of bone loss.

Compounded Bioidentical Hormones

Compounded Bioidentical hormones are compounds that are advertised as chemically identical to the hormones naturally produced by the human body but are however, incorrectly confused with actual bio identical therapies. They are often promoted as a more “natural” alternative to traditional MHT, though their safety and effectiveness have not been conclusively proven in large studies. These are mixed with unstudied agents and risks are unknown of the compounds. The only time a compounded therapy is recommended is when special circumstances arise (like allergies) are required; at these times a trusted pharmacy can create a compounded agent with well studied ingredients including chemically identical hormones (example: 17beta Estradiol).

Bioidentical Hormones

Bioidentical hormones are compounds that are chemically identical to the hormones naturally produced by the human body. These are readily available in pills, gels and patches and you can discuss risks and benefits with your health care provider.

The Role of Lab Work in Menopause

The diagnosis of menopause and menopause transition is usually done based on the pattern of someone’s periods and how the person is feeling, their age and their symptoms. There are times when hormonal blood work is needed but it is important to know that it is often not necessary to diagnose someone being in these phases. Menopause is more about how someone is feeling and the stage they are at versus the lab values. Notably, there are lab values that can rule out other causes of symptoms experienced and can guide management at times.