What to Expect: The Menopause Years
by Rebecca Clemson, ND
When many women think about menopause, they think of suffering in silence for years with symptoms like hot flashes that culminate with the end of their menstrual cycle. What many women do not know is that this is a critical period for their health and an important time to lay a good foundation for the postmenopausal stage of their life.
This blog post will detail what to expect during perimenopause and menopause, including hormonal changes, the timeline of menopause, health concerns, how to alleviate menopause symptoms, and how testing hormones can help.
Perimenopause and Menopause: Definitions and Timing
Menopause is defined as having no menstrual cycle for twelve consecutive months. Although hormones are often measured, no laboratory tests are necessary to confirm menopause.
The average age for menopause onset is 51, and it typically occurs between ages 45 and 55. Early menopause is defined as menopause occurring between the ages of 40 and 45. Menopause that occurs before the age of 40 is defined as primary ovarian insufficiency.
Surgical menopause occurs as the result of a complete hysterectomy (ovaries and uterus are removed). Although women will stop menstruating with a partial hysterectomy (when they retain their ovaries), and often after a uterine ablation, these procedures do not count as surgical menopause. These women will often still have cycling hormones even without having menses.
Perimenopause marks the time leading up to a woman’s last menstrual cycle. Most women begin to experience perimenopausal symptoms in their forties. Perimenopause typically lasts five to seven years and is characterized by declining fertility and fluctuating hormone levels.
Hormones During Perimenopause and Menopause
Perimenopause is often referred to as a second puberty or reverse puberty due to the hormonal changes that women experience; many women become estrogen dominant during this stage. During perimenopause, progesterone levels begin to decrease as women begin to have more anovulatory cycles (cycles where no egg is released) and as egg quality also declines.
At the same time, estrogen levels can go on a “rollercoaster ride” and start to fluctuate from high to low. Estrogen levels can be quite erratic during this stage, but eventually, they become low as menopause approaches. These hormonal changes lead to the common symptoms experienced during perimenopause which will be discussed below.
Menopause is characterized by low levels of estrogen and progesterone. The ovaries are no longer producing these hormones. The small amount of circulating estrogen in the body is made from the conversion of androgens, mainly in fat tissue. A small amount of progesterone is produced from the adrenal glands.
Although the ovaries can still produce some testosterone during the postmenopausal years, this production declines with age, and most androgens are produced from the adrenal glands. Adrenal health is key to supporting menopausal hormone levels.
Health Risks Associated with Menopause
The transitional period from perimenopause to menopause is considered a critical window in women’s health. The hormones that dominate the premenopausal years (estrogen and progesterone) are very important for overall health. They support:
- Cardiovascular health
- Bone health
- Muscle mass
- Insulin sensitivity
- Weight management
- Collagen production
Due to the decrease in estrogen and progesterone during menopause, women experience an increased risk for disease. This is an important time to focus on healthy lifestyle interventions to decrease these associated risks.
Symptoms of Perimenopause and Menopause
Many women dread this stage of life due to the symptoms that often accompany perimenopause and menopause. Fortunately, for most women, these symptoms can be relatively mild. However, for others, they can be severe and have a profound impact on their quality of life. The good news is that these symptoms won’t last forever.
Due to the hormonal fluctuations associated with perimenopause, the most common symptoms women experience are:
- Irregular cycles, often accompanied by heavy periods
- Intermittent hot flashes (experienced by up to 80% of women)
- Sleep disturbances
- Mood swings
- Weight gain
Unfortunately, many of these symptoms may persist post-menopause. The most common postmenopausal symptoms are:
- Hot flashes and night sweats
- Low libido
- Vaginal dryness
- Brain fog
- Weight gain
These symptoms last for four years (on average) after menopause, but this timeline can vary from person to person. Underlying health and stress levels can greatly impact the length and severity of symptoms.
Alleviating Menopause Symptoms
There are numerous treatment strategies to help with menopause symptoms and related health risks ranging from lifestyle interventions, supplements, and menopausal hormone therapy (MHT).
Simple lifestyle choices can have big impacts on symptoms and overall health. Focusing on blood sugar balance can not only help with hot flashes and sleep disturbances but also with the weight gain and insulin resistance that is common in menopause.
Limiting simple carbohydrates, sugars, and alcohol, focusing on whole foods, and increasing protein intake may help decrease the risk of metabolic syndrome and weight gain. Decreasing your intake of caffeine, alcohol, sugar, spicy foods, and hot beverages may alleviate hot flashes.
Regular exercise and increasing weight-bearing activity may help prevent weight gain and decrease muscle loss while also decreasing insulin resistance and supporting bone health.
Sleeping well and practicing stress reduction with yoga, breathing exercises, or meditation may also be helpful.
Some women find benefits from herbal supplementation or MHT. Commonly used herbs may include black cohosh, red clover, dong quai, maca, evening primrose oil, and wild yam. MHT may look like taking progesterone, estradiol, estriol, testosterone, and/or DHEA to support hormone levels during menopause.
How Hormone Testing Can Help
While testing hormones during perimenopause and menopause is not often done in conventional medicine, understanding hormone levels and their metabolism (as well as assessing HPA axis function) can help guide treatment recommendations to support women during this stage in their life.
During perimenopause, when many women become estrogen dominant, understanding their estrogen metabolism and if they need detoxification support can help with decreasing estrogen dominance symptoms.
Estrogen metabolism may also be helpful to understand when using MHT to limit the negative impact of increasing estrogen levels with replacement. Testing may also be helpful for monitoring hormone levels while using MHT to make sure levels are within a therapeutic range.
Assessing androgens can be helpful as they are the sole source of estrogen post-menopause. They also support libido, mood, and bone health.
As mentioned above, adrenal health is key in menopause. The adrenal glands are the source of hormones during menopause. Checking in on the HPA axis during perimenopause and menopause can help guide appropriate treatment to support this system.
How to Time Testing
Testing hormones during menopause is easy. You can test on any day. Testing during perimenopause can be a little trickier. When women are still cycling, it’s best to test hormones during the luteal phase of the cycle so their provider can see progesterone and estrogen levels.
Often perimenopausal women have irregular cycles, which can make it tough to catch a mid-luteal phase sample. If cycles are very short (less than 21 days) or long (months without a period), it may be best to just test on any day.
If cycles are still fairly regular, utilizing basal body temperature testing can be helpful to figure out the timing for a mid-luteal phase sample. Unfortunately, ovulation predictor kits (OPKs) can yield false positives during perimenopause as LH levels begin to rise with FSH levels. These are less reliable to use to help with test timing.
While perimenopause and menopause do come with significant symptoms and associated health risks, for many women, these symptoms are mild. On a positive note, many postmenopausal women feel more confident and enjoy newfound freedoms during these later years of life.
There are many treatment options available to help optimize health and ease this transitional time. Working with a knowledgeable provider and utilizing testing like the DUTCH Test can help to create treatment protocols personalized for each patient.