Perimenopause and Menopause: An Introduction

 
Over the last few weeks, we’ve received feedback from many of you, detailing your experiences, concerns and right now, your experiences and questions are focused on better understanding menopause and perimenopause. It’s clear there’s a significant appetite for evidence-based and accessible information about these transformative phases in a woman’s life – we have heard that in several posts:

“Getting proper medical care was among other challenges of perimenopause. During an initial consultation, I was brushed off and told this is all normal.  But if it’s so normal, why aren’t there more effective treatments tailored to our needs?”  

Especially because healthcare professionals are often not as up-to-date with menopause symptoms as they could be, or frequently dismiss what women are saying.  We see what many of you are saying in scientific literature. For example, in the UK, Respondents experienced an average of 10.7 menopausal symptoms, but only 47% of respondents felt they had the knowledge and tools to manage their symptoms. ¹

It is estimated that 1 billion women will be in perimenopause or menopause by 2025 – you are not alone.   

So, as a direct response to your feedback, we’re launching a series that delves into the world of women’s health, starting with this post on menopause and perimenopause. Here, we introduce perimenopause and menopause – and over the next few weeks we will do a deep dive into specific topics looking at the latest research and what experts suggest as solutions.

To address the need for easy to access information, we are committed sifting through the academic literature and consulting experts in the field. Our goal? To bring plain language explanations and insights straight to you – whether those are about the challenges of perimenopause and menopause or the latest products from femtech or new research findings that could enable the development of better treatments that address women’s needs. Whenever possible, we will cite the research we reference, to ensure transparency and trustworthiness. That said, we recognise that there is a huge gap in data for women’s health and that many potential solutions remain untested.

Furthermore, we recognize that while there’s a wealth of technical podcasts and academic articles out there, they might not be easily digestible for everyone. So, we pledge to ‘translate’ these resources, turning them into easy-to-understand and actionable posts for our audience.

What will we cover in this post to understand menopause and perimenopause?

1. What are Menopause and Perimenopause?
2. The Timeline of Menopausal Transition.
3. Average Age of Menopause Onset: Global and Ethnic Differences
4. Most Common Symptoms of Menopause.
5. Impact of Menopause on Quality of Life and Productivity.

What are Menopause and Perimenopause?

To understand menopause and perimenopause we need to look at both separately. Menopause is a natural process that marks the end of a woman’s reproductive years, characterized by the cessation of menstrual periods for a year or longer. While often dubbed the “change of life,” menopause is more than just the cessation of menstruation; it involves a spectrum of physical, emotional, and hormonal changes.  At the heart of menopause lies the decline of hormones produced by the ovaries: estrogen and progesterone. As a woman ages, her ovaries gradually decrease hormone production, which triggers the various symptoms associated with menopause.

Perimenopause is the transitional period leading up to menopause. This phase can last for several years, possibly up to eight years, and is marked by hormonal fluctuations and varied symptoms, as the body prepares to enter full menopause.

The Timeline of Menopausal Transition

Menopausal transition is typically divided into three phases:

Perimenopause

This begins several years before menopause when the ovaries gradually produce less estrogen. It lasts up to the point of menopause, which is the moment menstruation stops completely. This phase can start in a woman’s late 30s or early-to-mid 40s and usually lasts for about 4 to 8 years.

Menopause

Officially starts when a woman hasn’t had a menstrual cycle for 12 consecutive months. It’s a point in time and typically occurs around age 51 ².  In the UK, about 10% of women can have an early menopause (below 45) and 1% can have premature ovarian insufficiency (below 40).

Postmenopause

The years that follow menopause. This phase can last for the rest of a woman’s life. However, many years after menopause, it has been observed that there may be a further decline in levels of Follicle Stimulating Hormone (FSH) in very old persons. ³^,4

Average Age of Menopause Onset: Global and Ethnic Differences

Globally, the average age for menopause onset is around 51 (Gold, 2011). However, these figures can vary considerably based on genetics, health, and environmental factors. Some ethnic and racial groups might experience menopause earlier or later than others. For instance, African and Hispanic women tend to reach menopause slightly earlier, while Asian women often experience it later than the global average. It’s essential to remember that individual experiences can vary widely within these general trends.

Understanding Menopause and perimenopause – common symptoms

To understand menopause and perimenopause we need to look at the most common symptoms. These are outlined below and affect more than 80% of women and are severe in about one-third of these women.⁵ However, we still do not have enough data and evidence on just what women are suffering during perimenopause. The experiences are so varied and there is really little understanding of what causes such differences between women.

Hot flashes

These are one of the most common symptoms of menopause estimated to occur in 75% of women. The sudden sensation of extreme heat in the upper body, particularly the face, neck, and chest is referred to as a “hot flush.” Flushing, chills, clamminess, sweating, anxiety, and occasionally palpitations. Typically, hot flashes last for 1-5 minutes and are most prevalent in the late menopause transition stage. However, some women report chronic hot flashes that last well past the onset of menopause.

Vasomotor symptoms (VMS), more commonly known as hot flashes and night sweats, are the most common symptoms of menopause. About 4 out of 5 people who go through menopause get vasomotor symptoms.

