Menopause is a natural biological phase in a woman’s life marked by the end of her menstrual cycle. When a woman goes through menopause, her body produces less of the hormones estrogen and progesterone. The ovaries also no longer release eggs, which means the woman can no longer become pregnant. Menopause is considered complete after 12 consecutive months without a menstrual period.

STAGES OF MENOPAUSE

The menopausal transition includes three main stages: perimenopause, menopause, and post-menopause. Some women may experience menopause earlier than expected, known as early or premature menopause.

PERIMENOPAUSE

Perimenopause refers to the transition to menopause and a woman’s last menstrual period. This transition can last two to eight years and usually begins during your late forties.

There are two stages of perimenopause: the early transition and the late transition. The early transition is characterised by menstrual cycles with few irregularities or interruptions, and the late transition involves periods of 60 days or more when menstruation is absent.

MENOPAUSE

Menopause officially occurs after 12 consecutive months of having no menstrual period, at which time the woman stops having periods permanently. This is a natural and expected part of a woman’s life. During perimenopause, the body begins producing less of the hormones estrogen and progesterone, and once menopause occurs, these hormones decline even further. The average age at which women experience menopause is 51, but the transition commonly occurs between the ages of 45 - 55 years old. This can differ depending on age, ethnicity, location, etc.

DO YOU KNOW?

The age at which your biological mother went through menopause may be a clue that you’ll experience it around the same time.

POST-MENOPAUSE

Post-menopause, which refers to the period after menopause, is characterised by the absence of menstruation and the inability to become pregnant. Although the body no longer menstruates during this time, menopausal symptoms such as hot flashes, trouble sleeping, and vaginal dryness may persist. Low estrogen and progesterone levels may also be associated with certain health risks during this time, such as osteoporosis, stroke, and heart disease.

If you experience vaginal bleeding post-menopause, speak with your GP right away. This could be a sign of a serious health problem and is not typical during this stage.

EARLY OR PREMATURE MENOPAUSE

For some women, menopause occurs earlier than average. If menopause occurs before the age of 40, it’s considered premature menopause, and if it occurs between the ages of 40 to 45, it’s considered early menopause. Women who were never pregnant may experience menopause earlier than women who were pregnant more than once. Early or premature menopause can also occur as a result of certain surgeries, health conditions, or medications.

The following reasons may contribute to early or premature menopause:

• Certain cancer treatments (chemotherapy or pelvic radiation)

• Certain health conditions (thyroid disease, rheumatoid arthritis, HIV and AIDS, chronic fatigue syndrome)

• Family history of early or premature menopause

• Missing chromosomes (Turner’s syndrome)

• Surgery to remove the ovaries

• Surgery to remove the uterus

Women who experience premature or early menopause usually experience the same symptoms as those who go through menopause. However, because these women will experience the post-menopause stage for longer, they may have a higher risk of certain health conditions associated with post-menopause such as heart disease or osteoporosis. They may also experience more intense menopausal symptoms in general, such as feelings of depression related to the early onset of these bodily changes.

SIGNS AND SYMPTOMS OF MENOPAUSE

Everyone experiences menopause differently, and symptoms of menopause may vary from woman to woman. Several factors may influence the type and severity of symptoms experienced, including:

• Activity level

• Body mass index (BMI)

• Ethnicity

• Geographic location

• History of anxiety and depression

• Medications

• Medical history

• Smoking status

DID YOU KNOW?

Menopausal hot flashes can be triggered by things like spicy food, alcohol, caffeine, a hot environment, or stress. Tracking your daily habits and hot flashes can help you figure out what triggers them and help prevent them in the future.

Vasomotor (temperature dysfunction), urogenital (affecting the urinary and genital tracts), and mental health-related symptoms are the most common types of symptoms that women experience during menopause.

