MaryO’Note: Some of these links have been removed.
What is Menopause and Perimenopause?
Menopause is defined as the cessation of menstruation as a result of the normal decline in ovarian function. Technically, you enter menopause following 12 consecutive months without a period. Menopause has become increasingly medicalized, which means it is viewed as something that requires intervention and treatment rather than as a natural life transition that may benefit from support. Menopause signals the end of fertility and the beginning of a new and potentially rewarding time in a woman’s life. Part of the stigma of menopause is its association with aging, but we age no more rapidly in our 50s than in any other decade of life.
When Does Menopause Happen?
For most women, natural menopause occurs between the ages of 45 and 55, with the average age of onset being 51.4 years of age. In rare instances, menopause can occur as early as the 30’s or as late as the 60’s. Menopause is considered premature if it occurs before the age of 40, or artificial if radiation exposure, chemotherapeutic drugs, or surgery induces it. Other factors that may contribute to the early onset of menopause include a history of smoking, poor nutrition, a co-existing medical condition, or even a traumatic experience.
Until a woman is technically considered menopausal (aka postmenopausal), she’s considered to be premenopausal, also referred to as perimenopause. It’s during the perimenopausal phase that most women experience the worst symptoms.
Menopause (or postmenopause) occurs when a woman hasn’t had her period for 12 consecutive months. Once hormones have levelled off, most of the symptoms experienced during perimenopause will disappear — although some women have occasional hot flashes, anxiety, bouts of depression, et al, for a few years after they become postmenopausal.
The Physiology of Menopause
To best understand what occurs at menopause, it is helpful to know about the physiology of menstruation and the hormones that are involved in our monthly cycle. Hormones are substances in our bodies that act like messengers. They travel throughout the body and can bind to specialized areas of cells known as receptor sites, where they then initiate a specific chain of events. The first half of the menstrual cycle is dominated by estrogen, whose role is to build the lining of the uterus in preparation for a potential pregnancy. At approximately day 14 of the cycle, or two weeks prior to menstruation, an egg is released from the ovaries. This is referred to as ovulation.
As a result of ovulation the ovary begins producing progesterone. It is during this second half of the cycle that progesterone is dominant. Progesterone’s role is to change the character of the uterine lining to prepare for pregnancy, and to prevent further buildup of the lining by estrogen. At the end of the cycle, if the egg is not fertilized, estrogen and progesterone levels drop, causing a sloughing of the uterine lining, or menstruation. The body goes through this cycle every month to ensure a fresh uterine lining in preparation for a potential pregnancy.
If a woman fails to ovulate, however, she does not produce progesterone, and this may result in the experience of symptoms of hormonal imbalance. Women are born with a finite number of eggs that eventually runs out. At birth, a woman has close to a million eggs, by puberty a mere 300,000. In the 10 to 15 years prior to menopause, this loss begins to accelerate. Perimenopause is the term used to describe the time of transition between a woman’s reproductive years and when menstruation ceases completely. Typically perimenopause occurs between the ages of 40 and 51 and may last anywhere from six months to ten years. During this time, hormone levels naturally fluctuate and decline, but they do not necessarily do so in an orderly manner. Shifts in hormones are a major contributor to that sense of physical, mental, and emotional imbalance that may characterize a woman’s experience of menopause.
Eventually estrogen levels decrease to the point that the lining of the uterus no longer builds up and menstruation ceases. This is menopause. After menopause, estrogen levels off at approximately 40 to 60% of its premenopausal levels and progesterone falls close to zero. Although there are similarities in what happens hormonally, each woman’s experience can be very different. Genetics may play a role in the timing, but lifestyle can certainly influence a woman’s experience of menopause. Many women find that the right combination of herbs, exercise, nutritional support, and natural hormones helps them to manage most of their symptoms. Others find they may need some medical intervention and pharmaceutical agents. This site will help guide you in making the decisions that best support your individual needs.
How long does perimenopause last?
It varies. Women normally go through menopause between ages 45 and 55. Many women experience menopause around age 51. However, perimenopause can start as early as age 35. It can last a few months to quite a few years. There is no way to tell in advance how long it will last OR how long it will take you to go through it. Every woman is different.
I’ve been depressed in the past. Will this affect when I start going through perimenopause?
It could. Researchers are studying how depression in a woman’s life affects the time she starts perimenopause. If you start perimenopause early, researchers don’t know if you reach menopause faster than other women or if you’re just in perimenopause longer.