Night sweats

Hot flashes that occur at night, leading to disrupted sleep. The knock-on effect of sleep deprivation is profound, and has a further impact on hormone production.

Mood changes

This can include mood swings, depression, and anxiety.  The prevalence of moodiness, or depressed mood is variable but estimated to range 19% to 34% between late reproductive stage and menopause. 6

Vaginal dryness

Resulting from decreased moisture production, between 3% and as high as 32% of women experience this. Vaginal dryness get significantly worse in late menopause transition and most common 2 years post-menopause. 6

Weight gain

During menopause, there is an increase in fat mass and a decrease in lean muscle mass.⁷   Key body shape changes include an increase in belly fat.⁸  Additionally, medications used to combat the hormonal and physical changes of menopause in women, such as antidepressants and hormone treatments, have been shown to promote considerable weight gain. ^9,10,11

Thinning hair and dry skin

 Skin cells produce sex hormones like estrogens and so, in when changes in hormones occur during perimenopause, that affects skin, and hair ¹²

Tell us more about the symptoms and experiences you have had. This would enable our community to better understand menopause and perimenopause and we can advocate for better solutions and treatments to address women’s health needs.

Understanding menopause and perimenopause impacts on Quality of Life and Productivity

Menopause can significantly impact a woman’s daily life – from coping with physical symptoms like hot flashes to managing emotional effects like mood swings, these changes can be challenging. This doesn’t only affect personal life but can seep into professional life, leading to decreased productivity, increased absenteeism, and a potential decrease in work satisfaction. Some of your posts describe the frustration you have with this situation:

To be honest, I’m pretty angry and annoyed that there are no easy answers for women’s health. I’m mid-thirties and still struggling to be productive for nearly a quarter of my year. It seems insane in 2023 that this is the case. I’m really tired of women’s pain being trivialised as ‘normal’.

A study published in April 2023, put numbers on the cost of menopause in women to the workplace – in the US alone, an estimated $1.8 billion in lost work time per year and $26.6 billion annually when medical expenses are added. ¹³

While menopause is an inevitable part of a woman’s life, but understanding it better can help in navigating this transition more comfortably. In the posts to follow, we’ll delve deeper into each of these aspects, ensuring that you’re armed with knowledge and understanding as you or your loved ones undergo this change. Your feedback has been invaluable in shaping our content, and we thank you for guiding us on this journey of enlightenment and support.

References consulted for this post:

1. Huang DR, Goodship A, Webber I, Alaa A, Sasco ER, Hayhoe B, El-Osta A. Experience and severity of menopause symptoms and effects on health-seeking behaviours: a cross-sectional online survey of community dwelling adults in the United Kingdom. BMC Womens Health. 2023 Jul 14;23(1):373. doi: 10.1186/s12905-023-02506-w. PMID: 37452317; PMCID: PMC10347781.
2. Geukes M, Oosterhof H, van Aalst MP, et al. Attitude, confidence and social norm of Dutch occupational physicians regarding menopause in a work context. Maturitas. 2020;139:27–32.
3. Hall JE. Neuroendocrine physiology of the early and late menopause. Endocrinol Metab Clin North Am. 2004;33:637–659
4. Hall JE, Lavoie HB, Marsh EE, Martin KA. Decrease in gonadotropin-releasing hormone (GnRH) pulse frequency with aging in postmenopausal women. J Clin Endocrinol Metab. 2000;85:1794–1800
5. Avis NE, Crawford SL, Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am. 2018 Dec;45(4):629-640. doi: 10.1016/j.ogc.2018.07.005. Epub 2018 Oct 25. PMID: 30401547; PMCID: PMC6226273
6. Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005 Dec 19;118 Suppl 12B:14-24. doi: 10.1016/j.amjmed.2005.09.031. PMID: 16414323.
7. Greendale GA, Lee NP, Arriola ER. The menopause. The Lancet. 1999;353(9152):571–580. 1999/02/13/ [3]
8. Fenton A. Weight, Shape, and Body Composition Changes at Menopause. J Midlife Health. 2021 Jul-Sep;12(3):187-192. doi: 10.4103/jmh.jmh_123_21. Epub 2021 Oct 16. PMID: 34759699; PMCID: PMC8569454.
9. Stanford FC, et al., The association between weight-promoting medication use and weight gain in postmenopausal women: findings from the Women’s Health Initiative. Menopause, 2020. 27(10): p. 1117–1125. [PubMed: 32665534]
10. Reid R, et al., Managing menopause. J Obstet Gynaecol Can, 2014. 36(9): p. 830–833. [PubMed: 25222364]
11. Serretti A and Mandelli L, Antidepressants and body weight: a comprehensive review and metaanalysis. J Clin Psychiatry, 2010. 71(10): p. 1259–72. [PubMed: 21062615]
12. Zouboulis CC, Kosmadaki M, Roó E, Goldstein SR, Kosmadaki M, Roó E. Skin , hair and beyond : the impact of menopause. 2022
13. Faubion SS, Enders F, Hedges MS, Chaudhry R, Kling JM, Shufelt CL, et al. Women in the Workplace. 2023;1–13.