Not that long ago, the only term frequently heard to describe the end of women’s reproductive years was the catch-all ‘menopause’ (and not long prior to that, the only thing heard – if anything at all – was a hushed reference to the euphemistic ‘change’, with a capital ‘C’). Now, greater awareness and understanding has led to various similar-sounding terms entering the conversation: premenopause, perimenopause, menopause and post-menopause. These are sometimes referred to as the four stages of menopause, but what do they mean?
Premenopause and perimenopause are possibly the most confusing, as these phases both occur before menopause and the terms are sometimes used interchangeably. They are, however, distinctly different phases.
Premenopause
Premenopause refers to the reproductive years in between when menstruation commences (menarche), and the start of perimenopause. During this time, menstrual periods may be regular, irregular or a mixture of the two.
Hormonal variations are cyclical over the duration of approximately a month, corresponding to the periodic release of an egg (ovulation), and corresponding physical and mental symptoms vary on the same time frame. Symptoms such as cramps, fatigue, bloating and mood swings are common in the days leading up to, and during, the menstrual phase. Typically there is an increase of energy and strength around the time of ovulation.
The premenopausal age span encapsulates the most fertile years and extends from roughly the early teens to the early/mid-forties, with some individual variation.
Perimenopause
Perimenopause is the transition phase that occurs towards the end of the female reproductive life span, when the hormone levels that govern the menstrual cycle start to fluctuate in the lead up to menopause. It can last about 4 to 8 years. Menstruation still occurs but becomes increasingly irregular or erratic, with periods often increasing in frequency towards the end. Although ovulation may no longer happen every month, when it does occur pregnancy is possible and so contraception is still required.
For many women, these hormonal fluctuations cause physical, mental and emotional symptomssuch as hot flushes, sleep problems, mood swings and fatigue, to name a few. Not all women experience all of these, some may experience a few or none at all, and those that do experience them may not have them all at once.
Recent research has shown that perimenopause is the best time to start hormone replacement therapy (HRT) – should you want to – to minimize risks of cognitive decline later on.
Perimenopause typically starts in the early to mid-forties although in very few cases, women can experience early perimenopause in their 30s or younger. Some women may experience an early onset of perimenopause if they have had chemotherapy, a family history of early menopause or have had their reproductive organs surgically removed.
It is possible that abnormal menstruation can signify other underlying issues so if there is any doubt it is worth talking to your healthcare provider about your symptoms.
Menopause
Menopause is when menstruation and the reproductive life span ceases because the body is not producing sufficient hormones to maintain it. Ovulation has ceased forever, pregnancy is no longer possible and contraception is not required. Women are considered menopausal when a year has passed after their last period.
For many women, menopausal symptoms also cease around this time. However, for a small number, symptoms continue.
The typical age of menopause is 50-52 years, with some variation depending on ethnicity. Menopause before the age of 40 is considered premature.
Postmenopause
Postmenopause refers to the remaining lived years beyond menopause. Ovulation and periods have completely ceased and pregnancy is not possible.
Many women will experience an easing or ceasing of menopausal symptoms but some women will continue to experience the effects of low hormone levels. It is not unusual to experience the occasional hot flush. Some women may experience postmenopausal bleeding, which in most cases is benign. In about 9 per cent of cases it can indicate endometrial cancer, so it is important to get it checked by a healthcare professional.
At this stage cholesterol levels can increase, as can the risk of osteoporosis and cardiovascular illness, so it is important to maintain an active lifestyle with healthy eating.
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