What should I expect as I go through perimenopause?
The 34 Signs/Symptoms of Menopause.
Some women have symptoms during this time that can be very difficult. Some of these symptoms include:
- Changes in your menstrual cycle – i.e., longer or shorter periods, heavier or lighter periods, or missed periods
- Hot flashes (power surges — sudden rush of heat from your chest to your head)
- Palpitations, skipped heartbeats
- Internal shaking / tremor-like feelings
- Night sweats
- Vaginal dryness
- Dry skin and skin changes
- Itching
- Formication (feeling like ants are crawling on your body)
- Insomnia and other sleep disturbances
- Mood swings
- Allergies, sinus problems
- Wheezing, respiratory problems, coughing
- Depression
- Anxiety
- Panic attacks
- Crying for no apparent reason
- General irritability and/or anger
- Hair thinning or loss
- Pain during sex
- More urinary infections
- Urinary incontinence
- Decreased or non-existent libido
- Increase in body fat, especially around your waist
- Forgetfulness, brain fog, problems with concentration and memory
Additional Reading: The 34 Signs/Symptoms of Menopause.
There are numerous articles addressing all of these issues and more in Power Surge’s ‘Educate Your Body’ Library.
Excellent suggestions for coping with menopause in Power Surge’s Menopause Survival Tips
I don’t understand why I get hot flashes. Could you tell me what’s going on with my body?
Read What’s A Hot Flash? We don’t know exactly what causes hot flashes.
It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger the hot flashes.
I feel so emotional. Is this due to changes in my hormones?
Your mood changes could be caused by a lot of factors. Some researchers believe that the decrease in estrogen triggers changes in your brain causing depression. Others think that if you’re depressed, irritable, and anxious, it’s influenced by menopausal symptoms you’re having, such as sleep problems, hot flashes, night sweats, and fatigue, and/or by issues you’re dealing with that aren’t strictly related to hormonal changes. It could also be a combination of hormone changes and symptoms. Remember, menopause doesn’t happen in a vacuum. All the issues you came into menopause with are only exacerbated by your changes.
Menopause doesn’t happen in a vacuum. It’s part of the bigger transition of “aging.” Other things that could cause depression and/or anxiety include:
- Having depression during your lifetime
- Feeling negative about menopause and getting older
- Increased stress (look at the world we’re living in)
- Having severe menopause symptoms
- Children growing up and leaving home – empty nest syndrome
- Smoking
- Being sedentary – not being physically active
- Not being happy in your relationship or not being in a relationship
- Not having a job, or being unhappy in your current job
- Continuing working during a difficult menopause
- An unfulfilling marriage / marital problems
- Financial problems
- Low self-esteem (how you feel about yourself)
- Not having the social support you need
- Feeling isolated
- Not having anyone to talk to (Use our message boards)
- Regretful that you can’t have children anymore
What can I do to prevent or relieve symptoms of perimenopause?
- Read the Power Surge Recommendations for treating various menopause symptoms.
- Read Power Surge’s Menopause Survival Tips
- Keep a journal for a few months and write down your symptoms, like hot flashes, night sweats, and mood changes. That can help you figure out the changes you’re going through
- Record your menstrual cycle, noting whether you have a heavy, normal, or light period
- Find a physical activity that you’ll enjoy doing
- If you smoke, try to quit. There are areas, such as A Breath of Fresh Air! for help.
- Keep your body mass index (BMI) at a normal level. Figure out your BMI by going to www.nhlbisupport.com/bmi/bmicalc.htm
- Network with other women who are in perimenopause or menopause. Most likely, they’re going through the same things you are!
- Do something new: start a new hobby, do volunteer work, take a class
- Learn meditation and breathing exercises for relaxation
- Use a vaginal lubricant for dryness and pain during sex Read the article on Midlife Sexuality / Vaginal Dryness for more information.
- Dress in lighter layers (preferably cotton), so if a hot flash comes on, you can peel away the top layer (without getting arrested!)
- Try to figure out (and avoid) those triggers that may cause hot flashes, such as spicy foods, caffeine, or being outside in the heat.
- Talk with your health care practitioner if you feel depressed, or have any other questions about how to relieve your symptoms
- Educate yourself about what tests you need when entering perimenopause. Oftentimes, doctors won’t prescribe them unless YOU ASK for them!
- An excellent resource for your questions about menopause — < Ask Power Surge’s Experts!
