What is Menopause?

Most simply defined, menopause marks the end of one’s reproductive years. Menopause itself officially occurs 12 consecutive months after your last menstrual cycle. In the decade or so before menopause occurs — called perimenopause or the menopause transition — women may experience a variety of symptoms, including, most commonly, changes in their periods, mood swings, and hot flashes.

The road to menopause most often starts when a woman is between the ages of 45 and 55 and usually lasts between four and 10 years, though it can be shorter or — in some rare cases — longer. Average age of menopause in the US/Canada is 51 and naturally occurs between the ages of 40–60 with the majority of women experiencing it sometime in their mid-late 40s — early 50s. Average length of the transition, perimenopause, is around 4 years but can last upward of 10.

In this time period, the amount of estrogen and progesterone made by your ovaries will fluctuate (sometimes wildly!) which can impact every system in your body. While the median age for menopause is 51, researchers have found it can occur up to two years earlier for Latina and Black women. In fact, menopause may affect women of color differently all around — an area of health that’s been woefully understudied and requires more research. Ovarian health and genetics are two factors that dictate when you’ll begin menopause, and how severe your symptoms may be as your hormones change in preparation for menopause. Age and symptom frequency/intensity related to ethnicity and race are less well understood and have conflicting data but health disparities in general do seem to be related, according to this well-researched article on menopause, reviewed by a leading menopause researcher, Nanette Santoro.

What’s the difference between perimenopause and menopause?

While menopause is often thought of as one phase of our lives, it actually involves three stages:

  1. Perimenopause, a transitional time that can last between 4 and 8 years and usually begins when your period becomes irregular. Many women experience significant symptoms during perimenopause, while some don’t even know it’s happening. Average length is 4 years and can last upward of 10.
  2. Menopause, which begins one year after your final full menstrual period or, more plainly, after you’ve missed your period for 12 consecutive months.
  3. Postmenopause, as the name suggests, occurs after the initial intensity of menopause has passed, though some symptoms (like hot flashes) can linger for a few years, and up to a decade, but usually with less frequency.

But the terms perimenopause, menopause and postmenopause can be confusing. We like to frame the entire menopause experience as the transition from our hormonal balance in our reproductive years to our hormone balance in our postmenopausal years.

In our late reproductive years (typically our late 30s-early 40s), our estrogen levels are preserved, but progesterone levels begin to change and may be experienced as subtle changes in our menstrual cycle or no observable change at all.

Perimenopause describes the transitional period between our late reproductive years and our postmenopausal years. For most women, estrogen levels do not steadily decline but rather fluctuate as they head toward their new lower level. The fluctuations can be variable among women and within an individual woman. This pattern explains the variability in symptom intensity and frequency and why many symptoms resolve or lessen in intensity/frequency once we’ve settled into our postmenopausal years. In general vasomotor symptoms as well as mood and cognitive changes resolve/lessen and genitourinary symptoms as well as impact on heart and bone health intensify.

Postmenopause is technically life after menopause but it’s important to remember that we don’t reach our new lower hormonal balance immediately after 12 months without our cycle (technically, menopause). It can take up to five years to reach that new balance. It’s also important to note that our bodies don’t stop making estrogen — they just make less of it for the remainder of our lives.

How Will My Body Change During Menopause?

Your body will perform a number of changes during menopause that extend far beyond your reproductive system. For one, you will begin to process energy in a different way, your body’s natural systems will slow down a bit, your fat cells will change, and you may notice you put on weight more easily. A second big change is many women lose bone density during the menopause transition and postmenopausal years, which could make you more susceptible to things like hairline fractures, and in extreme cases broken bones. Also important to note parallel and intersecting factors at play like aging, other health issues, stress, external factors.

How Do I Know If My Symptoms Have To Do With Menopause?

If you’re experiencing symptoms in line with the menopausal transition, talk to your healthcare provider — he or she will most likely ask about your specific symptoms, your age and how menopause has affected women in your family. They may want to check your hormone levels to confirm your symptoms fall under the perfectly-natural menopause umbrella and confirm they’re not caused by something else.

Menopause 101

State of Menopause. Symptoms, meet solutions.