Menopause and Perimenopause: Your Guide to the Menopause Transition  

What is Perimenopause and Menopause? 

At birth, a woman’s ovaries contain 1 to 2 million dormant eggs. As puberty approaches, the hypothalamus in the brain releases hormones that trigger the awakening of these eggs and puberty. Throughout our reproductive years, estrogen, progesterone, and other hormones engage in a finely tuned and dynamic interplay, orchestrating the body’s complex reproductive processes so that each month an egg and the lining of the uterus mature.  

As we age the number, quality and sensitivity of these eggs to estrogen drops and this interplay becomes erratic and unbalanced. The menopause transition, also called the perimenopause, is a period of hormonal upheaval, similar to puberty. When estrogen levels eventually stabilize after the menopause, they will settle at much lower levels than before.  

Estrogen experiences the most significant decline of all the hormones affected during menopause, driving many of the challenging symptoms associated with this transition. Progesterone also drops significantly, while testosterone decreases more gradually and continues to be produced in smaller amounts by other glands in our bodies. 

Menopause (literally the ‘ceasing’ of ‘monthly’ periods) is a single point in time, 12 months after a woman’s last menstrual period.  

Perimenopause or menopause transition is the period of time leading up to menopause, and it can last anywhere from one to 10 years, the average being around 5 years. Unfortunately, there are no current reliable or helpful tests to diagnose perimenopause. Hormones blood tests can be done (such as FSH); however, studies show that this is unreliable as during the perimenopause our hormones can yo-yo widely and may look normal some months and abnormal other months. I think this can be both confusing and challenging for women. Wouldn’t it be helpful if we were given the head’s up from a blood test saying ‘Hey, you are entering perimenopause! Those symptoms that are bothering you could be from hormonal chaos!’ Because there is no reliable test currently it is really important for us as women to understand what the symptoms of the perimenopause are and how to get relief, look after ourselves, and seek help when needed. There are also conditions that can mimic the perimenopause and that can be picked up and diagnosed through blood work or other tests (such as hypothyroidism, autoimmune conditions, arthritis, sleep apnea etc.). This is where seeing your doctor and working through it together can be very helpful.  

What age do Perimenopause and Menopause occur at? 

The average age in Canada for perimenopause to start is in a woman’s mid 40s. The average age range that most women experience menopause is between 45 and 55, with the average age being around 51. 

But we are not all an average! 

Premature menopause, defined as menopause before the age of 40, develops in 1-2% of women. Premature menopause is also referred to as premature ovarian failure (POF) or premature ovarian insufficiency.  

Early menopause is when the final menstrual period occurs between ages 40 and 45.  

Women who experience premature or early menopause need extra care to ensure optimal future health and should definitely be in the care of a doctor. 

Late menopause is when the last menstrual period occurs between ages 55 and 60. 

What are the Common Symptoms of Perimenopause and Menopause? 

During perimenopause, your ovaries produce less estrogen, it is the estrogen shift that is at the root of many of the symptoms that women experience. Estrogen receptors are found throughout the body, including in the brain, heart, bones, and vagina. The decline in estrogen affects not just the reproductive system, but also a woman’s overall health.  

Although we often think of irregular periods and hot flashes it is brain fog that women report as the most bothersome symptom affecting quality of life in perimenopause and menopause (link to brain fog and mood disorder resource). 

Most common symptoms 

• Brain fog mental fuzziness, forgetfulness, and difficulty concentrating – impacting concentration, memory, and the ability to multitask. 

• Hot flashes and night sweats: These are what we call vasomotor symptoms – sudden feelings of intense heat that can leave you sweating and uncomfortable. 

• Irregular periods: Your periods may become shorter or longer, heavier or lighter, and you might skip periods altogether. 

• Sleep disturbances: Many women experience difficulty falling asleep or staying asleep during perimenopause and menopause. 

• Mood changes: You might feel more irritable, anxious, or even depressed. 

• Vaginal dryness: As estrogen levels decline, the tissues of the vagina can become thinner and drier, which can cause discomfort during intercourse. 

Other symptoms 

• Hair loss or thinning, or changes in hair texture 

• Heart palpitations 

• Weight gain, bloating, and constipation 

• Urinary frequency, urgency, and infections 

• Joint aches and pains 

• Itchy ears 

• Dry skin 

• Accelerated facial aging 

• Tactile sensitivity 

Menopause – Symptom Relief and Thriving 

Lifestyle Changes: 

• Exercise is our superpower: Regular exercise for our physical and mental health is incredibly beneficial during menopause. Incorporating 30-60 minutes of moderate-intensity activity 5 days of the week is a great target to work towards. Cardio and strength training help reduce stress, support bone density, improve muscle mass, metabolism, balance, energy and mental wellbeing.  

