October 18 is World Menopause Day. Honestly, it feels a bit weird to have a day dedicated to a normal phase of life. However, as menopause is rarely discussed and is often treated as if it is a disease, awareness campaigns are definitely needed. So until the entire world can accept and accommodate menopause, we need to keep talking about it.
As a doctor who is now about five years into menopause, who discusses it daily in her medical practice, who reads about it regularly, and who has written a book on the subject, here are 10 things I wish everyone knew about menopause.
Menopause is the end of ovulation. A lot of people don’t really know what menopause is, medically speaking, so this is the best place to start our list. The majority of estrogen in the body is produced by the follicles (developing eggs) in the ovaries. When the follicles can no longer produce sufficient estrogen to signal the brain and the uterus to trigger menstruation, menopause has occurred. I am really proud of this video that I made with TED, which illustrates what is happening to your ovaries during menopause.
The last menstrual period signifies that menopause has started. Since we can’t immediately know if your most recent period is the last one or not, menopause officially starts one year after the final menstrual period. So the diagnosis is made in retrospect. The time leading up to menopause is known as the menopause transition, but some people may still know it by its older names of perimenopause or premenopause.
The worst symptoms are often during the menopause transition. Think of the menopause transition as puberty in reverse. During this time a variety of hormone levels go up and down, so it’s hormonal chaos. It is this chaos that is often the cause of a wide variety of symptoms, such as menstrual irregularities, hot flashes/flushes, and sleep disturbance.
The most common symptom of the menopause transition is menstrual abnormalities. Irregular periods, heavy periods, and skipped periods. By the time you are going 60 days between periods, your final period is likely less than three years away.
Blood tests are NOT needed to diagnose the menopause transition or menopause. This also includes saliva tests or urine tests, like the so-called DUTCH test. If you are 45 years or older, then medically-speaking menopause is not a surprise. Just as we don’t need a blood test to tell us if a 12 year old with a growth spurt and her first period is in puberty, we don’t need blood tests to tell us if a 48 year old woman with irregular periods is in the menopause transition. If your provider says you need hormone levels to “see where you are,” or to manage your menopause transition or menopause, get another provider.
Menopause is not a disease of estrogen deficiency. First, menopause is not a disease, it is a normal phase of life. The evolution of menopause is fascinating and can be explained through something called the Grandmother Hypothesis. We have menopause because for our ancestors, having another pair of experienced hands who weren't themselves encumbered with childbearing and rearing was useful. When you have more help, you can have more children. You can learn more about the Grandmother Hypothesis in the episode of my podcast, Body Stuff, that is about menopause (click here). Secondly, menopause isn’t a state of estrogen deficiency any more than being a child before puberty is a state of estrogen deficiency. We expect estrogen levels to decline with menopause, but the term deficiency implies disease. In addition, menopause is much more complex than estrogen levels. In fact, estrogen levels don’t predict many of the symptoms of menopause and other hormones may actually drive some of the changes that are experienced. Basically, it’s a complicated physiologic process.
Brain fog is a common experience, but it is not a sign of neurological decline. Brain fog is a term used for temporary changes in memory and cognition that typically occur during the menopause transition. The actual cause of brain fog is unknown, but it is not related to hormone levels. Hormones also don’t treat brain fog, this has been well studied. You can read more on brain fog here.
Menopause does raise the risk of some medical conditions. Osteoporosis, heart disease, and dementia are three of the biggest ones. The earlier your menopause, the greater the risk. On the flip side, the later the menopause the greater the risk of breast cancer. Knowing that you are at increased risk for these conditions allows you to be more proactive with your health.
Estrogen is not a panacea. There are some providers who will tell you that estrogen is the answer for every symptom in menopause, and even go so far as saying menopause hormone therapy or MHT is “essential” for every woman. That is untrue and not supported by the science or the guidelines of every major medical society invested in menopause. Estrogen can help with hot flushes/flashes, with sleep disturbance due to hot flushes/flashes, for low mood in the early menopause transition (not moderate or severe depression), and in the prevention of osteoporosis. Vaginal estrogen can help with a variety of symptoms and conditions related to menopause, such as pain with sex and recurrent bladder infections. But there are also other therapies that can help for those who don’t like the idea of hormones or can’t take them.
If you can only do one thing for a healthy menopause, pick exercise, and don’t forget resistance training. All of the medical conditions linked with an earlier menopause are reduced with exercise. I’ll also add a 10b, as an equally important point is to get educated from reliable sources. In addition to my book, The Menopause Manifesto, and the articles you find here at TheVajenda I also recommend reading Menopocalype, by Amanda Thebe (and she is totally worth a follow on Instagram, click here) and also checking out the North American Menopause Society website (click here). Dr. Annice Mukherjee, an endocrinologist, is also a great follow on Instagram (click here)
Stay Tuned for 10 Things I Wish Everyone Knew About Menopausal Hormone Therapy!