I’m going through perimenopause right now. My period is very heavy, and I’m bleeding after sex. Is this normal?
Irregular periods are common and normal during perimenopause, but not all changes in bleeding are from perimenopause or menopause. Other things can cause abnormal bleeding.
Talk to your health care provider if:
- The bleeding is very heavy or comes with clots (although clotting isn’t uncommon during perimenopause)
- The bleeding lasts longer than 7 days
- You have spotting or bleeding between periods
- You’re bleeding from the vagina after sex
- Can I get pregnant while in perimenopause? Yes. If you’re still having periods, you can get pregnant. Talk to your health care provider about your options for birth control. Keep in mind that methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don’t provide complete protection against STDs and HIV. The only sure protection is abstinence (not having sex of any kind). But appropriate and consistent use of latex condoms and other barrier methods can help protect you from STDs.For women under 50, it is recommended that you continue some form of birth control even after your period has stopped for one year (24 consecutive months). For women over 50, it is recommended that birth control be practiced for one year after entering menopause.For perimenopausal women, it is essential that you continue some form of birth control while your periods are erratic — even if you’ve been without a period for six or seven months — you can still get pregnant. For women whose periods have stopped for twelve consecutive months, it is still recommended that you practice some form of birth control for approximately one year after entering menopause.
MaryO’Note: Links are removed from this list
There’s been a list of the “34 signs of menopause” circulating for years. The list originated with Judy Bayliss’ wonderful newsgroup, The Menopaus Listserv (That’s Menopaus without the “e” at the end).
I’ve taken the liberty of adding my own Notes to the original list. You’ll find hundreds of articles pertaining to menopause symptoms, treatments and menopause / midlife-related health and emotional issues including articles on midlife relationships, weight and fitness issues, intimacy, psychological problems associated with menopause in Power Surge’s, “Educate Your Body” extensive library.
I suggest you begin with the comprehensive article explaining what menopause is: in “An Introduction To Menopause: Signs, Symptoms and Treatments”
You’ll find remedies for most of these symptoms on the Recommendations page.
Here is the list of: “The 34 Signs of Menopause:”
1. Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling (related to increased activity in the autonomic / sympathetic nervous system). Without becoming too, technical, messages are sent to the hypothalmus because of declining estrogen production via neurons which result in vasodilation — widening of the lumen of blood vessels (lumen being the cavity of a tubular organ, i.e., the lumen of a blood vessel,) which, in turn, causes flushing or hot flashes. Tips for treating/minimizing (and even avoiding) hot flashes: Power Surge’s Menopause Survival Tips. Also, read the Power Surges (hot flashes) Forum
2. Bouts of rapid heartbeat (related to increased activity in the autonomic / sympathetic nervous system)
Note: Along with rapid heartbeat (palpitations), women can experience skipped heartbeats, irregular heartbeats. These are generally normal vasomotor responses experienced during menopause – usually due to fluctuating hormone levels. However, if these problems continue, it’s always a good idea to be checked by your health care practitioner. An echocardiogram is a common procedure to tell the doctor what he needs to know about your heart. If your health care practitioner doesn’t suggest it, ASK FOR IT! Read the Palpitations, Heart Issues, Hypertension Forum
3. Irritability. Note: Along with irritability, a host of “anger” problems can develop during menopause. Just as a perimenopausal woman can find herself suddenly crying for no apparent reason or provocation, so can she find herself reacting to given situations in an angrier manner than she normally does. This anger can sometimes feel like “rage.”
Again, this is hormone-induced, but for some women, the anger can become inappropriate and a woman can feel like she’s out of control. There’s nothing wrong with seeking counselling to discuss these issues with a mental health professional. This is a challenging time of life and some objective outside help can be tremendously useful in helping a woman cope with all the emotions she’s feeling. Remember, menopause isn’t simply physical changes, but emotional and spiritual changes as well. There’s an excellent forum on the Power Surge Message Board that deals with the issues of Anger / Mood Swings / Rage.
4. Mood swings, sudden tears. Note: Mood swings can include anything from mood shifts (happy one moment, depressed the next) to sudden bouts of crying when nothing overt has occurred to cause the crying. Mood swings can and have been misdiagnosed as bipolar disorder because one can feel such extremes of emotions due to hormone imbalance. Anxiety, depression, panic attacks and even feelings of agoraphobia aren’t uncommon during menopause. The panic attacks often can develop with the onset of hot flashes. For some women, hot flashes can be severe and quite frightening.
