An ode to the transitional years

The perimenopausal and menopausal years represent a watershed phase in a woman’s life.

Over my years in practice, I have become increasingly passionate about this particular area of medicine as it represents such a challenge for women going through so many confusing physical and emotional changes with most patients being uncertain as to what layer of their experience is hormonal and what is not. However, I believe that every challenge also presents an opportunity- this new phase of life can be an invaluable opportunity for health empowerment and personal growth- an opportunity to redefine who we are as women and establish our terms to live the lives we desire.

It is very normal for women to begin doubting themselves when hormones begin to change or to start to feel like they are going ‘crazy’ without realizing that their hormones have a deep connection to their brain and neurochemical processing -thus hormones impact emotion, mood and behaviour. By the time most women come to see me, they are also exhausted and overwhelmed by all the information out there, some of it being conflicting information too, which just adds to the confusion and challenge of this phase of life.

It is my hope, that we can help you navigate your way through this journey with a sense of understanding and empowerment so that you feel in control of your body again and that you can make the treatment decisions that are the best for you, armed with accurate information and supported in your uniqueness by us.

Please enjoy the series of blogs that will touch on and highlight some of the most important aspects of the peri and menopausal years both from a biological and emotional point of view.

A quick overview of Peri/ Menopause

Menopause, is a natural biological process of age and ovarian decline resulting in the loss of the main ovarian hormones- estrogen and progesterone, results in the absence of menstrual cycles and an array of symptoms attributed to the loss of these hormones.

In medicine, we say we can make the diagnosis of menopause when 12 consecutive menstruations have been missed and hormonal blood test can be used to confirm this. In reality, however, we wouldn’t necessarily leave a woman to suffer through symptoms whilst waiting to reach this so-called 1 year milestone and conversation around a women’s particular symptoms and management can begin much earlier.

Menopause can occur in a woman’s 40s or 50’s with an average age in the US as being 51 years old.

Most women and doctors are on the lookout for signs of menopause and the absence of menstrual cycles and commencement of hot flushes can be obvious pointers. However, signs of hormonal changes and imbalances can actually precede the menopause by as much as 10 years. During these years, symptoms can be far more subtle and often, hormonal changes are not adequately investigated or considered as causal factors.

Peri-menopause is the period of time preceding menopause and can vary in length form woman to woman. The hormonal patterns of peri-menopause can be very unpredictable- estrogen and progesterone levels can fluctuate greatly. Particularly, as a woman ages and her capacity to release mature or ripe eggs diminishes, the release of her natural progesterone that occurs after ovulation is also diminished. Against a backdrop of fluctuating estrogen levels, a relative imbalance of progesterone to estrogen (sometimes referred to as estrogen dominance) can ensue.

Common symptoms of the peri-menopause and estrogen dominant hormonal patterns can include heavy menses, tender and engorged breasts, weight gain, bloating (or that sausage-like feeling of water retention), night sweats, new anxiety and insomnia.

There are typically two stages to peri-menopause- early and late. In early peri-menopause hormone levels may fluctuate greatly- estrogen is usually being produced but progesterone levels may vary and begin to decline. In late peri-menopause, as the ovaries get closer to their ‘final act’ estrogen levels may also start to decline. Typical symptoms related to estrogen deficiency include vaginal dryness, hot flushes, dry skin, mood changes and loss of breast volume.

A metaphor that I often use to explain to process of transition from peri-menopause to menopause is to aliken the ovaries to the engine of a car. Prior to our 30’s the ovaries are like brand new engines and release our hormones in a balanced and rhythmical way (assuming there is no hormonal disorder in our younger years) gearing us up for a potential pregnancy and species survival with each cycle. As we age, our engines age too and as with a car, an engine can start to act unpredictably- stopping and starting until one day, it cuts out altogether.

From a purely biological and evolutionary point of view, once our reproductive function is over, marked by the end of the ovaries ability to produce estrogen and progesterone, our risk for a number of chronic health conditions like heart disease and dementia increases (this is due to the important roles hormones play in a number of different systems in the body, explored in the next blog) In a sense, this can be considered nature’s way of ‘picking us off’ since we no can no longer serve a ‘survival-of-the species function’.

I say (with utmost respect and fondness) ‘screw nature.’

We have the science and capability today to embrace preventative medicine and invest in our longevity and health like never before. Today we understand the role that hormones play in both maintaining health and function (think mood, sleep, memory and the ability to move your body) and indeed, protecting it for years to come.

Women have so much richness to offer the world and I believe that by keeping the vessel intact and in balance, a great deal of wisdom and experience can be shared with the world by our menopausal generations