Menopause: the three stages

Menopause typically occurs around the age of 45 and marks the end of the menstruation cycle, after 30 or so years of monthly periods. It is not a one-off experience, and it in itself is a long process that can last another 10 years. In this article, a consultant obstetrician and gynaecologist breaks down each stage of the menopausal process.

The menopausal process is broken into three stages: perimenopause, menopause, and post-menopause.

Perimenopause

As they enter their 40s, women and other menstruating people will gradually stop producing ovules, or eggs, to be deposited into the uterus in preparation for conception. This is because the ovaries stop functioning as they used to, and cease to produce oestrogen and progesterone – sexual hormones necessary in the maturation of the eggs – but it brings along with it some side effects which will intensify during the actual menopausal stage.

In perimenopause, they will still experience periods, but they will become more irregular, both in timing and in blood flow (if they weren’t always irregular). Fertility is greatly reduced at this stage, though very rarely, pregnancy is possible for some still although it may be dangerous for both the mother and the child, which is why it is advised to continue using contraceptives.

This transitory period differs in length for every person; for some, it can last as long as 10 years.

Menopause

A previously menstruating person is only classified as truly being in menopause if they have not had a period for 12 consecutive months (barring other causes such as illness or pregnancy). At this stage, pregnancy is truly no longer possible. On average, people reach this stage at 51, but it can happen to those younger or older.

People in menopause have their hormonal system in flux, and will have greatly declined levels of oestrogen and progesterone but on the other hand, will have higher levels of follicle-stimulating hormone and luteinizing hormone.

The symptoms that menopausal people are likely to experience at this stage include

• Hot or cold flushes
• Joint pain
• Memory problems, difficulty concentrating, and brain fog
• Sleep issues
• Mood swings
• Excessive sweating
• Anxiety and low feelings
• Lower libido
• Vaginal dryness
• Fatigue

Medications and therapies can be explored to help alleviate the strain of the symptoms, such as hormone-replacement therapy to replenish oestrogen levels, or antidepressants to help stabilise the mood.

Post-menopause

After some time, the body will adjust to the hormonal changes and the symptoms should cease or at least lessen. Life can continue as normal, but it is important to stay aware of the possible risks that people in post-menopause are vulnerable to due to these hormonal changes, such as:

• Osteoporosis, which can happen as the lack of oestrogen, a key component in bone health, causes bone brittleness and loss of density.
• Cardiovascular disease, which again can occur due to oestrogen loss. Prevention techniques include healthy diets with few saturated fats and staying active.

Common, but less dangerous symptoms or conditions that can occur include chronic vaginal dryness, which can be alleviated with lubricants and creams, urinary incontinence, as the pelvic muscles weaken, and depression, as the loss of fertility may be difficult for some to cope with.

Some may experience postmenopausal bleeding, which is not the same as menstruation, but can be caused by inflammation or thickening of the endometrium (womb lining), cervical polyp growths, or it could be a sign of a gynaecological cancer. If bleeding occurs after menopause, patients should see a gynaecologist as soon as possible,

If you are struggling with menopause or have further concerns regarding your menstrual cycle, consult with a specialist on Top Doctors.