The 3 Stages of Menopause
During menopause and the years leading up to it, you may experience some of the following changes. Most are due, directly or indirectly, to fluctuating hormone levels and the decline in estrogen production. Urinary incontinence is caused by a thinning of the vaginal walls and muscles, which support and control the bladder. Many of these changes, such as hot flushes and mood swings, are temporary. Others, such as changes in your skin and vaginal tissue, are permanent unless you undergo estrogen replacement therapy.
For women who experience it naturally (not as the result of surgery or other causes), menopause has three distinct stages: perimenopause, menopause and postmenopause. Read on to find out more about these stages.
Perimenopause, which means “around the end of menstruation,” is generally what we think of as the menopause experience. During this time, a woman’s ovaries start producing less of the sex hormones estrogen, progesterone and testosterone. The decline isn’t necessarily steady. Sometimes hormone levels fluctuate and cause irregular periods. (If you suddenly experience heavy periods, let your doctor know so other causes, such as fibroid tumors and endometrial cancer, can be ruled out.) Symptoms such as hot flushes, insomnia and forgetfulness are at their peak. The tissues of the vagina and urinary tract may become dry and atrophied, possibly making sex uncomfortable and making urinary-tract infections more common. It is still possible for a woman to become pregnant.
If you’re not sure whether you’re in perimenopause, your doctor can order blood tests to measure your hormone levels. Consistently high levels of follicle stimulating hormone (FSH) and low levels of estradiol (the most common form of estrogen), combined with some of the symptoms above, provide compelling evidence.
Women may benefit from beginning hormone replacement therapy (HRT) at this stage. Alternatively, your doctor may prescribe low-dose birth control pills as a form of HRT. The advantage of this is better control of the menstrual cycle. It’s important to remember that taking either birth control pills or HRT can make it more difficult to determine exactly when menopause has occurred.
While women can enter natural menopause at any time during their forties or fifties, the average age of menopause in the Western world is 51. Perimenopause begins on average at the age of 47 and lasts anywhere from two to 10 years. Contrary to popular belief, there is no relationship between the age at which a woman started menstruating and the age at which she enters menopause. Chances are, you’ll go through menopause at about the same age as your mother and grandmother did. Women who smoke typically enter menopause two to three years earlier than those who don’t.
In literal terms, menopause is a single, isolated event in a woman’s life: her last period. Of course, you can’t know when your last period took place until no others follow, so this is a retrospective determination. Doctors consider menopause has occurred once you have gone 12 consecutive months without a period.
The period from menopause through the rest of a woman’s life is called postmenopause (“after the end of menstruation”). Once upon a time, when living to the age of 55 was rare, this was the beginning of the end. With life expectancy now extending beyond the eighties and even into the nineties, women today may enjoy nearly as many years of life after menopause as before it.
Women face an increased risk of heart disease, stroke and osteoporosis during postmenopause. For this reason, some doctors recommend hormone replacement therapy following menopause and encourage women to engage in lifestyle behaviors that reduce their risks. These include supplementing with calcium, magnesium and vitamin D; eating a nutritious, low-fat diet; and regular, moderately intense exercise.