Let’s Talk Menopause
Congratulations! You’ve just joined a large party of women here to celebrate one of life’s most profound (and universal) rites of passage: Menopause. Oh, you didn’t know it’s a party? Or that there’s a celebration involved? Here at pepper&wits we believe the more you know about menopause, and the more freely you talk about it, the easier and more manageable it will be. So sit down and relax, grab a glass of (virtual) bubbly, and help yourself to this glossary explaining the next best chapter of your life.
It’s not a disease or a disorder; you can’t prevent it, and there is nothing to be “cured.” Menopause refers to your final menstrual period, confirmed after you have not menstruated for 12 consecutive months. So if you don’t have a period for 4 or 5 months and then you spot or bleed the next month, you’re back at square one and you need to begin counting towards 12 consecutive months all over again. By the way, ever hear of “change of life babies”?” Fair Warning: Until you have counted out your year without a period, you are still fertile, so don’t toss the birth control.
The average age of naturally-occurring menopause in the U.S. is around 51-years-old. If your menopause occurs before you’re 45, it’s called early menopause. Before age 40 it’s premature menopause.
And in the Department of Unusual Circumstances, there is immediate menopause, which occurs very suddenly because of surgery or medical treatments or medications—for example when a woman’s ovaries, fallopian tubes, and uterus are surgically removed in a total hysterectomy. Removal of both ovaries (a bilateral oophorectomy) also puts you into immediate menopause. (Though the surgical removal of only the uterus does not. If you also have your cervix removed, you won’t have monthly periods but, depending on your age, your ovaries may still be producing the hormone estrogen.) Radiation therapy to the ovaries or some cancer chemotherapies may cause what’s called induced menopause.
You know what can feel like PMS for months on end? Perimenopause, the time leading up to menopause when you start to experience symptoms. (It’s also called, more formally, the menopausal transition.) Most women begin perimenopause in their mid-40s; it can last as long as 12 to 15 years, or it can be as short as a few months. During perimenopause, you may notice that your periods come more frequently and/or they’re irregular. You may also begin to have some of the symptoms associated with menopause, like night sweats, hot flashes, fatigue, trouble sleeping, breast tenderness, a lower sex drive, vaginal dryness, pain with intercourse, mood swings, and urinary urgency or leakage. Did we forget anything? Oh, right: memory loss or brain fog. These symptoms tend to become more apparent and bothersome toward the end of perimenopause/menopause.
VMS rhymes with PMS…and stands for vasomotor symptoms or hot flashes and night sweats, the two most commonly reported menopausal symptoms. About 75% to 85% of women have VMS during perimenopause and menopause, and a small percentage continue to have VMS long after menopause. The symptoms are typically worse during the first few years, and then begin to taper off (whether or not you treat them), lasting from 5 to 7 years, though they can last longer. Some women are lucky enough to win the hot flash lottery, never experiencing a single one.
If you’ve had a hot flash you know how it feels. But the quality varies, as does the frequency. Women typically describe a hot flash as a rush of warmth or intense heat spreading over the body – especially over the head, neck, and chest, lasting from 30 seconds to a few minutes or longer. You may also perspire, flush, and get chills. Some women report anxiety or even heart palpitations. When hot flashes occur when you’re trying to get some shut-eye, they’re called night sweats. Many women report waking up drenched in sweat—enough to need to change their pajamas or even the sheets.
In case you’re asking, “Why?” or “Why me?” we’re sorry to say that doctors don’t understand exactly what causes VMS. We do know they’re associated with decreasing estrogen and progesterone levels. If your symptoms are so severe or frequent that you need treatment, your doctor might recommend weight loss, quitting smoking (are you still smoking? Stop that!), herbal and vitamin supplements, hormonal therapies, and/or nonhormonal medications.
Diminishing estrogen levels can affect your genitourinary system, too, causing genitourinary syndrome of menopause (GSM). You might notice some of the vulvovaginal symptoms caused by vulvovaginal atrophy (VVA). (Vulva is the term for all your external sex organs – the pubic mound, the inside and outside of your vagina, the vaginal lips, and clitoris.) Women who have VVA may complain of vaginal dryness or pain, diminished sexual desire, pain with sexual intercourse, or vaginal irritation. Decreasing estrogen levels can also affect your bladder and urinary opening, causing urinary frequency, pain, urgency, and recurrent urinary tract infections (UTIs).
GSM symptoms start a little later than VMS and they don’t resolve on their own, so if yours are bothersome, talk to your doctor about options, which might include over-the-counter products or prescription medications.
That’s it. You’re now fluent in the language of menopause. Any questions?
Constantine GD, Graham S, Clerinx C, et al. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health. 2016;22(3):112-122.
Kaunitz AM, Manson JAE. Management of menopausal symptoms. Obstet Gynecol. 2015;126(4):859-876.
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