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Getting on the same page: Definitions

This post is dedicated to Colleen D. who wrote to me last weekend about this section being one of her favourites in MOKITA: How to navigate perimenopause with confidence & ease.

There is a quote I love by Gloria Steinam that says, “The first challenge is not to learn, but to UNlearn.”

This speaks to me because I’ve learned through thousands of conversations that it is common for women to arrive at this phase of life relatively uninformed and unprepared for what it could mean. And for many of us, before we can adequately learn about what hormone changes to expect, how to navigate perimenopause, and how to be our own best health advocates, we must first UNlearn any of the myths or misconceptions we picked up—either consciously or unconsciously—about what menopause means.

Definitions are a very important part of learning about our own health and having effective, meaningful conversations. Using the correct language is so important in helping to clear the confusing and conflicting messages around menopause.

You might think that for a life phase that every woman experiences, education for perimenopause and menopause would be common, easy to access and straight-forward.

This is not the case. However, I am hopeful. As more and more women discuss their midlife health openly—and as more health professionals invest in their learning, share their expertise, and integrate their practices—perimenopause and menopause are being redefined.

Perimenopause is the transition from the reproductive years to menopause. Perimenopause can begin as early as thirty-five and as late as fifty-nine, and it can last from five to fifteen years. The prefix “peri” means “around.”

About ten to fifteen years before you reach menopause, your body starts giving you tiny hints that changes are coming. You may notice differences in your periods, including changes to the length, frequency, duration, or flow. If you had been keeping track, you would likely see that your length of cycle has changed from your early twenties to your mid-thirties. This occurs because maturing follicles produce less progesterone during each cycle, shortening the period of time when the uterine lining thickens in preparation for a fertilized egg.

As perimenopause begins, the number and quality of follicles diminishes to the point where not enough estrogen is produced to prompt ovulation, causing periods to become erratic—it’s the mirror image of what happens when a girl first gets her period. The closer you get to the end of your reproductive years, the more changes you may notice to the duration and flow of your cycle.

Nobody told me about this—I grew up assuming menopause was like a switch, and one day your period just turned off ! Isn’t it fascinating that there are ads on television for erectile dysfunction and urinary incontinence, yet women in perimenopause are often surprised (and frightened) when changes occur to their period.

Although there is tremendous variation in how women progress through perimenopause—no two women are alike—it is common, as this shift happens, for women to go six to ten months between periods toward the end. There is no way to tell in advance how this may unfold for you.

What you need to know:

  • Perimenopause and menopause are NOT synonyms for symptoms or suffering. Perimenopause is defined by your age and fluctuating hormones; not by symptoms.

  • Menopause is not an ailment nor a condition--therefore it does not have symptoms; it is merely one day on the calendar (the 12 month anniversary of your final period.)

  • So what do we call all the discomfort and disruption to our health, then?

    • That's a great question--and it is so important to name it. Any disruption to our health must be priority concern. Is it a symptom of estrogen fluctuating? Or a symptom of progesterone beginning to decline? Or is it stress? A nutritional deficiency? Something else? We have to find and treat the root cause. My fear in calling any disruptive experience a "menopause symptom" is that women will process that to mean "it is just something they must endure." This couldn't be further from the truth. In fact, by not addressing sleep disruption, brain fog, vasomotor symptoms, joint pain--we miss the opportunity to restore our quality of life NOW--as well as INVEST in our future heart, brain, bone & vaginal health.

  • 20% of women sail through this phase of life. 20% of women have their worlds rocked upside down by hormone imbalance. 60% notice mild-to-moderate changes, and smart, savvy women who want to prioritize their current and future health, take those changes as a signal from their body that it wants something--and choose to invest in their most important asset.

Menopause is one day—it could even be a day to throw yourself a party! Natural menopause is the twelve-month anniversary of your final menstrual period. Surgical menopause is the day your ovaries are removed surgically, also known as a hysterectomy. A partial hysterectomy is the removal of the uterus only, leaving one or both ovaries in tact—so, the woman will no longer have periods, but she has not technically reached menopause yet.

Why is this important? Some women are very focused on knowing the exact countdown and definition. However, the only critical reason to know when and if you have reached menopause is if you are making birth control decisions.

In April of 2018, I attended the World Congress on Menopause, where Dr. Tim Rowe shared new information in this regard. Previously, it was pretty much a blanket statement to tell women they could no longer get pregnant if they had gone twelve months without a period—even though we knew that the twelve-month deadline was set arbitrarily and that every woman is different. Now, the guidelines for birth control indicate that if a woman is less than age fifty at the time of menopause, she should use protection for two years post- menopause. If she is fifty or older at the time of menopause, she should use protection for one year post-menopause.

The final phase to define is post-menopause, which is everything that comes after your anniversary party.

The reproductive life phases are often drawn in textbooks and taught in medical schools as being “black and white.” This happens, and then this happens, and then this happens. The reality is that every woman’s experience is unique. Many women arrive in the Menopause Chicks Private Online Community unsure about what life phase they are at.

The term perimenopause was coined in 1996, so many of our mothers and grandmothers may have said “going through menopause” when they actually meant going through perimenopause, and the experiences that are associated with it. You will find that health practitioners still use this terminology, and it’s okay to clarify definitions with them when they do!

If you are curious, it might be helpful to draw your own timeline using these definitions.

For example, I got my first period at twelve, noticed the first sign of hormonal shift (boobs hurt, brain fog, period started to change) at thirty-nine, had my last period at forty-eight (after one ten-month “pause and restart”), and reached (and celebrated!) menopause at forty-nine.

Now, I am 54 and in the post-menopause phase of my life.

Many are surprised to learn just how new the term perimenopause is, and how little research actually exists on the subject. But this does help to explain how these terms can get misused—both socially and professionally. I’ve included some common mix-ups below.

PREmenopause Is Interchanged with PERImenopause I find the term PREmenopause is not really used very often, except when someone is actually talking about PERImenopause. Some books also refer to this stage as the “reproductive years,” but that can get confusing because you are still fertile during perimenopause. Watch for this, and seek clarification if you think the term is being used incorrectly. Most of what we talk about in the is indeed perimenopause.

Menopause Is Interchanged for PERImenopause This is common. I cringe when women tell me they have been told by their doctors that as long as they still have a period, it can’t be menopause. While technically this is true, this is outdated thinking and a disservice to women to ignore the importance of our health in perimenopause.

Menopause is interchanged fro POSTmenopause

Menopause is an umbrella or category term used to define a large span of years--let's say 35 and up. It's important to distinguish when a woman is in post menopause, because those are the years where estrogen has declined (in perimenopause, estrogen is generally high and progestersone is low) and when she most needs to prioritize her heart health, bone health, brain health and vaginal health.


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