5. Trouble sleeping through the night (with or without night sweats). Note: This can develop into insomnia or just waking at 2 in the morning for an hour. Relaxation and breathing exercises can be useful at this time — many women may log onto the Power Surge message boards and are surprised to find so many other women there in the middle of the night. More help on the Insomnia, Sleep Disorders Forum
6. Irregular periods: shorter, lighter or heavier periods, flooding, and phantom periods. Note: A phantom period is when you experience all the symptoms you’re accustomed to having before you menstruate — but… no period comes. This is a common experience during perimenopause before a woman’s period actually stops.
7. Loss of libido (sex drive). Note: Not every woman loses her libido entirely during perimenopause, although some may temporarily. Many women simply have a decreased interest in sex – often it’s simply because they generally don’t feel well and sex is the last thing on their mind! Also, bear in mind that there are many medications that can affect one’s libido, including the anti-depressants some women take to cope with the depression and anxiety associated with menopause to anti-hypertensives.
8. Dry vagina (results in painful intercourse) Note: Click here for an excellent article about vaginal dryness, sexuality and midlife relationships. Recommended: Sexual Issues/Libido Forum
9. Crashing fatigue. Note: I’ve never been able to determine if the “fatigue” associated with perimenopause is a symptom in and of itself, or if it’s a side effect of the cumulative symptoms and general exhaustion (from them) many women experience. Take all the symptoms and “dump” them on one person — is it any wonder perimenopausal women are so fatigued? If you can, try to find time to grab a nap.
One of the things that helped my fatigue, and it’s all chronicled in my personal odyssey to find remedies, is the use of considerable amounts of soy isoflavones and protein, which I found in R Soy. I can’t say that it specifically targetted and relieved the crashing fatigue, but it helped so many other symptoms and gave me a burst of energy, that I feel comfortable in attributing the fatigue relief to R. There are various vitamins, such as those in the “B” family, that can help with fatigue as well. Also, increased amounts of vitamin C. The Recommendations page lists numerous vita-nutrients that can be useful in treating fatigue and other symptoms associated with perimenopause.
10. Anxiety, feeling ill at ease. Note: One of the biggest complaints during menopause. Read the Anxiety/Stress Forum
11. Feelings of dread, apprehension, and doom (includes thoughts of death, picturing one’s own death). Note: It’s possible that this can be a manifestation of depression associated with menopause, or possibly feelings that come from going through daily discomfort through a difficult menopause transition that can last anywhere from 3-12 years.
A woman living under these circumstances can feel totally overwhelmed and frightened by the physical, psychological and spiritual changes. When there seems to be no reprieve from the suffering, for some it can leave them feeling drained wondering when and IF they’ll ever feel well again. It isn’t unusual for women at this time of life to have thoughts about dying. One phase of their life is coming to a close (not soon enough for many). There may be apprehension and fear about moving on to the next phase of life and wondering whether things will get better or worse. Helpful: The Panic Attacks / Disorder / Fear / Apprehension Forum
12. Difficulty concentrating, disorientation, & mental confusion. Note: Forgetfulness during perimenopause is often referred to lightly and humorously as “brain fog” but it’s not always funny. Note: An excellent article, Menopause And The Mind. Also, visit the Memory Loss, Foggy Thinking, Forgetfulness, Verbal Slips Forum
13. Disturbing memory lapses. Note: See #12
14. Incontinence — especially upon sneezing, laughing: urge incontinence (reflects a general loss of smooth muscle tone).
15. Itchy, crawly skin (feeling of ants crawling under the skin, not just dry, itchy skin Note: the feeling of ants crawling on your skin is called “formication”) Visit the Your Skin: Dryness, Itching, Vaginal Dryness, Disorders, Discomfort Forum
16. Aching, sore joints, muscles and tendons. (may include such problems as carpal tunnel syndrome). Note: Osteoarthritis can develop during perimenopause – and those with existing arthritic and/or rheumatic pain may find it’s exacerbated during the menopausal transition. See the Joints Aches and Pains/Arthritis Forum
17. Increased tension in muscles.
18. Breast tenderness. Note: Breast swelling, soreness, pain.
19. Headache change: increase or decrease. Note Many women develop migraine headaches during perimenopause. However, if one doesn’t have a history of migraine headeaches, they’re generally a short-lived experience of perimenopause. Also see the Headaches, Migraine Forum
20. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea. Note: For nausea, try some ginger or, as I use, boiling hot water with a few teaspoons of lemon or lemon juice concentrate in it. Many women also develop acid reflux (Gerd). For some, it can be an uncomfortable feeling of severe burning sensations in the throat. If it persists, see your health care practitioner.
