What is the menopause?
You might not feel like you need an explanation as to what the menopause is – you feel it in your bones, muscles, in body aches, dizzy spells, and mood swings – that’s the menopause, what more do you need? But truth be told, to really treat and best care for yourself during the menopause, it’s important to really know what’s going on. If you’re already fairly familiar with the menopause, use this as a refresher or share it with a friend who might not be too sure.
First thing’s first: the menopause actually only lasts one year. When people talk about the menopause, they’re often talking about the menopausal transition, i.e. the few years before, during, and after the menopause, in which you experience symptoms of the menopause. However, the actual menopause is defined as the 12-month timeframe in which you do not experience a period. After that year, you’re post-menopausal and before that year, you’re perimenopausal. Therefore, the menopause is a retrospective diagnosis.
As your ovaries stop releasing eggs, your estrogen levels will decrease.
So, what exactly happens? When you’re born, you have a finite number of eggs, which are stored in the ovaries, which also produce estrogen and progesterone hormones. Every month (starting with your first period), your body releases an egg. Eventually, as you age, your ovaries will stop releasing eggs (you might not necessarily “run out” – but the ones you have left won’t be fertile and won’t be released). As your ovaries stop releasing eggs, your estrogen levels will decrease. This process happens gradually and irregularly (which explains the irregular periods during perimenopause) until your ovaries completely stop releasing eggs for 12 consecutive months, and your estrogen levels stabilize at a new-low.
This drop in estrogen is why you feel the way you feel. In very simple terms, estrogen is responsible for making us feel good. When estrogen levels decline, our bodies get a bit out of function. For example, estrogen helps keep your skin clear and moisturised, your immune system functioning properly, your bones strong, your cholesterol regulated, and your body temperature controlled. Take estrogen away, and most of your body functions become unstable, which can explain many of your symptoms (dry skin, allergies, osteoporosis, body aches, fatigues, hot flushes, night sweats, etc etc). But it’s a bit more complicated than that.
Your symptoms are most severe during perimenopause, the years leading up to the menopause, because your estrogen levels are fluctuating (see Figure 2). It’s as if your body functions are in an on-again-off-again toxic relationship with your estrogen levels: one day everything is fine, and the next day it comes crashing down, only to come back up and down over and over again. After a few years, they break up, and your body functions get used to the low-levels of estrogen, meaning your symptoms eventually alleviate. In other words, it’s the fluctuation of estrogen on top of the depletion of estrogen that causes your body to act up. But wait, there’s more!
Your symptoms aren’t just caused by changes in estrogen levels, but by changes in the ratio between estrogen and progesterone levels in your body. As in Figure 1, at he menopause, there’s a relatively high level of estrogen compared to progesterone in your body. This imbalance is particularly responsible for symptoms such as mood swings, depression, anxiety, panic attacks, and headaches. Menopause research often focuses more on the effects of estrogen depletion without considering progesterone depletion as well, which might explain why some of these symptoms (particularly the mental-health symptoms) are not as understood.
There are plenty of different types and ways to take HRT, which is a completely individual choice…
Hormone Replacement Therapy (HRT) is considered to be the most effective treatment for the menopause, because it restores estrogen and/or progesterone levels. There are plenty of different types and ways to take HRT, which is a completely individual choice and depends greatly on your family history, your hormone levels, your risks, and your lifestyle choices. Additionally, there are plenty of alternatives to HRT that are worth considering to help alleviate symptoms (they don’t help restore hormone levels, but they can treat symptoms directly).
Finally, what can you expect? As explained in our article The Average Menopause, every woman experiences the menopause differently, but on averagethe menopause occurs at the age of 51, with perimenopause starting roughly around age 45. Symptoms on average last about 7 years and gradually fade in time, including hot flushes, vaginal dryness, night sweats, and anxiety.
In short, the menopause is really when your ovaries stop releasing eggs and your estrogen and progesterone levels decrease (at different rates). Everything you experience is a reaction to these changes in your hormones, and will eventually get better in time as your body adjusts to new, stable, low-levels of hormones. The menopause itself lasts a year by definition, but the menopausal experience lasts a lot longer than that. Ultimately, it’s important to know what exactly is happening in your body and why, so you can be well-informed when trying to tackle your symptoms. Again, every individual story is different, so there is no right or wrong way to handle the menopause! With that, do what you can to feel better and know that it will get better!
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