In ancient times, the three phases of a woman's life were referred to as maiden, mother and crone. Today, they're known as prepubescence, reproductive years and menopausal/postmenopausal. More recently, there's been more dialogue around another stage: perimenopause. Quite possibly, this one is the most difficult to pinpoint because it can last for up to a decade, present with symptoms that could be signs of other health concerns, and be erratic enough that we may just think we're losing our minds.
For decades, both perimenopause and menopause have been widely misunderstood and neglected topics. Even the term post-menopause suggests there's an end to menopause, when, in fact, there's no other side—even if symptoms improve over time.
Let's examine how each term is defined:
The time right before menopause, perimenopause typically starts when women are in their 40s, and may be identified by irregular periods, hot flashes, vaginal or bladder issues, and mood changes. It ends at 12 consecutive months without a menstrual cycle.
At that one-year point is when menopause begins. Menopause can also happen abruptly with certain medical treatments or ovary removal. Either way, the ovaries stop releasing eggs and pregnancy is not possible.
Post-menopause is the time after menopause has occurred, and it will last the rest of our lives.
That's the quote-unquote "easy" part. To learn more about changes in the menopause conversation, misperceptions about treatment options, ways to mitigate bothersome symptoms, and how to position ourselves for a more comfortable shift, we talked with Dr. Barbara DePree with Holland Hospital Women's Specialty Care and Natasha Peoples, Family Nurse Practitioner with Spectrum Health Women's Health & Wellness Center.
WHY IT NEEDS MORE ATTENTION
If menopause were simply about the cessation of our periods, many of us might be jumping for joy. The reality is, lower estrogen production could contribute to the development of serious conditions, such as cardiovascular disease, type 2 diabetes, and osteoporosis—and, it can cause weight gain and joint pain, affect sexual health and decrease pelvic floor function. Also, the vasomotor symptoms (VMS)—hot flashes and night sweats—that are prevalent in most menopausal women can be disruptive in significant ways, especially in affecting sleep.
If, for example, we enter menopause at 52, we likely have a significant part of our lives left.
"One of the reasons we're trying to put some energy into better understanding menopause is because it encompasses about 40% of a woman's lifetime," DePree said. "We feel like it's important to understand the impact of hormones or absence of hormones for that significant duration."
EASING THE TRANSITION
It seems a foregone conclusion that menopause will create discomfort and we just have to suffer through it. Beyond our physical wellbeing, menopause symptoms can also affect us mentally and emotionally. However, it doesn't have to be this way.
Both DePree and Peoples stress the importance of being proactive with our habits in our younger years, in preparation for perimenopause and menopause. Often though, our 30s and 40s are filled with responsibilities that make it difficult to put ourselves first.
"Most people go into menopause having not set themselves up for success, and now they have to try to fix everything," said Peoples. "That's why I love it when I have a new patient consult with someone who's just starting the transition, because we can talk about what's coming and what proactive steps they can take."
These include: Drinking adequate water every day; limiting caffeine, simple carbs and sugars; adopting a healthy diet, such as plant-based or Mediterranean; and engaging in regular exercise, including weight bearing. And, prioritizing sleep.
TO HRT OR NOT HRT?
Here's where things get interesting. For years, there's been a belief that hormone therapy could cause more harm than good, and thus, many doctors and patients have avoided it. This notion surfaced thanks to results from Women's Health Initiative trials that suggested it could cause a greater risk for certain diseases. Over time, we've learned this caution might not be warranted, and that for healthy women without contraindications, it can be a valid option. And now, there's also a non-hormonal medication available that effectively addresses VMS, called Veozah. For those reluctant to try hormone therapy, or can't, this is an exciting solution that both DePree and Peoples support.
NEXT STEPS ...
Even as we enter a new understanding of menopause and its treatments, our primary care physicians may not yet be in step. DePree and Peoples recommend seeking out a local Menopause Certified Specialist, who can be found via a practitioner search on menopause.org.
Allison Kay Bannister has been a West Michigan resident since 1987 and a professional writer since 2002. A GVSU alumna, she launched her own freelance writing business in 2017. Allison is a cookie connoisseur, word nerd, aspiring gardener, and metastatic breast cancer thriver who loves traveling in Michigan and beyond, and enjoys art, world cuisine, wine, music, and making homemade preserves.
This article originally appeared in the Oct/Nov '23 issue of West Michigan Woman.