21. Sudden bouts of bloat. Note: Bloating, water retention are common complaints during perimenopause. Also, Acid reflux and heartburn are very common during perimenopause. Treat them as you would if you weren’t going through menopause.
22. Depression (has a quality from other depression, the inability to cope is overwhelming, there is a feeling of a loss of self. Natural hormone therapy, ameliorates the depression dramatically). Note: There are various natural methods of treating depression. Read Power Surge’s Menopause Survival Tips.
Also, many women using progestins or progesterone supplementation experience “depression” as a side effect. Power Surge recommends only naturally compounded, bio-identical hormones. Naturally compounded estrogen and progesterone supplementation doses can be individually adjusted to suit each woman’s needs. So, if a woman is experiencing depression from progesterone, the level of progesterone supplementation can be reduced until the compounding pharmacist comes up with the right blend. The combination of estrogen and progesterone is important in achieving the desired results. Other remedies, such as St. John’s Wort can be very effective in alleviating the depression associated with menopause.
My personal experience was that my perimenopause-related depression was eliminated when I started using R Soy Protein. R is excellent for mood swings, but I was astonished by the impact it had on the hormone-related “lows” I experienced before using it. Also recommended, The Depression Forum
23. Exacerbation of any existing conditions. Note: Often, conditions women had prior to entering perimenopause become
exaggerated (worse) during the menopause transition.
24. Increase in allergies. Note: Many women who suffer from allergies develop worse allergies during the menopausal years. Many women who’ve never had allergy or respiratory problems may develop them for the first time. Many people don’t realize that histamine levels are affected by hormone levels. Women can develop wheezing, coughing and a host of respiratory problems. This generally disappears as the hormones level out once a woman becomes menopausal.
25. Weight gain. (is often around the waist and thighs, resulting in “the disappearing waistline” and changes in body shape.) A good read, Weight Gain and Fitness Issues
26. Hair loss or thinning, head or whole body, increase in facial hair. Note: There is often a loss of pubic hair during menopause. Many women are more comfortable simply shaving their pubic area instead of having patches of hair.
27. Dizziness, light-headedness, episodes of loss of balance. Note: Although common complaints during menopause, I always recommend anyone suffering from dizziness, dysequilibrium have her blood pressure checked just to be on the safe side. However, women can experience these symptoms during perimenopause without having hypertension.
28. Changes in body odor. Note: I wouldn’t be too concerned about this one. It can happen, but in 13 years of running Power Surge, I’ve heard of relatively few cases of developing body odor during menopause.
29. Electric shock sensation under the skin & in the head (“take the feeling of a rubber band snapping against the skin, multiply it (exponentially, sometimes) radiate it & put it in the layer of tissues between skin & muscle & sometimes a precursor to a hot flash.”) Note: Those buzzing sensations, as though you’ve put your finger into a live electrical socket, can be frightening. They’re all part of the hormones, nerve endings and electrical waves running through our bodies when our hormones are constantly fluctuating. Many women experience this during perimenopause, but it eventually passes.
30. Tingling in the extremities (can also be a symptom of B-12 deficiency, diabetes, or from an alteration in the flexibility of blood vessels n the extremities.)
31. Gum problems, increased bleeding.
32. Burning tongue
33. Osteoporosis (after several years)
34. Brittle fingernails, which peel & break easily.
Some additional signs from Dearest:
- Internal shaking / tremor-like feelings. Read the Internal Shaking Forum
- Acne and other skin eruptions
- Itching wildly and erratic rashes
- Shoulder pain / joints / arthritis development or flare up in
preexisting conditions
- “Heart pain” – a feeling of pain in the area of the
heart (if persistent, get checked by your health care practitioner)
- Acid reflux / heartburn / difficulty digesting certain foods
Some of the 34 signs may also be symptoms of one of the following:
- Hypothyroidism
- Diabetes
- Depression with another etiology
- Other medical conditions (see The Educate Your Body Library)
If you have reason to believe you may have one of these conditions, see your healthcare practitioner for treatment.
Dearest
Note: Remember that although these may be common complaints during menopause, they might also indicate some other health problem. Be sure to consult with your personal health care practitioner before attributing these symptoms to menopause.
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