is the period of time in a woman’s life in which her menstrual periods stop, and she is no longer fertile. The average age of menopause is about 51 years, but it can last anywhere from age 40 to 59 years of age. Menopause is usually preceded by “perimenopause” by a few years.
In perimenopause, the hormone levels of oestrogen and progesterone normally produced by the ovaries begin to decrease. The periods become irregular but do not stop altogether. Women can get symptoms of menopause during perimenopause (hot flashes, night sweats, and mood changes, to name a few) but they aren’t as frequent as when a woman reaches menopause.
Premature Menopause
Premature menopause is sometimes referred to as premature ovarian failure or primary ovarian insufficiency. This is when the ovaries begin to fail prior to the age of 40. The ovaries do not produce enough oestrogen, and ovulation occurs sporadically or not at all. This results in early infertility, which is difficult to treat.
The term “premature menopause” is often used interchangeably with premature ovarian failure, but they are not exactly the same thing.
Women in premature menopause actually stop having their period prior to age 40, while women with premature ovarian failure can still have some ovulation and will have irregular periods, often lasting several years. The treatment for premature ovarian failure is oestrogen replacement therapy, which helps the symptoms but does not treat the infertility.
The Three Stages of Menopause
There are actually three stages a woman goes through as part of the menopausal process. These include the following:
Perimenopause. This is when the ovaries begin to decrease their production of oestrogen. There will be some symptoms of hot flashes and other menopausal symptoms, but the woman will have occasional periods. Mood swings are common in perimenopause. Many women enter perimenopause sometime in their 40s while other women do not have this stage at all.
Menopause. This is when the periods finally stop. The woman is said to be in menopause when she has not had a period for at least 12 months. There are often symptoms, including mood swings, hot flashes, and night sweats. Menopause can last for 1-3 years.
Post-menopause. This is when the periods have finally stopped, and the ovaries are no longer producing much oestrogen at all. Usually, the symptoms taper off, but many women continue to have dry vaginal mucosa and are at an increased risk for osteoporosis and heart disease.
Symptoms of Perimenopause
As mentioned, some women will not have any symptoms in perimenopause, while others will have noticeable symptoms. Common symptoms of perimenopause include the following:
Hot flashes and night sweats. These are feelings of increased bodily warmth and flushing of the face. They can occur at any time of the day or night and can be uncomfortable. If they happen at night, the woman can experience night sweats, in which she wakes up drenched in sweat.
Irregular periods. The ovaries may still ovulate, but they do so in no predictable pattern. This can result in periods that are shorter than normal or periods that are longer than normal. The menstrual flow may be very heavy, especially if the period is short. Sometimes periods are skipped altogether, causing the woman to worry that she might be pregnant.
Mood swings. Some women in perimenopause may suffer from an increased risk of depression or irritability during this stage. Sleep may be elusive as night sweats, and hot flashes can happen during the night.
Bladder difficulties. The urethral tissue is responsive to oestrogen, and when oestrogen decreases, the urethral tissue also shrinks. This can lead to incontinence of urine. It can also lead to painful intercourse because the cervix no longer produces increased cervical mucus during sex.
Decrease in libido. A woman in perimenopause can have a decrease in sexual desire. She may not want to have sex as much as she did before. Sometimes, this is not a problem as the couple becomes adjusted to the change in sexual activity and desire, however other couples may not be as lucky, and this situation may lead to tension and problems in the relationship.
Decreased ability to get pregnant. The rate of ovulation goes down during perimenopause, so the woman has a reduction in the ability to get pregnant. Pregnancy can still happen, so if you do not want to get pregnant, you should still continue to use some form of birth control until menopause occurs.
Osteopenia. The strength of the bones depends on high circulating levels of oestrogen. As oestrogen levels decline, the bone mass decreases, and there is a risk for osteoporosis that can increase a woman’s risk of having bone fractures.
Symptoms of Menopause
As menopause approaches and the periods stop, the symptoms resulting from low oestrogen levels become obvious. Common symptoms of menopause include the following:
Stoppage of periods. The periods will begin to become irregular and will eventually stop. When you haven’t had a period for 12 months in a row, it means you have likely reached menopause. For some women, it’s time to celebrate, and others feel sad because their fertility is finally gone. Being in touch with your feelings, and not doing this season of your life alone truly helps.
Increased hot flashes. The hot flashes may be similar to those in perimenopause but can be more frequent and more intense. Most hot flashes last as little as 30 seconds or as much as 10 minutes before you feel better. About 2/3 of all women will experience hot flashes as a part of their menopausal symptoms.
Vaginal dryness. Without the protective effect of oestrogen and progesterone, the cervix and vagina do not secrete as much fluid. This can result in pain during intercourse as well as an increased risk of yeast infections, bladder infections, and vaginal itching. It is best treated with a water-based lubricating gel such as KY jelly.
Sleeping difficulties. While in menopause, sleep can be difficult. You may have difficulty getting to sleep at night or may wake earlier in the morning, with difficulty in falling back to sleep. Good sleep habits can help prevent this complication.
Incontinence of Urine. Women in menopause may experience an increase in the urge to urinate or incontinence of urine. Stress incontinence can occur, which is the kind of incontinence that occurs when coughing, lifting heavy objects, or sneezing. Urge incontinence is the type of incontinence that causes you to have sudden urges to void, sometimes not making it to the toilet before urinating.
Bladder infections. Women in menopause may have more bladder infections than normal. This is because the lack of oestrogen has resulted in atrophy of the urethral lining, making way for bacteria to have a greater chance of traveling up to the bladder, resulting in an infection. Drinking plenty of water can help reduce the chances of getting a bladder infection.
Decreased sex drive. The lack of male and female hormones in the woman’s blood can result in a decreased interest in sex. There may be fewer orgasms or no orgasms at all. This can be treated with prescription medications that help a woman achieve an orgasm.
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