The Stages of Menopause: Perimenopause, Menopause, and Postmenopause

Sep 30, 2024

Menopause is a natural biological process that marks the end of a woman's reproductive years. It is a significant transition that every woman will eventually experience, and it comes in stages: perimenopause, menopause, and postmenopause. Understanding these stages can help women better prepare for the changes their bodies will undergo and find ways to manage symptoms effectively. This article delves into each stage, providing an informative and engaging comprehensive overview.

Perimenopause: The Transitional Phase

What is Perimenopause?

Perimenopause, often referred to as the menopausal transition, is the period leading up to menopause. It typically begins in a woman's 40s but can start as early as the mid-30s or as late as the mid-50s. The experience that officially meets the criteria for entry into the perimenopause or menopause transition is the onset of variable-length menstrual cycles. Several years before this in late reproductive age, many women experience a discernible decrease in cycle length (mean cycle length of 25–26 days instead of 28–29 days), then once they enter the perimenopause, cycle length can vary between about 14 and 50 days. This stage is characterized by fluctuations in hormone levels, particularly estrogen and progesterone, which can lead to various symptoms. (Hale, G. E. et al., 2014), (Santoro, N. 2016), (McNamara, M. et al., 2015)

Symptoms of Perimenopause

The symptoms of perimenopause can vary widely among women and can last for several years. Common symptoms include:

Irregular Periods: Menstrual cycle length, flow, and frequency changes. The majority of women experience at least mild symptoms along with changes in the menstrual cycle in late reproductive age and the menopause transition. (Hale, G. E. et al., 2014)
Hot Flushes and Night Sweats: Sudden feelings of heat, often accompanied by sweating and flushing. Even before early perimenopause, just over half of women begin to experience symptoms such as headache, joint aches or stiffness, back pain, waking at night, night sweats, hot flushes, and difficulty concentrating. (Hale, G. E. et al., 2014)
Mood Changes: Increased irritability, anxiety, and depression. (Hale, G. E. et al., 2014)
Sleep Problems: Difficulty falling asleep, staying asleep, or experiencing restful sleep. (Hale, G. E. et al., 2014)
Vaginal Dryness: Decreased estrogen levels can lead to dryness and discomfort during intercourse. (Hale, G. E. et al., 2014)

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Managing Perimenopause Symptoms

While perimenopause is a natural part of aging, its symptoms can be managed through various approaches. The decision to begin hormonal therapies during perimenopause will be determined by the presence of symptoms including sleep disturbance, vasomotor symptoms, and abnormal uterine bleeding.

General management and prevention measures on the other hand should be universal and include a blood pressure measurement, thyroid function, Vitamin D level, fasting lipid profile, and a general CHD risk assessment. Heading off the increased risk of CHD during this time in reproductive life is very important. (Hale, G. E. et al., 2014)

Menopause: The End of Menstruation

What is Menopause?

The “menopause” is the final menstrual period. The menopause transition is from the onset of menstrual cycle changes or vasomotor symptoms until one year after the final menstrual period. (Roberts, H., & Hickey, M. 2016).

Menopause is a natural biological process that occurs when a woman ceases menstruation, typically around the age of 45-55. Menopause is officially diagnosed when a woman has gone 12 consecutive months without a menstrual period. The average age of menopause is 51, but it can occur earlier or later. This stage marks the end of a woman's reproductive years, as the ovaries cease to produce eggs and levels of reproductive hormones decline significantly. (Honour, J. W. 2018), (Santoro, N et al., 2017), (Harlow, S. D. 2018).

Symptoms of Menopause

Menopause brings about many of the same symptoms experienced during perimenopause, often with increased intensity. These symptoms can include:

Hot Flashes and Night Sweats: Hot flushes and night sweats are the commonest affecting more than 80% of women during the menopausal transition.
Sleep Disturbances: Insomnia and disrupted sleep patterns continue to be prevalent. Natural aging is associated with sleep decline; however, most research suggests that the menopausal transition magnifies sleep deterioration. A survey of more than 12 000 women in SWAN showed that nearly 40% of women reported difficulty with sleeping that correlated with timing of the menopausal transition but remained independent of age
Mood Swings and Depression: Hormonal changes can lead to emotional instability. Mood changes marked by increased depression and anxiety are common during the menopause transition.
Cognitive Changes: Some women report memory lapses and difficulty concentrating. Cognitive decline is mostly associated with somatic aging rather than menopause. Several studies have refuted the benefits of estrogen on cognitive function.
Physical Changes: Weight gain, particularly around the abdomen, and changes in skin elasticity are common.

The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family, and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular, and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. (Monteleone, P. et al., 2018), (Talaulikar, V. 2022), (Santoro, N. et al., 2021)

Health Risks Associated with Menopause

Menopause is associated with an increased risk of several health conditions due to the decline in estrogen levels:

Osteoporosis: Reduced estrogen accelerates bone density loss, increasing the risk of fractures.
Cardiovascular Disease: Estrogen helps protect the heart, so its decline can increase the risk of heart disease.
Urinary Incontinence: Weakened pelvic floor muscles can lead to bladder control issues.

The onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern.

Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above includes lifestyle management, smoking cessation, excessive alcohol consumption, a healthy diet, moderate exercise, and mentally stimulating activities. (Lobo, R. A. et al., 2014), (Daan, N. M., & Fauser, B. C. 2015), (Monteleone, P. et al., 2018)

Managing Menopause Symptoms

Effective management of menopause symptoms involves a combination of lifestyle changes, medical treatments, and natural remedies.

Treatment options for menopausal symptoms include hormonal preparations, non-hormonal medications, and non-pharmacologic therapies. HT with estrogen is the most effective treatment for menopausal VMS and GSM. Women with significant sleep or mood disturbance during the menopause transition may also benefit from HT. HT therapies are considered safe and effective in low-risk women without underlying coronary heart disease or a history of breast cancer, age <60 years, and who are <10 years from menopause onset. (Santoro, N. et al., 2021), (Monteleone, P. et al., 2018)

Lifestyle changes include:

Healthy Diet: A diet rich in calcium and vitamin D supports bone health, while a balanced diet helps manage weight and overall health.
Regular Exercise: Weight-bearing exercises like walking, jogging, and strength training improve bone density and cardiovascular health.

Post-menopause: Life after Menopause

What is Post-menopause?

Post-menopause refers to the years following menopause. Once a woman has not had a menstrual period for 12 consecutive months, she is considered postmenopausal. During this stage, many of the symptoms experienced during perimenopause and menopause may continue but often decrease in intensity over time.

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Enhancing Quality of Life in Post-menopause

Staying healthy and active is key to enjoying the postmenopausal years. Strategies to enhance quality of life include:

Healthy Eating: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
Regular Physical Activity: Engage in a mix of cardiovascular, strength, and flexibility exercises.
Mental Health: Stay socially connected, engage in hobbies, and practice mindfulness or relaxation techniques.
Regular Medical Check-Ups: Monitor blood pressure, cholesterol levels, and bone density regularly.

Various studies have reported the negative effect of menopause on the quality of life. Although hormone therapy is the standard treatment for the early symptoms of menopause, due to its side effects such as the risk for embolism and breast cancer, using these combinations routinely is not considered appropriate. Using non-medicinal methods for preventing the symptoms of menopause and improving the quality of life has been emphasized. Some studies have evaluated the effect of different educational and counseling methods, participating in physical activities, using medical plants containing phytoestrogens and isoflavones, and using food supplements such as soy, licorice, red clover, and fish oil to improve and enhance the quality of life in postmenopausal women. (Taebi, M. et al., 2018)

Embracing the Postmenopausal Years

Post-menopause is a time to embrace new opportunities and focus on personal growth and well-being. Many women find this stage of life empowering and fulfilling as they navigate the changes with confidence and resilience.

Conclusion

Menopause is a significant life transition that encompasses three stages: perimenopause, menopause, and postmenopause. Each stage brings its own set of challenges and symptoms, but with the right information and proactive management, women can navigate these changes with grace and confidence. Understanding the stages of menopause allows women to take charge of their health, seek appropriate treatments, and embrace the opportunities that come with this new phase of life. Whether it's making lifestyle changes, seeking medical interventions, or exploring alternative therapies, women have numerous options to maintain their well-being and quality of life during and after menopause.

References

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Santoro, N. (2016). Perimenopause: from research to practice. Journal of women's health, 25(4), 332-339.

McNamara, M., Batur, P., & DeSapri, K. T. (2015). Perimenopause. Annals of internal medicine, 162(3), ITC1-ITC16.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 53-58.

Honour, J. W. (2018). Biochemistry of the menopause. Annals of clinical biochemistry, 55(1), 18-33.

Santoro, N., Crawford, S. L., El Khoudary, S. R., Allshouse, A. A., Burnett-Bowie, S. A., Finkelstein, J., ... & Lasley, B. (2017). Menstrual cycle hormone changes in women traversing menopause: study of women’s health across the nation. The Journal of Clinical Endocrinology & Metabolism, 102(7), 2218-2229.

Harlow, S. D. (2018). Menstrual cycle changes as women approach the final menses: what matters?. Obstetrics and Gynecology Clinics, 45(4), 599-611.

Talaulikar, V. (2022). Menopause transition: Physiology and symptoms. Best practice & research Clinical obstetrics & gynaecology, 81, 3-7.

Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause—global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199-215.

Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15.

Lobo, R. A., Davis, S. R., De Villiers, T. J., Gompel, A., Henderson, V. W., Hodis, H. N., ... & Baber, R. J. (2014). Prevention of diseases after menopause. Climacteric, 17(5), 540-556.

Daan, N. M., & Fauser, B. C. (2015). Menopause prediction and potential implications. Maturitas, 82(3), 257-265.

Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A., & Kariman, N. (2018). Strategies to improve menopausal quality of life: A systematic review. Journal of education and health promotion, 7(1), 93.