Peri-menopause & Post-menopause Explained
Have you been saying to yourself, “I don’t know what’s happening to me! The hot flushes are terrible, my skin, hair and nails are becoming so weak and my emotions are all over the place”?
If you’re anything like me you like to understand what’s going on so today’s post will explain two things simply:
1. What is happening in the run up to menopause
2. What we can expect after menopause.
Maybe you’ve come to the conclusion that the menopause is an illness and you just need drugs to get through it. Hanging out of a second floor windows, into gale-force winds trying to cool the furnace that used to be your face has convinced you of this! But wait a minute, how did women cope before HRT? In fact, how is it that women in other cultures don’t get these unpleasant symptoms that we in the West tend to expect?
There’s no getting around it, hitting the menopause can be the most challenging stage of a woman’s life. So many things are happening all at once. Big physiological changes are happening within the body bringing nasty symptoms that for some are completely debilitating and depressing and all this coinciding with the empty nest syndrome, caring for elderly parents or any number of other major relational or career changes. As if all that’s not enough, the final assault on our feeling of wellbeing is looking in the mirror and seeing our mother (we loved her dearly but never wanted to look her age!)
If you’re feeling overwhelmed with everything that’s happening to you right now or you’re struggling with a sense of lost youth or family grown up, you may find my blog post Menopause is a crossroads helpful.
The word menopause actually refers to your very last period and is diagnosed with certainty after one full year with no periods in the absence of any other medical explanation. Most people however use ‘menopause’ to describe the whole transition time that can last 10 years or more. The term perimenopause refers to the period of time running up to that final period.
This is where the whole drama begins and is not to be confused with premature menopause (before age 40 years) or early menopause (at or before age 45 years).
A woman during peri-menopause may still be having regular periods but her supply of eggs is now very low. Out of the roughly 2 million eggs she was born with, she may have just a few thousand left. In fact by puberty she was already down to about 750,000 and throughout her life she has probably only released a maximum of 400 or so eggs in her monthly cycles, the rest just naturally dying off. Due to the dwindling supply of eggs she will increasingly have monthly cycles but not ovulate (no egg released, these are called anovulatory cycles).
Hormonal changes begin to kick off in response to the lack of eggs and those changes can trigger the start of symptoms.
Amongst its many jobs, progesterone helps to redress the harmful effects of too much oestrogen but none is produced in the monthly cycles without an egg and so the body is increasingly exposed to only oestrogen. So although oestrogen levels are dropping, many women become surprisingly oestrogen dominant due to the lack of progesterone during peri-menopause which can produce or worsen symptoms.
Follicle Stimulating Hormone (FSH). The pituitary gland in the brain responds to the low levels of progesterone by raising the levels of FSH in the blood stream because this hormone’s job is to stimulate follicles on the ovaries to begin to develop into eggs and then the rising oestrogen levels coming from the ovaries would in return switch off FSH. This feedback system is the basis of how a number of hormones get switched on and off in the body. Problem is, the ovaries are increasingly not developing eggs so do not pump out oestradiol (the most potent form of oestrogen) as much as before, FSH is therefore not switched off and the levels keep rising throughout this stage.
At menopause oestrogen production drops by roughly a half or a third but the shortfall does get picked up by:
The adrenal glands as they produce oestrone (a weaker form of oestrogen) but the adrenal glands main job is handling stress so prolonged high stress levels will interfere with and reduce this important source of oestrone production.
Body fat also manufactures oestrone so although being obese is not an answer, it is true to say that being slightly heavier rather than very slim is helpful at this stage of life for helping with oestrogen levels (up to 10lbs heavier is fine).
If you’re going through the peri-menopause right now and suffering in any way from unpleasant symptoms you may like to keep an eye out for my upcoming eBook on ‘14 Symptoms of the Menopause and What to do About Them’.
Cigarette smoking is really bad news as it brings menopause forward by roughly 2 years as the toxic chemicals in cigarettes cause the eggs to die off faster plus they interfere with the ovaries, reducing the amount of oestrogen they produce. A hysterectomy (even without the removal of the ovaries) can bring on the menopause early by about five years and sterilisation (Fallopian tubes severed as a contraceptive measure) can also induce early menopause.
On the other hand, women who are very overweight may have a later menopause because of the extra oestrogen produced by fat cells. The same is true for those who have fibroids as they also produce extra oestrogen.
Many women find that the symptoms that they suffered through the peri-menopause slowly clear up after menopause as their oestrogen production stabilises with other hormones in the body. In fact many find they have a new lease of life.
The downside though is that the reduced oestrogen of post-menopause does present increased risks for bone and cardiovascular health and increases the vulnerability to vaginal/urinary tract problems.
So these are the areas of health you need to be mindful of as you approach menopause (or are waving goodbye to it behind you): Heart, bones and vagina.
Oestrogen had a protective effect on blood vessels and blood fat levels and after menopause the body is producing a weaker form of oestrogen and less of it so the potential long-term risk of cardiovascular disease does increase. LDL cholesterol and triglycerides levels can rise and blood vessels can lose their elasticity and become stiffer.
However this does not have to be the case and there is much that women can do to look after themselves. So if diet and lifestyle are not areas that you’ve ever given much thought to, now is definitely the time to start! Because a few key changes in these areas can ensure that you keep your heart and blood circulation in the best shape possible. To find out how, take a look at this blog post on heart health.
A fascinating fact is that in both men and women, bones are the strongest they will ever be at about the age of 30 years and thereafter they begin to decline. Then in women this decline accelerates at menopause. As an aside, I just have to say that this really does emphasize the importance for children, teenagers and young adults to eat and live in a way that builds bone strength because if they do not accumulate sufficient bone mass during those formative years they are at greater risk of osteoporosis in later life.
So the risk of developing osteoporosis starts much sooner than you might of thought. However, regardless of how strong your bones might or might not be at the onset of the menopause there, now is the time to make sure you are strengthening your bones on a daily basis by choosing the right foods and exercising in the right way. See my blog post on bone health here.