What is menopause? (And what is perimenopause?)
Menopause occurs because of the winding-down of the female cycle, as the hormonal system moves from its reproductive function to "maintenance" for the rest of your life. The perimenopause (the months and sometimes years before menopause occurs) and the postmenopause afterward bring on many changes in your body, mind, and emotions. In this section, you'll learn about:
- The female hormonal system
- Before menopause
- Natural or induced menopause
- Hormone shift at menopause
- After menopause
The female hormonal system
Even before you reached puberty, your body began to produce hormones, or chemical messengers that travel through the bloodstream. The pituitary gland in the brain produces FSH (follicle-stimulating hormone) during the first half of your cycle, and LH (luteinizing hormone) during the second half.
Each month, FSH stimulates the follicles in the ovaries, which contain eggs, to begin secreting estrogen into your bloodstream. For the next two weeks, the follicles grow, and one becomes mature enough to ovulate (release an egg). Once the follicle is mature, the pituitary gland cuts back on its production of FSH and produces a surge of LH, which causes the follicle to break open so that the egg can be released.
During the next two weeks, the empty follicle produces more estrogen, as well as progesterone, the other hormone essential to reproduction. Progesterone builds up the lining of the uterus into thicker and thicker layers, as a possible home for an implanted egg that might develop into a fetus.
If the egg is fertilized, it implants and begins to divide and grow. But most months, the unfertilized egg simply continues its journey through the bloodstream, the levels of estrogen and progesterone drop, and the lining of the uterus sloughs off in a menstrual period.
When you reach your early-to-mid forties, this cycle begins to slow down, and the hormonal system isn't as regular as it used to be. Perimenopause ("peri" means "time before") is a time when you can begin to learn all you can about your changing body and mind.
You may begin to experience the following symptoms of menopause:
- Your periods may become irregular, or you may find that it's harder to get pregnant.
- You may have your first hot flashes, as your hormonal system pumps harder in an attempt to keep stimulating the dwindling supply of eggs in your ovaries.
- You may have emotional symptoms, like moodiness or depression.
- You may experience a drop in energy and an increase in tiredness.
Natural or induced menopause
Menopause occurs when there are very few eggs left to be fertilized, and the output of estrogen and progesterone is so small that the eggs are not stimulated to ovulate. For most women, this happens in their early 50s.
For other women, some external event brings on menopause:
- Bilateral oophorectomy (removal of both ovaries) puts the body into menopause immediately, because there are no ovaries to produce estrogen and progesterone. A partial oophorectomy has a less severe impact on the body because only one ovary is removed.
- Hysterectomy (removal of the uterus) speeds up menopause by approximately 2-3 years.
- Chemotherapy for cancer or pelvic radiation may damage the ovaries so they can no longer produce hormones. However, some younger women who are treated for cancer may begin to menstruate and ovulate again.
Hormone shift at menopause
During ovulation, the pituitary gland pumps out a high amount of FSH to prepare the release of an egg from the ovaries. This high level of FSH signals the body to increase its production of estrogen to complete ovulation. Once ovulation has occurred, the production of FSH decreases until the start of the next reproductive cycle (see Fig. 1). For menopausal women, however, the body does not produce enough estrogen to complete ovulation, so FSH levels remain high (see Fig. 2).
When you have not had a period for 12 consecutive months, you have gone through menopause. After menopause, you no longer need to be concerned about birth control or having monthly periods. This is a milestone for every woman, and with all its inconvenience, it definitely has a plus side. It means you have passed through "the change", and are now ready to meet the challenges of the next half of your life - hopefully with more self-awareness and self-confidence than you had when you were younger!
It's common for women to spend decades taking care of everything and everyone but themselves - a husband, a boss, children, pets, a home - but this is a time for you to make a conscious choice to discover what it is you really want out of life. This is your moment to re-establish your principles, your priorities, and your passions.