How Do You Know When Your Starting Menopause

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How Do You Know When Your Starting Menopause

Women go through significant physical changes throughout their lives. What a woman’s body is capable of is extraordinary, and the way women adapt to change is even more extraordinary. In this series I focus on the changes in the body before, during and after menopause.

Average Age Of Menopause

As you know, menopause marks the end of reproduction for a woman. Menopause has different stages, and the whole process can take several years. Typically, women reach menopause in their 40s or 50s, but the average age in the United States is 51 (1). The stages of a woman’s life are as follows:

Perimenopause is when the symptoms of menopause appear. Women still have periods, whether regular or irregular. Women are also in their reproductive years. Although there may be hormonal changes in the body, they do not cause any obvious changes. Hormonal changes can begin 8 to 10 years before menopause, most often in women in their 40s, but can also begin in their 30s. I would like to start hormone testing in 35 year old women to make sure hormones are adequate. I would first check if symptoms or illness warrant it.

Perimenopause means “at or near menopause.” During this phase, women start experiencing symptoms of hormonal changes. The average length of the perimenopause phase is about four years. For some it may last only a few months, and for others it may last more than four years. It is still possible to get pregnant during this period.

Menopause is when a woman stops menstruating for 12 consecutive months. This happens when the ovaries stop producing eggs and also stop producing most of their estrogen. As mentioned, the average age of menopause is 51 years.

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Postmenopause – If more than a year has passed since a woman’s last menstrual period, she is in postmenopause. She will remain in this stage throughout her life.

The symptoms or challenges of perimenopause can be very similar to the symptoms or challenges of menopause or postmenopause.

Hormones play a major role in menopause. If you remember from biology class, hormones are chemical messengers that are secreted into the blood or other cellular fluids. They send messages to specific body parts or target sites telling those parts what to do. The five hormones central to menopause are follicle-stimulating hormone (FSH), luteinizing hormone (LH), gonadotropin-releasing hormone (GnRH), progesterone, and estrogen. Let’s review what the roles of these hormones are before we examine the challenges associated with hormonal changes.

Follicle Stimulating Hormone (FSH) – FSH plays an important role in regulating the menstrual cycle and stimulates the development of eggs in the ovaries. FSH levels fluctuate throughout the menstrual cycle, with FSH at its highest level just before an egg is released from the ovary.

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Luteinizing Hormone (LH) – LH helps regulate the menstrual cycle as well as release the egg from the ovary.

Gonadotropin-releasing hormone (GnRH) – released by the hypothalamus to stimulate pituitary release of FSH and LH.

Progesterone – Progesterone prepares the endometrium, the inner lining of the uterus, for possible pregnancy. This signals the lining to thicken to provide a suitable home for the fertilized egg. Progesterone also prevents the uterus from contracting, which causes the body to reject the egg. If pregnancy occurs, progesterone levels remain high, preventing ovulation. If pregnancy does not occur, progesterone levels decrease, allowing menstruation to continue.

Estrogen – Estrogen plays a major role in puberty and beyond. The primary source of estrogen comes from the ovaries, but the adrenal glands and adipose tissue also produce small amounts of the hormone. Estrogen is responsible for:

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As perimenopause and menopause begin, hormone levels may still appear somewhat normal. However, as a woman reaches the later stages of menopause, estrogen and progesterone levels decrease, while LH and FSH increase in an attempt to stimulate estrogen. FSH and LH will then remain high for the rest of the woman’s life.

2. Ovaries stop releasing eggs – this is a characteristic symptom of menopause. As you approach menopause, your periods and ovulation may become more irregular. At menopause, ovulation stops completely.

3. Ovaries Stop Producing Estrogen and Progesterone – Estrogen and progesterone are necessary to regulate menstruation and reproduction. With menopause, the ovaries stop producing these hormones. Estrogen now comes from the production of the adrenal glands and fat cells. A decrease in estrogen lowers the metabolic rate at which women use starches and carbohydrates. This can contribute to the weight gain that women experience in menopause.

4. Increased levels of LH and FSH – As the ovaries stop producing estrogen, there is no longer enough estrogen to suppress FSH, which can cause these levels to rise. The same applies to LH.

Signs And Symptoms Of Menopause

Along with these major body changes during menopause, women can face a variety of challenges, from classic hot flashes to mood swings to UTIs. In this article, I will provide an overview of these challenges so patients can understand what to expect. Find more articles in my menopause series to learn more about how to deal with these challenges.

Estrogen can strengthen the tissue of the urinary tract by strengthening the surface layer of the bladder. Due to the lack of estrogen in menopause, the lining of the urethra and bladder thins. This thinning allows the layers to become pockets for infection to progress, causing more UTIs to occur in the perimenopausal, menopausal, and postmenopausal stages. Women may experience dysuria or pain/discomfort during urination. However, I have also seen many menopausal or postmenopausal women with no symptoms of a UTI, even though a urinalysis reveals a UTI. These persistent UTIs gradually wear down the immune system, leaving these women prone to inflammation and more infections.

At the onset of perimenopause, a decrease in estrogen can cause the tissues of the vulva and vaginal lining to become thinner, drier, and less elastic. This is known as vulvovaginal atrophy. Women have less vaginal secretions and less lubrication. This can cause dryness, itching, irritation, burning and/or vaginal pain. Intercourse may be unpleasant or painful (3). Some women may experience it as early as perimenopause, while others won’t experience it until their estrogen levels drop, or possibly not at all. These symptoms may also refer to a bacterial or fungal infection of the vagina (an increased risk during menopause) or a UTI. I like to use all natural vaginal suppositories with women as we work to regulate hormones and other factors.

Low estrogen levels can also cause problems in the brain. All brain cells have receptors for estrogen, and low levels of estrogen cause a decrease in signaling to these brain cells. This can make the brain more susceptible to disease and dysfunction. More and more research is beginning to show a link between menopause and Alzheimer’s disease. Menopause can also cause headaches, mood swings, memory loss, depression and anxiety (4, 5).

Menopause And Perimenopause: The Basics

A hot flush is a sudden feeling of warmth, usually around the face, neck and chest. Women may also experience a fast heart rate, flushing (possibly including red, flushed skin), anxiety, and/or sweating during hot flashes. They usually last about 5 minutes. As the heat passes, there is a feeling of coolness. Frequent hot flashes or night sweats can cause long-term sleep disturbances. Although no one knows why hot flashes occur, it is suspected that low estrogen levels cause your hypothalamus (your body’s thermostat) to become more sensitive to slight changes in body temperature. If the hypothalamus senses that your body is too hot, it starts heating up to try to cool you down (6).

Low estrogen levels in menopausal and postmenopausal women are also associated with increased joint pain. You may find that previous joint injuries can start to hurt again, and you may feel pain in your joints overall. Although it is not fully understood, it is believed that estrogen reduces inflammation in the body. A lack of estrogen can lead to increased inflammation, leading to joint pain.

Along with menopause, hormonal changes can also cause weight gain. As I discussed earlier, the ovaries have stopped producing estrogen, and this hormone now comes from the production of the adrenal glands and fat cells, which affects women’s processing of starches and carbohydrates. This change in hormones has a big impact on where women gain weight. Before menopause, women with balanced hormones tend to gain weight around the thighs and hips in the form of subcutaneous fat. As hormone levels decrease during menopause, they gain visceral belly fat. Visceral fat does not produce as much estrogen and is more inflammatory.

Thyroid function can also decrease at this point in life, which can lead to weight gain. Hypothyroidism can share symptoms with menopause, such as:

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