Phases of menopause include years before and after
Menopause refers to the stopping of a woman's monthly period, most commonly as a result of natural aging. A woman is considered to have reached menopause if she has not menstruated for 12 months in a row. The average age for this to happen is 51 years old although some women stop menstruating in their 40s and some later in their 50s. While menopause marks a milestone in a woman's life—her last period being as significant as her first—the menopausal phase encompasses the years leading up to the last period (perimenopause) as well as after (postmenopause).
Declining estrogen triggers perimenopausal symptoms
Production of the hormone estrogen steadily declines as you age. As you enter the perimenopausal years, which may be eight to 10 years before the onset of menopause, you may begin to notice changes due to a drop in estrogen levels, such as:
- Weight gain around the middle
- Changes in mood
- Night sweats and hot flashes
- Lack of sexual interest
- Foggy brain
Some women experience these kinds of symptoms while others hardly notice any changes. Throughout perimenopause you'll continue to have your period although you may start to experience irregular vaginal bleeding, such as spotting between periods, shorter or longer periods than you used to have, and longer times in between periods. You may also have unusually heavy periods, especially in your early 40s, due to fluctuations in the production of the hormone progesterone. Heavy bleeding may sometimes be a sign of uterine fibroids, but in some cases it is simply a nuisance. Be sure to talk to your OB/GYN about these and other changes, and what your options are. For example, procedures such as cryoablation can minimize the shedding of the uterine lining and therefore lessen the monthly bleeding.
Also keep in mind that as long as you are still having a period, regardless of how frequently you have it, you can still get pregnant. Your OB/GYN can advise you on birth control options, if appropriate, based on your health condition and your lifestyle needs. You will also continue to get regular mammograms as advised by your doctor.
Because of changes in metabolism and weight during this time, it's also critical to manage your weight with good diet and exercise. In perimenopause, you may also need to pay closer attention to your emotional and psychological well-being as this time of life may bring changes in your mood and ability to cope with daily stressors. You can also talk with your doctor about sexual health and libido (sex drive), which often declines with age and particularly during the years leading up to and after menopause. Nonetheless, many women continue to have a vital sex life well beyond menopause. Your body may be changing, but you will inevitably begin to adjust to this new phase of life. Diet and lifestyle changes, and sometimes medication as well as hormone therapy or bioidentical hormone replacement therapy (BHRT) can help smooth out perimenopausal symptoms.
Menopause and beyond
Once your period has “officially” ended, you are considered to be postmenopausal. You may continue to experience some of the symptoms you had during the perimenopausal years, and you may notice new changes in your body, such as vaginal dryness, due to the drop in estrogen production.
Women in postmenopause are also more susceptible to cardiovascular disease, urinary incontinence and osteoporosis, again due to the lack of estrogen production which once helped protect and support heart, bones, and certain bodily functions. With age it becomes easier for your bones to fracture, for example, so your doctor may recommend a DEXA scan to measure and monitor bone density.
Postmenopause, you will continue to see your OB/GYN and also receive regular screening mammograms for as long as your doctor recommends, based on your health history and current health condition.
Weight gain and sexual dysfunction continue to be challenges for some women after menopause so it helps to continue seeing your doctor, asking questions, and making purposeful changes to diet and lifestyle. You may also want to explore alternative therapies, such as yoga, tai-chi, acupuncture, and massage therapy. This whole-person approach can help offset the postmenopausal symptoms and help you look and feel your best as you age.
It's important to note that many women report having their best years in their 50s, 60s and 70s. Those who have children may have more free time on their hands. Women who've been plagued by PMS and perimenopausal problems may suddenly be freed up to experience greater health and energy than they have in years. Sex may even improve for some who have newfound feelings of well-being and energy. Embracing the changes and the advantages of being older and wiser can help you transition more easily through each of these phases.