Menopause
Clinically speaking, menopause is a date. For those women who still have a uterus, menopause is defined as the day after a woman's final period finishes. This date is fixed retrospectively, once 12 months have gone by with no menstrual flow at all. At this point a woman is considered to be a year into postmenopause, is considered to be infertile, and no longer needs to take into consideration the possibility of pregnancy.
In common everyday parlance however, the word "menopause" is usually not used to refer to one day, but to the whole of the menopause transition years. This span of time is also referred to as the change of life, the change, or the climacteric and more recently is known as "perimenopause", (literally meaning "around menopause").
The word menopause is also often used in popular parlance to mean all the years of postmenopause.
Perimenopause
In biomedicine, perimenopause is the term describing the menopause transition years. In women who have a uterus, perimenopause describes the years both before and after the final period (although it is only possible to determine in retrospect which episode of flow was indeed the final period).
During perimenopause, the production of most of the reproductive hormones, including the estrogens, progesterone and testosterone, diminishes and becomes more irregular, often with wide and unpredictable fluctuations in levels. During this period, fertility diminishes, but is not considered to reach zero until the official date of menopause. The official date is determined retroactively, 12 months after the last appearance of menstrual blood. Signs and effects of the menopause transition can begin as early as age 35, although most women become aware of the transition in their mid to late 40s, often many years after the actual beginning of the perimenopausal window. The duration of perimenopause with noticeable bodily effects can be as brief as a few years, but it is not unusual for the duration to last ten or more years. The actual duration and severity of perimenopause in any individual woman cannot currently be predicted in advance, and even during the process the course of an individual woman's perimenopause can be difficult if not impossible to chart.
In the perimenopause years, many women undergo noticeable and clinically observable physical changes resulting from hormonal fluctuations. The most well-known effect of these is the "hot flash" or "hot flush", a sudden temporary increase in body temperature. The "flash" sensation in a "hot flash" occurs as the body temperature soars upward at a rapid rate and reaches a peak mere fractions of a second after the onset of the temperature increase is first noticed. The "hot" sensation in a "hot flash" is not the initial temperature rise; instead, it is a reaction to the perceived slowness of the body's return to a more normal temperature range when compared to the speed of the run-up to the spike. Hot flashes can become so strong that they can raise the body temperature multiple degrees in a very short period of time; this extreme temperature differential can cause the sufferer to feel weak and break out in heavy sweating. Despite the discomfort to the woman, hot flashes are not considered harmful by physicians. In most cases, flashes can be treated to ease extreme discomfort, using prescription medications such as hormone replacement therapy (HRT) or SSRI medications, as well as by using over-the-counter plant estrogens and herbal remedies. Many women choose not to treat hot flashes through pharmacology and instead rely on dressing in ways to dissipate heat quickly (natural fibers, loose clothing, easily removable layers of lightweight garments) as well as mechanical means to aid the body in removing excess heat (fans, cool beverages, lighting changes, redirection of computer heat exhaust).
Other common effects encountered during the perimenopausal period include mood changes, insomnia, fatigue, and memory problems. The non-specific nature of these effects indicates to researchers that they may not be related to the actual hormonal fluctuations involved in menopause. One hypothesis as to why these effects are reported as either originating during or increasing in frequency or strength within perimenopause argues that these more general effects may be related to societal perceptions and economic realities about aging:
- Changes in economic conditions affecting plans for retirement for someone who works outside the home
- Having to deal with care for and/or the death of elderly parents
- The so-called "empty-nest syndrome" when older children leave home
- The birth of grandchildren placing people of "middle age" into a new category of "older people"
- Experiencing the end of the fertility period
Even women who are free of any troublesome physical effects of perimenopause may still experience psychological issues related to aging as they approach the end of their childbearing years. Medical treatment for these issues has improved greatly with the development of geriatric medicine as a specialized health field, as well as the dramatic increase in pharmaceutical treatments available for mental disorders like depression and anxiety. Recent research shows that melatonin supplementation in perimenopausal women can produce a significant improvement in thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing the depression associated with the menopause.
Premenopause
Premenopause is a word used to describe the years leading up to the last period, when the levels of reproductive hormones are already becoming lower and more erratic, and the effects of hormone withdrawal may be present.
Postmenopause
Postmenopause is all of the time in a woman's life that take place after her last period, or more accurately, all of the time that follows the point when her ovaries become inactive.
A woman who still has her uterus (and who is neither pregnant nor lactating) can be declared to be in postmenopause once she has gone 12 full months with no flow at all, not even any spotting. When she reaches that point, she is one year into postmenopause.
The reason for this delay in declaring a woman postmenopausal is because periods are usually extremely erratic at this time of life, and therefore a reasonably long stretch of time is necessary to be sure that the cycling has actually ceased completely.
At this point a woman is considered infertile, and no longer needs to factor in the possibility of becoming pregnant. However the possibility of becoming pregnant has usually been very low (but not zero) for a number of years before this point is reached.
In women who have no uterus, and therefore have no periods, post-menopause can be determined by a blood test which can reveal the very high levels of Follicle Stimulating Hormone (FSH) that are typical of post-menopausal women.
A woman's reproductive hormone levels continue to drop and fluctuate for some time into post-menopause, so any hormone withdrawal symptoms that a woman may be experiencing do not necessarily stop right away, but may take quite some time, even several years, to disappear completely.
Any period-like flow that might occur during postmenopause, even just spotting, must be reported to a doctor. The cause may in fact be minor, but the possibility of endometrial cancer must be checked for and eliminated.
Further Reading
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