When I turned 12 my aunt gave me a copy of Our Bodies, Ourselves; a pillar of the women’s health movement, this iconic guide has been ushering teens into puberty (and beyond) since 1973. I remember reading, in the book’s frank and fearless tone, that vulvas come in all shapes and sizes—this is normal—and a hand-held mirror is the best way to take a look and get to know yourself.
Now in my late 40s, I find myself seeking the fearless truth again, this time on the next pivotal change in my hormones—menopause.
Could This Be Menopause?
For many people around me, menstruation is winding down, and with it they are having a range of experiences. While some are waking nightly to ruminate at 3am, others find themselves on the verge of rage, tears or both, while others are soaking through pads and tampons at a rate they’ve never seen before.
But I’ve noticed, we all have one thing in common. Each of us wonders as we rage, or sweat, or stare into the dark, and very few know where to turn.
The menopause transition is associated with over 30 different symptoms, from bloating to painful sex to thinning hair. But the list is so broad and general, in many cases a person doesn’t know if their symptoms are related to menopause, other stresses in life, part of aging, or a sign of a health-related condition.
Experts suggest you see your doctor regularly during this time of life to track changes to your health and evaluate underlying risk factors for menopause-related health conditions, like osteoporosis or heart disease. And don’t be shy; share any and all bothersome symptoms, no matter how embarrassing or trivial they may seem.
But, here’s the problem.
When Should I See A Doctor?
My friend Louise, 50, was having new feelings of anxiety along with changes to her cycle, so she booked an appointment to see her family doctor. When she asked if her symptoms could be related to menopause, her doctor blew off her concerns, stating that “menopause is a new thing, so we don’t know much about it, because women used to die before menopause.” Shaken, but pressing on, she asked for a referral to a gynecologist with expertise in women’s health. Her doctor dismissed her request, “they won’t want to see you unless you’re taking out body parts” he said.
Louise is looking for a new doctor.
While some practitioners have experience managing patients through the menopause transition, many do not. So we need to be ready to advocate for ourselves.
What Is Menopause?
The word menopause actually refers to just one day—the first day of your last (or final) menstrual period. 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.
The terms perimenopause and menopause transition describe the time, usually about six to eight years, leading up to the last period. Technically 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 (hot flushes, mood swings, or leaky bladder, anyone?) all related to fluctuating, and overall dropping, levels of hormones in our body.
When Will I Be In Menopause?
Most Canadians reach menopause between the ages of 45 and 55, with an average age of 51. The final stage is called postmenopause; it starts with the final period and lasts for the rest of your life. Many women continue to experience menopause-related symptoms well into their postmenopausal years.
When people say they are ‘in menopause’, they are usually talking about the continuum of time around the last period. Some will say they are in menopause when they start feeling symptoms related to perimenopause, others will use it to mark the transition into the postmenopausal years.
Women’s Hormones Explained
We reach menopause when there are no eggs left in our ovaries capable of ovulation. Here’s how it works.
We are born with thousands of immature egg cells (or follicles) in our ovaries. They sit there quietly until puberty kicks off the monthly cycle.
Each month an egg is released from the ovaries (this is ovulation), and one of two things happens: the egg is fertilized and tries to implant and become a pregnancy, or, more often, it is not fertilized and is discarded along with the lining of the uterus (this is our period).
Behind the scenes, hormones (chemical messengers in the body) are running the show.
Here’s how it works. The brain tells the ovaries to prepare an egg for ovulation. The ovary starts producing increasing levels of estrogen. When estrogen peaks, the egg is released (ovulated) and the ovary starts to produce progesterone to support a pregnancy. But if there is no pregnancy, the progesterone drops, the lining is shed, and the cycle starts again.
This lasts from puberty until menopause.
Hormones In Menopause
As we enter our 40s, unbeknownst to us, the number of eggs in our ovaries starts to drop. It is a biological trigger that is not well understood, but we do know it is the beginning of a natural and normal transition out of the reproductive years.
First, we feel nothing, but over time, the quiet, steady decline of eggs is matched by fluctuating and overall dropping levels of estrogen and progesterone. Ovulation becomes erratic, cycles become irregular, and we start to experience symptoms related to the hormonal chaos inside us.
This when we ask ourselves, our friends, and our doctors, is this menopause?
How To Know If This Is Menopause?
The onset of perimenopause is stealthy. Between the busy phase of life (the 40s are notorious for demands on women from kids, parents, and careers) and a societally-driven denial about aging, most of us don’t know we are in the menopause transition until we are well into it. In a recent survey by the Menopause Foundation of Canada, 46% of women feel unprepared for (peri)menopause and 55% wish they had learned about it earlier in life.
The factors that impact when we start and how we experience the perimenopause years are complex and multifactorial. While genetic factors, like the timing of your mother’s menopause, play a role, so do lifestyle factors, such as smoking, along with many things we don’t yet understand.
This means, no one can predict when a person will start perimenopause, what type of symptoms they will experience, how much it will impact their quality of life, or, how long it will last.
But we do know it’s coming—natural menopause is a certainty for people with ovaries and a uterus. And we can be prepared.
Tips To Help You Prepare
These tips may help you feel more in control during this unpredictable period of life.
Track Your Period.
Whether you use an online period tracker, or a red dot on a calendar, like me, monitoring your cycle can help you feel more connected to and aware of important changes to your period. These details can be helpful to share with your doctor.
Know The Symptoms.
95% of women will experience menopausal symptoms. Check the list of potential symptoms so you know what to watch out for, you may be surprised by some. If you are experiencing new and bothersome symptoms in your 40s, it could be related to the menopause transition, and this is a good time to chat with your doctor.
Don’t Suffer In Silence.
For too long women have quietly and privately endured menopausal symptoms. If you have ever had a hot flush (or flash) in the middle of an important meeting, you’ll know this is no easy task. It’s also unnecessary. There are safe and effective hormone therapies and lifestyle tips that can help alleviate symptoms. Ask your doctor what might be right for you.
Be Aware And Proactive.
This is about our long-term health and well-being beyond menopause. Women need to know the drop in estrogen after menopause increases the risk for osteoporosis, heart disease, and genitourinary syndrome of menopause (GSM). These are serious health issues that have preventive strategies. Ask your doctor if you have any additional risk factors for these conditions and what you can do to lower your risk.
What Doctor Helps With Menopause?
Only a quarter of doctors will talk about menopause proactively, so don’t count on your doctor to bring it up. If you have questions, are experiencing symptoms, or just want to know what to expect, you may need to be the one to start the conversation. And if your doctor isn’t up for it, find a menopause practitioner* near you who can help guide you through the menopause transition and beyond.
*The North American Menopause Society (NAMS) publishes a list of Certified Menopause Practitioners if you need to find a doctor in your area to help you navigate this period of life.
North American Menopause Society (NAMS)
Menopause Manifesto, Dr. Jen Gunter
Menopause Foundation of Canada
MenopauseandU.ca, The Society of Obstetricians and Gynecologist of Canada