Specifically, possible signs and symptoms of menopause include:

• Changes in menstrual cycles

• Changes in arousal, decreased interest in sex (libido), and/or difficulty achieving orgasms

• Difficulty maintaining bladder control

• Headaches or migraines

• Hot flashes

• Insomnia and sleep disturbances

• Irregular heartbeat

• Joint pain

• Mood changes

• Depression and anxiety

• Memory problems

• Feeling shaky

• Night sweats

• Pain during sex

• Skin flushing

• Vaginal dryness

• Weight gain

POTENTIAL COMPLICATIONS OF MENOPAUSE

During menopause, a woman’s hormone levels are changing. As a result, they may be at an increased risk of experiencing certain health conditions or symptoms, such as heart disease, osteoarthritis, urinary incontinence, and oral issues.

HEART DISEASE

Cardiovascular disease (CVD), also known as heart and blood vessel disease, encompasses different conditions related to the buildup of plaque in artery walls or the formation of a clot, hindering or blocking blood flow in the body. Although menopause doesn’t cause CVD, studies continue to investigate the relationship between the menopausal transition and the associated increased CVD risk.

The following factors may play a role in increasing the risk of CVD.

Menopause age: Compared to women who experience menopause after the age of 45, women who experience menopause before the age of 45 may have an increased risk of developing coronary heart disease (CHD). CHD is a condition in which plaque builds up in the arteries of the heart.

Type of menopause: Women who have undergone a bilateral oophorectomy (BLO) at an early age (less than 40 to 45 years), a surgery to remove the ovaries, with no accompanying estrogen therapy, may be at higher risk of developing CHD compared to women who experience menopause at an older age or had a BLO at an older age.

Menopause stage: Blood pressure and cholesterol levels may rise more significantly during the late perimenopause and postmenopause stages than during premenopause or early perimenopause.
Estrogen levels: Estrogen is a hormone that helps regulate the menstrual cycle. Estrogen also protects against CHD by regulating cholesterol levels and the buildup of plaque in the artery walls of the heart. When estrogen levels decrease during the menopausal transition, an increased risk of developing CHD or a stroke from the buildup of plaque in the arteries is possible. This relationship continues to be studied.
Hot flashes, sleep, and depression: Vasomotor symptoms (e.g., hot flashes and night sweats), poor sleep quality, and depression have been linked to a higher risk of CVD.

DID YOU KNOW?

As your bones break down more quickly after menopause, toxins stored in the bones throughout your life, such as lead, may be released into the blood and increase your risk of atherosclerosis, kidney dysfunction, and cognitive dysfunction.

Osteoarthritis

Osteoarthritis (OA), the most common form of arthritis, causes inflammation and pain as a result of the breakdown of cartilage between joints. OA is more common in women, with incidences of hand and knee OA increasing after menopause. It is believed that this is due to estrogen’s role in the maintenance of bones and joint tissues. Because the ovaries stop producing estrogen in menopausal and post-menopausal women, this can make them more susceptible to osteoarthritis during and after menopause.

Urinary incontinence

A decrease in estrogen levels may weaken the urethra (the tube that allows urine to pass out of the body) and contribute to urinary incontinence. Urinary incontinence is the loss of bladder control, causing urine to involuntarily leak. It is a common issue; with postmenopausal women having trouble holding in their urine.

Oral issues

Changes in hormone levels during and after the menopausal transition may lead to oral issues such as pain and inflammation of the gums (gingivitis), an increased risk of cavities, and a decrease in saliva production which can lead to a dry mouth and cavities.

How to feel your best during menopause

The menopausal transition will feel different for each woman. Some may have a positive and uplifting experience as they enter this new life stage, and others may struggle with many of the new and often challenging symptoms. Maintaining a healthy diet, exercising regularly, getting adequate sleep, supporting your mental health, taking hormone therapy (for some), and maintaining sexual health are strategies that can help you feel your best during menopause.