• Eat a healthy, balanced diet: Focus on whole foods like fruits, vegetables, lean protein, and whole grains. Limit processed foods, sugar, nutrient-poor carbohydrates and unhealthy fats. 

• Prioritize sleep: Getting enough restful sleep is so important for mood, energy, and cognitive function. If you are suffering from hot flashes or other causes of poor sleep, you may need some help to be able to achieve this. 

• Explore healthy ways to manage stress: Stress can exacerbate many menopausal symptoms. Everyone has a different way to truly relax, making time for ourselves and giving ourselves the support and care we need is the first step. 

• Quit smoking: will improve health and menopause in so many ways. It is never too late to be worthwhile.  

• Limit alcohol intake: Alcohol reduces sleep quality, worsens hot flashes, contributes to unwanted weight gain and mood swings. Reducing alcohol can bring lots of physical rewards, increased energy and improved mood. 

• Cognitive Behavioral Therapy is another great option—it’s a type of talk therapy that can help you manage anxiety, sleep problems, and mood swings. 

Hormone Therapy: 

For the treatment of hot flashes and night sweats, menopause hormone therapy (MHT) is the most effective treatment. Hormone therapy is a safe and effective option for many women when it’s started within 10 years of menopause and under the age of 60. It also has other benefits such as improving bone health. Hormone therapy can also be used topically in the vagina. Talk with your doctor to determine if hormone therapy is a suitable option for you. Together, review your symptoms, risk factors, and goals to create a personal plan that is right for you. (Link to article on MHT to learn more). 

Non Hormonal Medication: 

There are effective non-hormonal treatments available for many menopausal symptoms. Gabapentin, a medication commonly used for nerve pain, can reduce hot flashes. Anti-depressants (SSRIs and SNRIs) can be used both for mood problems and hot flashes. The medication options depend on the most bothersome symptoms. (link to MHT article and GSM articles). 

Resources: 

Websites scientifically based information for patients 

The Menopause Society 

The Canadian Menopause Society  

Menopause and U  

Menopause Foundation Canada 

Informative booklets  

Canadian Menopause Society – Menopause Treatment Options 

Canadian Menopause Society – Bioidentical Hormones 

Canadian Menopause Society – 12 myths about menopause 

Canadian Menopause Society – FAQs about the menopause 

Canadian Menopause Society – Vaginal atrophy -when sex hurts 

Canadian Menopause Society – Treating osteoporosis with bisphosphonates 

Podcasts on the Health and the Menopause  

Aging Powerfully with Melisa Grelo 

Health by Dr Heather Hirsh 

The Doctor Louise Newson Podcast 

Books 

Menopause Manifesto by Jen Gunther 

The Vagina Bible by Jen Gunther 

Thrive through the menopause, a medical doctor’s holistic whole-body approach enabling you to live your best life by Daniela Steyn 

Unlock your menopause type: personalized treatments, the last word on hormones and remedies that work By Dr Heather Hirsh 

YouTube 

Dr Jen Gunther, Canadian born OBGYN, well-known author and speaker on women’s health, explains the menopause in a 5-minute TED talk. 

Dr. Nese Yuksel, pharmacist and president of the Canadian Menopause Society discusses evidence-based information on perimenopause, menopause and post-menopause. Menopause what you need to know. 

Apps 

Balance is an app by UK based menopause specialist Dr Louise Newsom. You can track your symptoms and learn about menopause. 

Instagram 

Three female Canadian MDs champion aging powerfully for women @ItsOurTimeCanada  

Dr Heather Hirsch midlife and menopause expert @heatherhrischmd  

Melissa Grelo @MelissaGrelo and @AgingPowerfullyWithMG 

Dr. Jen Gunter @DrJenGunter 

Dr Shafeena Premjii @drshafeenapremjii  

Some light relief on Instagram with Baroness von Sketch Show. 

Disclaimer 

It is important to note that the information provided here is general in nature and should not be considered a substitute for personalized medical advice. It is essential to consult with a healthcare provider to discuss the best treatment options for you based on individual circumstances and medical history.