Understanding the Menopause Transition

Menopause is a natural part of life, but it can be challenging for many women. The symptoms of menopause can range from mild to severe and can affect a woman's physical and emotional well-being. In order to make informed decisions about health and treatment, women should understand the menopause transition. (1)

 The transition into menopause, or perimenopause, typically begins between the ages of 45 and 55 and can last for about seven years to as long as 14 years. As women approach midlife, their ovaries gradually produce less of the hormone estrogen. Estrogen is important for regulating the menstrual cycle and maintaining reproductive health. (1, 2, 3)

What Is Menopause?

The word "menopause" literally means "pause of the month," when a woman's ovaries stop producing eggs and her menstrual periods stop completely. People often use the terms perimenopause and menopause interchangeably, especially when describing symptoms. However, they are not the same. Menopause is not officially confirmed until a woman has gone 12 consecutive months without a menstrual period. Menopause typically occurs at around 51 years of age. (2, 3)

What Is Postmenopause?

Postmenopause is the period of life after menopause. Once a woman reaches postmenopause, she will remain in that state for the rest of her life. Bone loss and heart disease are both more common after menopause. This is because estrogen, which helps keep bones strong and protects against heart disease, decreases after menopause. (3)

Menopause Transition (Perimenopause)

Perimenopause or the transition to menopause is marked by a wide range of symptoms that can vary from woman to woman. Some women don’t experience any menopausal symptoms, while others may experience severe symptoms. It’s important to note that some of these symptoms may be caused by aging and may not be related to hormonal changes. (2)

Symptoms experienced during perimenopause can continue into menopause and postmenopause for an average of four to five years. However, the frequency and intensity of symptoms will typically decrease over time. Symptoms can include the following (1, 2, 3, 4):

• Menstrual cycle changes: When the ovaries produce less of the hormones estrogen and progesterone, it causes the menstrual cycle to become irregular. This might be the first symptom noticed. Periods may be shorter or longer than usual, lighter or heavier, or come more or less frequently. Periods may also be skipped.

• Hot flashes and night sweats: These common vasomotor symptoms are sudden feelings of heat that last one to five minutes and can come on for no apparent reason. Hot flashes can include sweating, flushing, chills, and sometimes confusion. Experts don’t know exactly what causes hot flashes, but it’s believed that the decline in estrogen may affect how the body regulates its internal temperature.

• Sleep disturbances: Sleep disturbances are common during perimenopause. They can be caused by night sweats. It’s important to note that sleep patterns also change with age in both men and women.

• Vaginal dryness: When estrogen levels decline, vaginal tissues can become thinner and dryer. This can lead to itching, irritation, urinary tract infections, and painful intercourse.

• Uterine bleeding problems: Decreased progesterone can lead to a thicker uterine lining, causing heavy periods. Estrogen-fueled fibroids (non-cancerous tumors of the uterine wall)  and endometriosis (the movement of endometrial tissue) may also become more troublesome.

• Mood changes: While some studies have linked estrogen to depression, factors such as life stress, poor overall health, and a history of depression are more likely to cause mood changes than declining hormone levels. Some women are more sensitive to the effects of declining hormone levels on their mood.

• Cognitive function changes: Although estrogen and progesterone play a role in brain function, it’s difficult to distinguish the effects of aging factors from those related to hormone changes. Nonetheless, many women experience short-term memory problems and difficulty concentrating as they transition into menopause.

• Other body changes: Muscle loss, fat gain, a larger waist size, thinner skin, stiff and achy joints and muscles, headaches, and heart palpitations can also occur during the transition into menopause. However, some of these symptoms may also be related to aging.

Written By: Johna Burdeos

Resources

1. Perimenopause: Rocky Road to Menopause. Harvard Health Publishing. Accessed 6/22/2023.

2. What Is Menopause? National Institutes of Health. Accessed 6/22/2023.

3. The Menopause Years. The American College of Obstetricians and Gynecologists. Accessed 6/22/2023.

4. How Long Do Symptoms of Menopause Last? Healthline. Accessed 6/22/2023.