So, you may wonder: Am I going through menopause? It’s a good question because the menopause transition doesn’t come knocking at the door, saying, “I’m here!” It creeps up. And it just so happens to come when, for so many women, there are a host of other life changes going on.
Feeling out of sorts? From a medical perspective, midlife mood swings happen because of hormone deficiency. Hormone changes do play a part. But not so fast.
What if you’re flat-out exhausted from being stretched too thin? What if your partner’s health has tanked and you’re losing sleep, wondering how to make ends meet? Or what if being irritable or blue is your body’s cue to slow down and nurture yourself?
Having hot flashes, night sweats, forgetfulness, putting on weight or belly fat? From a medical perspective, these are ‘classic’ symptoms of menopause. But men experience these in midlife, too.
In truth, none of the markers of menopause are unique to this transition, or even to us as women. Our lives are complex. Our bodies are, too. So, how do you know you’re going through menopause? How do you make sense of the subtle and not-so-subtle changes you may be experiencing?
The Changing Hormone Landscape of Midlife
Let us offer you a glimpse at a roadmap that may help you find your way through this transition.
In actuality, the menopause transition starts well before we have any inkling about it. Ovaries begin to change in our late thirties or early forties, bringing about shifts in sex-hormone production. It’s the balance of hormones that orchestrates the rhythm of monthly cycles.
During perimenopause, the balance tilts. Estrogen can get pretty erratic for a handful of years, wavering up and down with no apparent rhythm before it finally declines. Progesterone tends to drop fairly early on. Menopause symptoms come about because there’s a change in the balance.
Also, because sex hormones are intertwined with so many functions across the body, the changing hormone landscape brings about changes elsewhere. What we notice going on in our bodies can tell us something about where we are in the transition.
When estrogen levels are high relative to progesterone, you may have heavy bleeding or painful periods. Your breasts may feel tender and get lumpy. These symptoms are often the first to appear in perimenopause.
When estrogen levels are low, you may feel achy, foggy-headed, or spacy. Hot flashes and night sweats also point to declining estrogen. Vaginal dryness and painful intercourse are symptoms of low estrogen, too. These symptoms tend to appear in the later phases of perimenopause, closer to menopause and after.
When progesterone levels are low, you may feel jittery, anxious, edgy. You may feel restless or blue and struggle to sleep. You may notice these changes early in perimenopause, and they may continue for a while until the body adapts. Many women with low progesterone feel like they have PMS all the time.
When testosterone (yes, women have this hormone, too) levels decline, libido diminishes, as do energy levels and motivation.
The Most Common Symptoms of Menopause
Here is a list of the most common menopause symptoms women experience during or after menopause:
- Changes to the menstrual cycle – the span between periods changes; breakthrough bleeding; heavy bleeding, irregular periods, longer or painful periods. Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start again for a few months.
- Weight gain, even though nothing has changed about your eating habits or activity levels
- Fat migrating to the waist
- Moodiness, feeling blue, agitated, cranky, out of sorts, worsening PMS
- Difficulty falling asleep or staying asleep
- Hot flashes, night sweats
- Lower libido, vaginal dryness, painful intercourse
- Urinary symptoms, urinary incontinence – leaking, especially during coughing, sneezing, laughing
- Forgetfulness, foggy-headedness
- Fatigue, exhaustion
- Bone loss, Achy muscles, joints; headaches
- Tender, swollen, or lumpy breasts
After menopause, your risk of certain medical complications can also increase. This isn’t to say they will, but it is important to have an understanding and awareness of the following:
Osteoarthritis is a prevalent form of arthritis. Some call it the “wear and tear” arthritis or degenerative pain disease. Osteoarthritis can happen on the hips, hands, and knees. Hence the name knee OA.
When osteoarthritis affects the system, the cartilage starts to experience significant damage. The body becomes prone to breakdown and inflammation, eventually leading to loss of cartilage in the joints. The longer you remain immobile or inactive, the bigger the risk for cartilage damage.
These bone changes happen slowly and worsen with time. That’s why this form of arthritis can cause swelling, stiffness, and pain.
During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
As a result of symptoms such as vaginal dryness, a low libido and painful intercourse, you may find sex less pleasurable. Genitourinary syndrome of menopause (GSM) is a chronic condition that affects the vagina, vulva, and lower urinary tract. It can cause vaginal burning, itchiness and dryness as well as bleeding during and after sex.
Vaginal atrophy is the thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. It frequently affects menopausal and postmenopausal women, resulting in painful intercourse. Water based lubricants can be of some benefit if you are experiencing this condition. It is also important to be open with your partner and discuss changes to your sex drive, which are natural are normal.
When your estrogen levels decline, you risk of cardiovascular disease increases. Heart disease is the leading cause in women as well men. So what can we do about it? Well there are steps everyone should take. Enjoying a regular exercise routine with some form of cardio or a brisk walk every day; eating healthy foods high in fiber and low in saturated fat, maintaining a health weight, managing stress, and limiting alcohol and smoking.
How Do I Know When I Reach Menopause?
Women reach menopause when a whole year has passed since last menstruating, for no other reason than that you’re getting older. That one-year mark is menopause.
Your body provides the best clues about where you are in the transition.
First, menstrual cycles get shorter. Closer to menopause, they get longer. Eventually, they stop altogether. The closer you are to 50, the more likely you are to have changes to your monthly cycle.
By age 55, almost all women have transitioned through menopause. The truth is there’s no one-size-fits-all experience with this transition. The best way to know if you’re nearing menopause is to pay attention to a combination of factors:
- Advancing age [51 on average; as early as mid-forties]
- Gradual changes in the length of the menstrual cycle – say from 28 days down to 21, and later, upwards of 35 days; later still, months between periods
- How you perceive what’s going on, meaning: do you feel your body is going through this change? The most reliable marker for the onset of perimenopause is whether or not you feel like you’ve started the transition.
- And then, any menopause symptoms you have and whether those symptoms are changing.
As unscientific as this may sound, it’s a feeling thing.
If that sounds confusing to you, you’re not alone. You know where you are by how you feel in your body. That takes a bit of trust in your body and a quality of listening to her cues. Medicalizing this passage can make us overly reliant on tests and less sensitive or attentive to the body’s messaging. Medicalizing menopause can also undermine trust in our body at a time that the body seems to be ushering us home to ourselves.
This does not mean it’s time to fire your healthcare provider! Instead, We hope this post encourages attention to the body, a self-assessment about how you relate with menopause and aging, and how you wish to navigate these years of your life. Getting clear about your personal preferences can guide conversations with your healthcare providers so that you make informed decisions that feel right to you.
Gateway to Vibrant Wellbeing
- What, if any, changes have you noticed that suggest where you are in the menopausal transition?
- What, if any, conversations might you want to have with your healthcare provider?