‘Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less’ – Marie Curie
Menopause is a whole-body, natural biological process that marks the end of a woman’s reproductive years. The average age of menopause in Australia is 51, but individual experiences vary. Perimenopause, the transition period before menopause, can last two to twelve years. This time is a crucial window of opportunity to make positive health changes that can benefit your future. This journal post explores the various stages of menopause, the underlying hormonal changes, the unique symptoms that women may encounter, and tools to manage and feel empowered in this phase of your life.
Please note: While many symptoms can be attributed to perimenopause, some may be indicative of other health conditions. If you have any concerns, it’s important to consult with your primary healthcare provider.
Understanding the Phases of Menopause
Menopause can be divided into four distinct phases:
Premenopause
The initial phase, often beginning in the late 30s or early 40s, is characterised by producing less progesterone, despite still having regular periods they may begin to differ in length by 2-3 days subtly. It is important to track your cycles. As the Progesterone declines, where there are more symptoms of brain fog, sleep disturbances, mood changes and low energy.
Perimenopause
This transitional phase, lasting approximately 2-10 years, is marked by significant hormonal changes, as you start losing Progesterone, Oestrogen begins to jump higher than it ever has before and fluctuates wildly. Professor Prior described this as the ovary’s grand finale or fireworks show, bringing the symptoms associated with perimenopause. Cycles begin to become irregular, they might be a little lighter or heavier, and they might be longer or shorter. There could be an increase in breast tenderness, painful periods, body aches, abdominal weight gain and headaches. The later phase of perimenopause (3 months or more prior to the final bleed), is where symptoms really kick in hard (average 45-47yo), the Oestrogen now begins on a downward trend and symptoms begin to creep in – mood changes, hot flushes, night sweats, brain fog, weight gain, difficulties sleeping, vaginal dryness.
Whilst these symptoms are disruptive, they are not uncommon and can be managed with the correct healthcare team.
Menopause
This day is officially diagnosed 12 months after a woman’s final menstrual period, it is merely a day on the calendar. After years of hormonal shifts, the oestrogen has now reached a lower state, it doesn’t go away it just functions at about 10% which is important for the postmenopausal woman.
Postmenopause
This final phase encompasses the remainder of a woman’s life after menopause. Research from the University of Melbourne concluded that the majority of women over 60 report feeling ‘pretty fantastic’ while other observations of women over 70 are likely to be the happiest they’ve been. It is important to note, that as the Oestrogen is now functioning at a lower level, we can see more genitourinary symptoms arise here such as vaginal dryness, stress incontinence, bladder infections, UTIs, low sexual desire and prolapse.
Hormonal Changes and Symptoms
Perimenopause is often characterised as a chaotic hormonal fluctuation. However, a more accurate understanding involves recognising it as a sequence of events. This process begins with a decline in progesterone levels while oestrogen levels remain high. As perimenopause progresses, oestrogen levels also decrease, leading to significant changes in insulin metabolism. By perceiving perimenopause as a series of describable stages, women can better understand their symptoms and identify appropriate treatment options throughout the transition. While symptoms may feel like they are neverending, they are mostly temporary.
Factors Influencing Menopause
Several factors can influence the timing and severity of menopause, including:
Genetics
A family history of early or late menopause can be a predictor. One study in 2011 indicated that women whose mothers or sisters experience menopause by the age of 45 were roughly six times more likely to do the same.
Medical Conditions
Certain health conditions, such as autoimmune diseases or surgical interventions, may impact menopause. Medical treatments like chemotherapy, radiation, or surgical removal of the ovaries during a total hysterectomy. This can lead to a rapid decline in hormones. Historically, many women had their ovaries removed as part of a hysterectomy to reduce the risk of ovarian cancer. However, this practice has evolved. In recent years, there has been a shift towards preserving the ovaries when possible, especially in women without a family history of ovarian cancer. This has led to more informed conversations about the body and its hormonal functions. While the ovaries may produce lower levels of oestrogen and androgens after menopause, these hormones can still play a role in supporting bone health, cardiovascular health, and cognitive function. Management strategies for partial or full hysterectomy can be found here – Surgical Menopause.
Lifestyle Factors
Smoking, excessive alcohol consumption, and stress can influence the onset of menopause.
The Brain and Menopause
Dr. Lisa Mosconi and her team are at the forefront of researching the brain in women pre-menopause, during perimenopause and into menopause. Dr Mosconi was recently interviewed on The Diary of a CEO Podcast and shared some interesting research and images on the changes in brain function in women, I highly recommend this episode – Neuroscientist, Dr. Lisa Mosconi on Menopause.
In the 1930s, scientists discovered a connection between the ovaries and the brain. Both organs share hormones, primarily oestrogen, progesterone, and testosterone. While initially believed to be solely involved in reproduction, later research revealed their critical role in brain health.
