Menopause: Are We There Yet?

November 8, 2022

By: Rachel Noonan, PharmD

Aging will interrupt your daily life in irritating, unpredictable ways. The journey to menopause is a messy one. Full of intrusive symptoms, it calls into question everything you thought you knew about your body.

Menopause stems from hormonal changes that begin nearly a decade before you notice them. These shifts go unnoticed because your body spends years compensating for reproductive aging, working to maintain fertility and regulate menstrual cycles.

The menopause transition, or perimenopause, is divided into an early and late phase. No two bodies are the same; every woman will experience this process a little differently. Still, there is a method to the madness. Studies find certain perimenopausal symptoms peak during specific stages. These symptom patterns increase awareness and pinpoint therapies targeted to your needs.

In the early transition phase, you will see menstrual cycle disruptions. You may become less regular or skip a cycle before resuming your previous schedule. Ovulation, mature egg release from the ovary, will be less consistent. Eventually, your body is no longer able to perform the balancing act. It can no longer compensate for the changes taking place. The late phase of menopause is marked by cycles over 60 days apart. Cycle patterns will vary greatly during this 1-to-3-year period. Once 12 months have passed since your last menstrual period, you have reached the early postmenopausal years.

Due to the unpredictable hormonal environment of perimenopause, symptoms surface. They usually spike when women move from early to late perimenopause. Some symptoms are mild to start and deepen throughout the transition. Anxious and depressive feelings tend to intensify as women move into the later phase. Similarly, vulvovaginal symptoms increase as estrogen levels decline. The closer you are to menopause, the more vaginal dryness, deterioration, and painful intercourse you may experience.

Many perimenopausal symptoms are linked. Addressing one complaint may remedy another. For example, hot flashes and sleep difficulties appear connected. The Study of Women’s Health Across the Nation study (SWAN) discovered that women experiencing moderate to severe hot flashes are much more likely to wake during the night and suffer from disrupted sleep. Addressing vasomotor symptoms (hot flashes and night sweats) with bioidentical hormone replacement therapy like estrogen, can also improve nighttime disturbances. Women supplementing with estrogen appear to exhibit higher sweating thresholds and less frequent attacks. Oral progesterone may also encourage uninterrupted sleep due to its sedative properties.

Identifying the signs of perimenopause early will give you time to act. Track your menstrual cycles manually-you can’t predict the unpredictable. Connect with your health care provider. Most women don’t reach out soon enough (or at all). Use available therapeutic options to minimize menopause’s impact. During moments of exhaustion or frustration, remember that your biology is uniquely beautiful. Beauty is pain, and menopause, is both.

References

  1. Allshouse A, Pavlovic J, Santoro N. Menstrual Cycle Hormone Changes Associated with Reproductive Aging and How They May Relate to Symptoms. Obstet Gynecol Clin North Am. 2018 Dec;45(4):613-628. doi: 10.1016/j.ogc.2018.07.004. Epub 2018 Oct 25. PMID: 30401546; PMCID: PMC6226272.
  2. El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, Karvonen-Gutierrez C, Waetjen LE, Matthews K. The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2019 Oct;26(10):1213-1227. doi: 10.1097/GME.0000000000001424. PMID: 31568098; PMCID: PMC6784846.
  3. Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas). 2019 Oct 1;55(10):668. doi: 10.3390/medicina55100668. PMID: 31581598; PMCID: PMC6843314.
  4. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1):1-15. doi: 10.1210/clinem/dgaa764. PMID: 33095879.
  5. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.

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