What is Menopause?
We don’t know enough about menopause; even the term itself can be confusing – see below. And we know even less about perimenopause. Menopause and its related stages are under researched and underserved; most doctors receive little to no training. And we are often expected to just ‘get through it’. None of this is okay.
Dr. Wendy Wolfman is Canada’s menopause guru. She is the director of the Menopause Clinic at Mount Sinai Hospital, a professor of Obstetrics and Gynaecolgy at the University of Toronto, is President of the Canadian Menopause Society, and a board member of the International Menopause Society.
Dr. Wolfman recently spoke about the fact that medical schools are not teaching enough, if anything at all, about menopause and perimenopause, whether it’s the undergraduate curriculum, training for family doctors, and even OBGYNs.
Dr. Wolfman has worked tirelessly in her various roles to train more menopause practitioners, but the demand is huge; it’s a 2-year wait to get into the Menopause Clinic at Mount Sinai. As Dr. Wolfman stated on a recent CBC podcast called White Coat, Black Art:
‘Now it has to be women who push physicians and medical societies to change’.
We agree, Dr. Wolfman.
If we are going to push for, and achieve, the change we all deserve, we need knowledge. Let’s start with some definitions.
The word menopause actually refers to just one day – the first day of your final menstrual period.
The word menopause is also used informally to describe the entire menopause experience, as in ‘I am menopausal’ once the final period has been confirmed, or ‘I am going through menopause’ when you are still having a period, but your body is telling you that things are changing.
The tricky thing is, you don’t know your last period is your last period until 365 days have passed without one. People who have gone 12 months without a period are very unlikely to start having their period again. In fact if you experience vaginal bleeding after you’ve reached menopause, it’s important to tell your doctor, as it can be a sign of a health problem.
Most Canadians achieve menopause between the ages of 45 and 55, with an average age of 51.
Natural menopause is another term used for menopause when it occurs after 12 consecutive months without menstruation for which there is no other obvious physiological or pathological cause and in the absence of clinical intervention.
The term perimenopause describes the time leading up to the last period. Perimenopause also includes the one-year window after the final period.
This time leading up to menopause is when we face that long list of potential symptoms all related to fluctuating, and overall dropping, levels of hormones in our body. Most of us are surprised by these symptoms, particularly as perimenopause can start as early as age 35 and end as late as 59. Don’t panic; the average length of perimenopause is considered 6 to 8 years.
The menopause transition describes the time leading up the last or final menstrual period, but does not include the one-year window after the final period.
The term premenopause is interchangeable with the term menopause transition and describes the time leading up to the final menstrual period.
The final stage of the menopause experience, postmenopause starts with the final period and lasts for the rest of your life. Many continue to experience menopause-related symptoms well into their postmenopausal years.
The term menopause experience is used to describe all of the phases related to menopause.
When the final menstrual period occurs between the ages of 40 and 45, this is considered early.
There is an increased risk of cardiovascular disease, osteoporosis, and dementia associated with early menopause. Hormone replacement therapy can reduce some of these risks and should be discussed with a qualified medical provider.
Premature menopause occurs when the final menstrual period occurs before the age of 40.
There is an increased risk of cardiovascular disease, osteoporosis, and dementia associated with premature menopause. Hormone replacement therapy can reduce some of these risks and should be discussed with a qualified medical provider.
Surgical menopause refers to menopause caused by the removal of both ovaries.
This menopause occurs abruptly on the day of surgery. Treatment, which may include hormone replacement therapy, is usually required to manage menopause-related symptoms and also lower the risk of disease later in life.
The term induced menopause can refer to surgical menopause, and also refers to menopause caused by a medical treatment where certain drug and radiation therapies can damage the ovaries and cause menopause.