Oestrogen, a key hormone for women, acts as a master regulator for the brain. It enhances blood flow, providing essential nutrients and oxygen. Oestrogen also promotes plasticity, enabling the brain to adapt and change. As oestrogen levels decline during perimenopause and menopause, cognitive function can be affected. Mental fatigue, brain fog, and difficulty with focus, memory, and language are common symptoms experienced by many women during menopause. These changes are often attributed to the decline in oestrogen. While not all women experience these symptoms to the same degree, it’s important to acknowledge the significant impact that menopause can have on the brain.
Brain fog, a common complaint, involves feeling as if the brain is “hijacked.” Despite efforts to concentrate, the brain may seem sluggish or unable to function properly. This can make it challenging to maintain focus, recall information, or find the right words. This validates women’s feelings and also alludes to the that menopause is a whole-body transition, essentially a renovation project on the brain & body.
Traditional Chinese Medicine Understanding of Menopause
From a Traditional Chinese Medicine (TCM) perspective, menopause is seen as a natural process influenced by the decline of Kidney Essence, the foundation of life, growth, reproduction, and aging. This decline affects both the cooling, moistening, and nurturing aspects of the body (Kidney Yin) and the warming, activating, and energetic aspects (Kidney Yang). Additionally, TCM emphasises the importance of maintaining a smooth flow of Qi and Blood, as stagnation can contribute to various menopausal symptoms such as mood swings, body aches, fatigue, and irregular menstruation.
TCM views each woman transitioning through menopause differently, as a unique diagnosis and pattern differentiation will determine the treatment plan and individualised recommendations. Liz describes Menopause as one of the Three Golden Opportunities in a woman’s life and has listed some helpful ways to manage it in this journal entry – What are the Three Golden Opportunities?
Managing Menopause
Every woman’s experience of menopause is different. What works for one person may not be effective for another. It’s essential to work with a healthcare team who can tailor a treatment plan to your specific needs and preferences. Traditional Chinese Medicine & Acupuncture can be a useful tool to support menopause, please see further research articles here – Evidence Based Acupuncture.
Areas of focus should include:
Regulating the Hypothalamic Pituitary Adrenal Axis
The HPA axis plays a crucial role in stress response and hormone regulation.
Supporting Mental Health
This is a transition of great change, it is also the ‘sandwich’ years of a woman’s life with teenage children and elderly parents to care for. Schedule adequate time for self-care and build a team around you this may include a psychologist.
Address Inflammation
Chronic inflammation can contribute to menopausal symptoms. Incorporating anti-inflammatory foods and supplements into your diet can be helpful.
Supporting Digestive Health
A healthy gut microbiome is essential for overall well-being. Consuming fiber-rich foods, and probiotics, and avoiding irritants can promote digestive health.
Lifestyle Modifications
A healthy lifestyle, including regular exercise, a balanced diet, limited alcohol, and adequate sleep, can significantly improve menopausal symptoms and overall quality of life.
Hormonal Interventions
Menopausal hormone therapy (MHT), previously known as Hormone Replacement Therapy (HRT), can be a valuable tool for managing menopausal symptoms.
MHT has a complex history. In the mid-20th century, it was widely prescribed, often at high doses. However, concerns arose in the 1990s when a large-scale study suggested potential risks associated with long-term MHT use in postmenopausal women. This led to a significant decline in MHT use. Today, MHT is approached with a greater understanding of its benefits and risks. Modern MHT formulations use different hormones, and lower doses and are designed to be gentler on the body. There are also different types including bioidentical options, rather than synthetic. It is important to approach MHT with a personalised plan. Individual needs and preferences vary, and a healthcare provider can help determine the most suitable treatment plan.
The Importance of Building a Multidisciplinary Team
A multidisciplinary approach and a supportive healthcare team can significantly enhance the experience of menopause. Open communication and a willingness to ask questions are essential for building a strong relationship with your healthcare providers.
Know your treatment options for your age, whether you have had a hysterectomy or other health conditions.
Build a healthcare team around you who can determine what is the most appropriate treatment for you & your quality of life. This should include a GP and/or Gynaecologist, Neurologist, and complementary allied health practitioners for your body & mind, including but not limited to, Women’s Health Physiotherapist, Psychologist, Exercise Physiologist, Acupuncturist, Nutritionist and Naturopath.
Menopause is a unique experience for every woman, yet it’s often stigmatised and misunderstood. Open conversations about menopause can help reduce stigma and empower women to seek the support they need. Understanding the phases, hormonal changes, and potential symptoms can empower individuals to make informed decisions about their health and well-being. By adopting a personalised approach and seeking appropriate support, women can navigate this transition with greater ease and confidence.
Helpful Resources
Evidence Based Acupuncture – Menopause
Australasian Menopause Society (AMS)
Jean Hailes Foundation
Lara Briden’s Book – Hormone Repair Manual
Ruby Warrington’s Book – Sober curious