Understand Your Menopause

Stages of menopause

To grasp perimenopause and menopause, let’s first understand the menstrual cycle. This cycle occurs roughly every 28 days and signifies that pregnancy hasn’t occurred. It starts during puberty and continues until menopause. When a female baby is born, she already has thousands of immature ovarian follicles that mature and are released each month, awaiting fertilization.

As you age, the ovaries become less responsive to hormones that encourage follicle maturation and ovulation (FSH and LH). This leads to changes in the menstrual cycle, like shorter cycles, heavier periods, missed periods, or prolonged bleeding. This phase is called perimenopause.

Here are some terms to understand:

Premenopause

This term is often used in American websites and refers to the time when individuals have no symptoms of perimenopause or menopause. In the UK, this would be described as the childbearing years.

Perimenopause

This phase refers to the time when individuals experience symptoms caused by fluctuating or declining oestrogen levels but still have menstrual periods (if hormonal contraception is not used). These symptoms may persist even when using hormonal contraception, and it is entirely reasonable to manage these symptoms with hormone replacement therapy (HRT) and lifestyle changes if they significantly affect quality of life. HRT and lifestyle modifications can often help alleviate some of the symptoms caused by a loss of or fluctuating oestrogen.

Menopause

Menopause is officially reached when menstrual periods have completely ceased, and there is no chance of natural conception. In the UK, menopause is diagnosed one year after periods have stopped in women over the age of 50, and two years after periods have stopped in women below the age of 50.

For women who have had a hysterectomy without the removal of the ovaries, menopause can still be diagnosed based on symptoms alone. Symptoms associated with the loss of oestrogen may persist and can be managed in consultation with the individual’s circumstances, risks, and benefits.

If a woman undergoes a total hysterectomy that includes the removal of the ovaries, it is considered a medical menopause. In such cases, HRT is typically offered as a routine, especially if the woman is under the age of 55 years.

Many women use the term “going through menopause” to describe this process, but it is important to recognize the specific changes leading up to menopause and accurately understand what menopause entails.

Next Steps