Diet

During the menopausal transition, maintaining a healthy, balanced diet is important and will help you feel better both physically and emotionally. Adequate nutrition is necessary for maintaining various bodily functions, including energy production, tissue formation, cognitive function, and immune function. A healthy diet provides adequate energy and essential nutrients to maintain optimal health. Studies evaluating diet quality as it relates to menopause indicate an association between a higher intake of vegetables, unprocessed foods, and whole grains, and a lower intensity of sleep disorders as well as mood changes, hot flashes, bladder issues, and physical symptoms such as pain during menopause.

Intake of highly processed foods (fast food, convenience foods) and sugars had also been associated with increased intensity of these symptoms. Based on your individual needs, a health practitioner like myself will recommend a tailored and specific type of diet just for you.

Exercise

Engaging in regular exercise can help prevent various chronic conditions and maintain muscle and bone mass as well as general strength. Participating in regular exercise can help you manage the physical and psychological changes that occur during menopause.

Exercise 30 minutes per day, five days per week. Types of exercise that may be helpful for menopausal and post-menopausal women include:

• Aerobic exercise (brisk walking, hiking, biking, swimming)

• Balance exercises (single-leg stands, squats, pilates)

• Resistance exercises (body weight exercises, banded exercises, weight training)

Sleep hygiene

Insomnia is a common symptom of menopause, and other symptoms such as hot flashes and night sweats can also cause sleep disturbances. Because sleep is essential for our body and brain to recover from daily activities, disturbances can impact quality of life and overall health.

Having good sleep hygiene can help you manage insomnia and minimise sleep disturbances. Sleep hygiene includes pre-bedtime practices that help create the most sleep-conducive environment and routine possible.

Sleep hygiene practices

Avoid or limit substance use: substances such as alcohol, caffeine, cannabis, and nicotine are all known to disrupt sleep and should be minimised or avoided, especially close to bedtime.
Create an environment suitable for sleep: Light exposure and noise can disrupt sleep and keep you awake. Using blackout curtains, a sleep mask, or sound-masking strategies such as a white noise machine can prevent unnecessary light and noise from disrupting your sleep. Keeping your room at a comfortable temperature can also help improve sleep.
Exercise regularly: Engaging in regular physical activity can help improve your sleep. Regular exercise has been shown to improve sleep in both healthy individuals as well as those who have chronic insomnia or experience regular sleep disturbances.
Have a consistent bedtime and wake-up time: Inconsistent sleep and wake times can disrupt your circadian rhythm, the daily patterns of sleep and wakefulness in your body. Sleeping and waking at the same time every day can therefore minimise sleep disturbances.
Minimise blue light exposure: Exposure to blue light from computers, phones, and TV screens near bedtime may prevent your body from producing adequate melatonin, a hormone that helps your body fall and stay asleep. Minimising screen use close to bedtime or using blue-light-blocking glasses may help to minimise the effects of blue light.

Mental health and stress management

During perimenopause, menopause, and post-menopause, women may experience worsening mental health or mental health issues for the first time due to fluctuating hormone levels and associated physical changes (hot flashes or trouble sleeping). During the menopausal transition, you may experience symptoms of:

• Cognitive impairment (memory issues)

• Depression

• Anxiety

DID YOU KNOW?

Women who experience high levels of anxiety before perimenopause are more likely to experience hot flashes during perimenopause.

Habits and practices that will help you feel your best during the menopausal transition will depend on your symptoms, unique health needs, and interests. Consider some of the following methods to help maintain your strong mental health during and after the menopausal transition.

Stay mentally active - take a class, learn a new skill, daily word puzzles, etc
Stay physically fit
Relaxation - self-care, epsom salt baths, reading, being in nature (see my Self-Care Course)
Join a group, a club or volunteer for a charity
Healthy diet
Menopause support group
Limit alcohol or remove
Reduce coffee intake

Lifestyle tips for addressing hot flashes

Hot flashes and night sweats can be uncomfortable and begin unexpectedly. Consider some of the following tips to help mitigate any discomfort during a hot flash: