What to expect in perimenopause and menopause

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Expert articles highlighting important issues in endocrine and reproductive health, insights from our clinical experience and our summaries and interpretations of pertinent studies.

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Going through the menopausal transition and wondering how long it will last?  Suspecting you may be starting to have perimenopausal symptoms and not sure what to do or expect next? Or maybe you are not expecting to go through perimenopause for some years, but are wondering what to expect when you do.  If so you are certainly not alone, these are some of the most common questions we are asked about about menopause and in this article we will try to shed some light on this!

Far too often we have seen women* who have been massively impacted by and caught off guard by the severity of their perimenopausal symptoms, sometimes with major impacts on their lives before anyone realised what was happening and why.  We hear statements like “I can no longer cope” and “this is all too much for me”.   Unfortunately sometimes we see women who have had careers or marriages end  because of menopausal symptoms before they start to realise what has happened.  

But when you know what to expect and have access to effective treatments, this is almost always preventable! So, to arm yourself with the knowledge to be ready, read on…

Why is this important?

Perimenopause is when ovarian function starts to fluctuate and eventually wind down, and menopause (defined as more than 1 year after your last period)  is when the ovaries have finished ovulating and producing hormones.

The menopause transition is a very normal and natural stage life for women*, but some people have very troublesome symptoms over this time and it is important to know that there are good treatments that can help.  The experience can be different for each person; some may have minimal symptoms and others may have severe symptoms and the symptoms can often come on very gradually so that by the time you realise that you have been having symptoms, you may not have been feeling your best for some time.  For this reason, knowing what symptoms to expect is important so that you can recognise them,  and see a doctor to discuss treatments so that you can get back on your way to feeling your best!  It is a good idea to become familiar with the symptoms of perimenopause from your 40s or even earlier.  

Understanding the changes that are occurring in your body also helps you to make decisions and plans that are right for you.  

What first signs should I look out for?

For many women the first changes happen in their 40s.  However, it is perfectly possible that for some these also happen in their 30s.  The order of symptoms can vary from woman* to woman*.  For some, a change in menstrual period patterns start first, or together with some other symptoms such as fatigue, brain fog, low mood, irritability, aches and pains, sweats and hot flushes for example.  Others may still have regular periods when they start to notice perimenopausal symptoms. It is also common to develop or experience worsening of PMS symptoms and hormonal migraines around perimenopause because fluctuations in hormones can be more pronounced erratic at this time.    

What changes occur to my menstrual cycles? 

Often, menstrual periods can become closer together (shorter cycles) and often periods can often get heavier.    As women* move further down the transition menstrual cycles move further apart and gradually there are less numbers of ovulatory cycles (cycles that produce an egg) per year. Contraception is important in perimenopause, particularly as ovulation can be unpredictable at this time.

What are some of the less recognised symptoms? 

Most of us know that menopausal hot flushes (an intense heat sensation) and sweats can occur.  But there are many other symptoms too.  Some notice more of a general heat intolerance than intermittent flushing.   Some have low mood, feel more emotional, irritable or angry.   Joint aching and stiffness can occur.  We are now starting to understand that the term “brain fog” is a very real thing for many women – word finding difficulties, trouble remembering names,  starting a sentence and then wondering what you were going to say!

What happens at the end of perimenopause?

Towards the end of perimenopause, periods become sporadic and officially,  one year after your last period we say you have been through menopause or are “post-menopause”.  Most women are quite reasonably concerned about how they are feeling and quality of life – not whether they had a period one year ago or not.  However it is important to note when your periods seem to stop, as bleeding more than a year after your periods have stopped (“post-menopausal bleeding”) is not expected and should be investigated.  

At the end of perimenopause, oestrogen deficiency becomes more prominent (and permanent) and so for some, this can often be the time of the most flushes and sweats, sleep change and joint discomfort.   Vaginal and urinary symptoms of dryness, irritation and frequency and urgency can also start or worsen, and bone density can start to change (there tends to be a reduction in bone density particularly in the first two years or so after menopause).

Some of these symptoms sound terrible! Will this happen to me?

Women are not textbooks and we are not all the same!   The menopausal transition will be slightly different for each of us.  For some women this transition can take 3-4 years, for some it can take 7-8 years.   About 20% of women will experience very few symptoms and about 20% of women are what the American’s call “super-flashers”.  (Note this does not mean that you take your clothes off in a park!)  The American’s call a flush a flash and the term“super-flashers” refers to women who are significantly affected by flushes and sweats indefinitely into their 60s, 70s and even 80s.  

What is the good news?

For those who have had menstrual issues, this transition means that there is an end to bleeding and any heavy painful periods, endometriosis, PCOS symptoms, premenstrual syndrome and menstrual migraines.  Post-menopause, you no longer need to worry about contraception.  Increasingly, medical research is shedding light on the significance of the menopausal transition on women’s future health and wellbeing.   Science is starting to tell us that if you can arm yourself with knowledge and understanding over these years you can make decisions that will shape your health and wellbeing in the post-menopausal years.    Women can emerge from this transition with more self-knowledge and wisdom.  Many cultures recognise that this is a time in women’s lives when much life knowledge and experience has been collected and that women in the post-menopausal season of life have so much to offer in the workplace, and in their communities as well as in family life. The Māori word for menopause ruahinetanga captures this beautifully.  Ruahine is said to mean “wise woman” and relates to the granddaughter of the kaitaki (leader) of the Aotea waka.   

So now that you have an idea of what to expect and when to expect it  we hope that you can face the menopausal transition with confidence, knowing that there are treatments available with symptoms (more on this in our upcoming ERH articles).  If you aren’t already, start to track your menstrual periods -this is an important indicator of health from your first period through to menopause

PS: Want to be walked through everything you need to know to be prepared to navigate and thrive in perimenopause and menopause in one place?  We are developing an App-based course to do just this! Find out more here.

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