Perimenopause and postmenopause: what are they?

Menopause is that time in a woman’s life when menstruation ceases and various hormonal changes occur. It signals the end of the reproductive part of a woman’s life. This normal, natural life event usually occurs between ages 40 and 58, with an average age of 51.

Menopause is defined as the final menstrual period and is confirmed after 12 consecutive months of no menstruation. However, the whole transition period, sometimes known as “the change”, can actually last for several years. This period is more technically called perimenopause, which translates to “around menopause”.

Perimenopause can last for 4 to 8 years, so that means that most women enter this life stage in their 40s. However, some women start to notice changes as early as their mid-30s. Perimenopause starts with variation in the length of time between periods and ends 1 year after the final menstrual period. So, although some people may consider perimenopause as the time prior to menopause, it actually includes the time of the last menstrual period (menopause) (1).

What changes occur during perimenopause?
Irregular menstrual periods occur in every woman during perimenopause. The time between periods can vary, as well as the length of each period, and the flow may be lighter or heavier. In some women, this is the only physical change that they notice.

Most women experience hot flashes–a sudden wave of heat usually in conjunction with sweating, skin reddening, and a faster heart rate. These hot flashes are severely problematic in about 1/3 of women, with some suffering from them for a decade or more (2).

Poor sleep is common during perimenopause. This is often due to hot flashes occurring during the night, known as night sweats (1). Depressed mood and increased anxiety are other relatively common changes during perimenopause (2).

Vaginal dryness is another common symptom, especially in the later stages of perimenopause (2). This can cause vaginal tightness during sex, along with pain or burning. Vaginal lubricants and moisturizers are often required to improve comfort during sex (1).

What hormonal changes occur during perimenopause?
The major hormonal changes are a gradual decrease in estrogen levels (although often in an irregular fashion), and increased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. These hormonal changes can all be detected in our Women’s Perimenopause Panel (E2, FSH, LH).

Postmenopause is the stage of a woman’s life after 12 consecutive months of no menstruation. The perimenopause symptoms described above usually occur for 1-2 years after menopause, but some women suffer from symptoms for 10 years or longer (2).

Are there any other changes that occur in postmenopause?
Two major hormonal changes that occur in postmenopause are very low levels of estrogen and progesterone. These hormonal changes can be detected in our Women’s Postmenopause Panel (E2, P4), and can increase the risk of various health complications in postmenopausal women, including (3):

• Heart disease. Before menopause, women make plenty of estrogen to help keep blood vessels in good health and maintain a healthy balance of “good” and “bad” cholesterol. However, in postmenopause, estrogen levels are a lot lower and the risk of heart disease increases.
• Stroke. Lower estrogen levels in postmenopause may also increase the risk of cholesterol build-up in the blood vessels supplying the brain.
• Osteoporosis. Low estrogen increases the breakdown of bone, which can lead to brittle and weak bones and an increased risk of bone fractures.
• Lead poisoning. The increased breakdown of bones also releases lead into the blood that has been stored in the bones over a woman’s lifetime. This lead can increase the risk of high blood pressure, atherosclerosis, kidney issues, and cognitive impairments.
• Urinary incontinence. Lower estrogen may weaken the urethra, increasing the risk of urinary incontinence.
• Oral issues. The risk of cavities and dry mouth increases after menopause.

References:
1. Menopause 101: A primer for the perimenopausal. The North American Menopause Society.
2. Santoro N. (2016) Perimenopause: From Research to Practice. J Women’s Health (Larchmt). 25(4):332–339.
3. Menopause and your health. Office of Women’s Health, U.S. Department of Health & Human Services. Updated September 2018.