No. There is a great deal of variability in the types and severity of symptoms. Genetics may play a role, so if possible, looking at your family history can help set your expectations for your own symptoms.

1. Dennerstein L, Dudley EC, Hopper JL, et al. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000; 96:351–358. [PubMed: 10960625]

 

Menopause is recognized to have happened after one year (12 months) without a period. You can also ask your healthcare provider to measure the blood levels of Follicle Stimulating Hormone (FSH) that rise during perimenopause and stay elevated during menopause.

1.http://www.menopause.org 2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

 

Genetic factors play a role in the timing of this transition, so if you are able, look to your family history to set expectations. Lifestyle quality and your general health will also contribute to the timing. However, there is a great deal of variability amongst women so it is impossible to predict with complete accuracy.

Make sure you have a supportive and knowledgeable healthcare provider who will give you annual health screenings who is pro- active about your concerns. Physiotherapists, psychologists, trained counselors, and nutrition experts can also help you manage your physical and emotional symptoms. http://www.menopause.org is a website that can help you connect with well- trained experts in perimenopause symptoms.

1. http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan

 

Like other stages of life, eating a balanced nutritious diet, getting adequate high quality sleep, exercising regularly and maintaining a healthy body weight are key elements to good health. As well, share your experiences with family, friends and co-workers – not only does this normalize what you are experiencing and keep you from being isolated and alone, it will give your support system the information they need to assist you. Keep track of your symptoms and share these with your health care team. Take action where you can and stay positive.

1. http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocriology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan

 

Hormone replacement therapy (HRT) is generally safe if you work together with a qualified healthcare provider. HRT is known to help many women with hot flashes, vaginal dryness, and keeping bones strong among other symptoms.

1. http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan

 

For most women, transition symptoms will likely fade away within one or two years of menopause. You might also still experience insomnia, memory challenges and depression. Every woman is a little different.

1. http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan

Some women gain adipose (fat tissue) around the middle even though there is no change in diet or lifestyle. You may experience bloating in your digestive system. If you have an autoimmune disease, it may become harder to manage. Migraines, depression and breakthrough bleeding are also associated with perimenopause.

1. http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging

 

Many women experience hot flashes, which are sudden surges of blood rushing to the surface of your face and torso. Other common symptoms include vaginal dryness, stress urinary incontinence (release of urine when you lift or sneeze), deep fatigue, insomnia, rapid mood swings and temporary forgetfulness.

1.http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

 

Your body enters into the late reproductive stage when it begins phasing out reproduction around age 35- 40. It may be harder to get pregnant at this stage of life. You may also experience an early or “premature” perimenopause at this time.

1.http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging

 

Your reproductive hormones are the main hormones changing their levels. These include estrogen and progesterone (from your ovaries), and luteinizing hormone (LH) and follicle stimulating hormone (FSH) from your hypothalamus located in your brain. During perimenopause, estrogen levels decrease overall, but might vary between very high or very low levels. These hormonal swings may account for mood disturbances (mood swings) and hot flashes.

1.http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging

 

Perimenopause, or the menopause transition, is a gradual, natural transition in your reproductive system that leads to menopause. It usually happens over 7-10 years and often starts around the age of 40. During perimenopause you will experience shorter and more irregular periods. The majority of women experience some troubling physical and mental symptoms.

1.http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging

 

Menopause is the day you have the last period of your life, which marks the release of your last ovarian follicle. Most of the troublesome experiences happen earlier during the perimenopause transition.

1.http://www.menopause.org

2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging

 

Yes, this is a normal symptom. As estrogen declines during the perimenopausal transition, inflammation in your system develops because estrogen modulates your immune system and the biochemical signals that cause inflammation. You may notice you are developing osteoarthritis in some of your joints, and old joint injuries may begin to hurt and become stiff. As well, some women may experience an increase in their auto-immune disease symptoms.

To date, it isn’t known whether standard HT with estrogen is helpful for joint pain and inflammation. However it is known that joint inflammation can be reduced by regular moderate exercise including modified strength training. Low- impact exercises such as swimming and cycling are excellent at reducing pain and inflammation, promoting high quality sleep and they won’t damage your spine, knees and hips.

 

Episodes of rage and anxiety are normal. They may be intense but usually pass quickly. Changes in mood are not very well understood so treatment options are currently limited.

If you are concerned about your rage, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.

 

Regular cannabis use by mid- life women in North America is fairly new and there is not much data on the safety and effectiveness of cannabis with respect to menopausal symptoms. Make sure your care provider knows about your cannabis consumption, particularly if you are using prescription medications.

Hot flashes can be addressed in many ways but it’s best to collaborate with your care provider to find a therapy that works for you. Hormone therapy (HT) can be effective at reducing the frequency and intensity of hot flashes for many women. Antidepressants, meditation and relaxation techniques work also well as they lower stress hormones. Ensuring you are eating a well-balanced nutritious diet can also help.

A Stress urine leakage or stress urinary incontinence (UI) occurs when the pressure in your bladder is stronger than your urethra, the tube that empties your bladder. You may pee suddenly when lifting, jumping, laughing or sneezing. Stress UI happens during perimenopause and post-menopause when the muscles that keep your urethra closed weaken due to lack of hormonal support.

You can help strengthen your pelvic floor muscles with Kegel exercises – see a trained physiotherapist to get training on the correct set of exercises for you. HT with estrogen applied topically (in creams or tablets) within the vagina is effective for both dry vaginal pain and urinary incontinence. The outer third of the urethra is estrogen-sensitive. When the estrogen cream is applied to the vagina it can increase blood supply to the urethra and nerve function which can help strengthen the muscle.

It might be also advised to stay away from caffeinated drinks because caffeine is a bladder irritant.

You should request a bone density exam by age 65 in order to test for osteoporosis (fragile bones). If you are at risk for low- impact fractures (because of family history) or you have had a low- impact fracture, request this exam by age 50. Low impact fractures commonly occur from falls and result in breaking a wrist or fracturing a vertebrae or hip bone). These types of fractures indicate you may be developing osteoporosis. Losing height by 1.5 inches or more also suggests that you may have some osteoporosis in your spine.

Women who are low-normal or below normal weight, who smoke, drink alcohol, and have low rates of exercise are at higher risk for osteoporosis in post- menopausal life.

 

This isn’t necessarily due to menopause! During the aging process, the lens of your eye undergoes natural changes that may make it harder to adjust your focus. However, decreasing estrogen in your blood can disrupt tear and oil secretions needed for lubricating your eyes, which can make vision blurry or dry your eyes. Your optometrist or your pharmacist can help with therapies for these symptoms.

It is suggested that women see a healthcare provider specifically about menopausal transition when you start to notice that your periods are getting irregular or you start to experience symptoms.

 

Natural menopause happens when your ovaries develop and release their last follicle and egg and stop producing estrogen. Medically induced, or treatment induced, menopause happens when there is surgical removal of both ovaries (oophorectomy). Medical menopause occurs also when a severe medical issue like breast or uterine cancer has been treated or managed with chemotherapy, radiation therapy, and/or hormonal therapy.

A hysterectomy, which is the removal of the uterus, does not necessarily mean menopause – it depends if one or both ovaries were removed at the same time. However, women who undergo a hysterectomy to treat fibroids or excessive bleeding have a nearly two-fold increased risk for developing menopause early.

 

Yes! Until you have had 12 consecutive months without a period, use contraception if you don’t intend to get pregnant.

Note that women who become pregnant after age 35 have an higher risk of miscarriage, and more than half of all pregnancies after age 45 end in miscarriage.

American Society for Reproductive Medicine

 

Mood swings are normal. They can be mild, very strong and disorienting or even make you feel giddy or reckless. Episodes of rage and anxiety may be intense but usually pass quickly. Mood swings are not very well understood so treatment options are currently limited.

If you are concerned about your mood swings, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.

 

Two things happen to women mid-life: their biological metabolism slows down and hormone levels change, both of which can lead to an increase in weight gain. Two hormones in particular are known to affect weight gain: estrogen (that declines), and follicle stimulating hormone (FSH) (that increases).

As well, women often decrease their exercise and movement levels, may eat more and drink more alcohol, and their quality of sleep decreases. All of these factors combined can cause weight gain, particularly around the middle – called central adiposity. Weight gain is not inevitable – simple actions such as walking 30 minutes daily and paying extra attention to healthy nutrition can help manage this impact.

 

This life stage usually lasts 7- 10 years. If you have a high BMI, you may have a longer Menopausal transition.

Bio- identical hormones are reproductive steroid hormones, such as estrogen or progesterone, used in hormone therapy (HT). The term “bio-identical” means the hormones in the HT product are chemically identical to those your body produces.

Bio-identical hormones can be easily recognized and used by our bodies so the effects are more consistent with our natural biochemistry. As well there is a smaller risk of unpredictable side effects than with synthetic or non-bio-identical hormones.

There are FDA approved bio-identical hormones that are safe and effective, but there is no evidence to date that bio-identical hormones are more effective or safer than synthetic hormones. There are also FDA approved natural hormones that are derived from plants.

 

There are options to help reduce or manage some symptoms. The primary tool is called Hormone Therapy (HT), also called hormone replacement therapy (HRT), menopausal hormone therapy (MHT), or hormone management therapy (HMT). HT is helpful for decreasing hot flashes, improving the health of your vagina and urinary systems, and supporting your muscle and bone health and strength.

Unfortunately, other symptoms may not respond as well to HT. Physiotherapy can help with physical pain and psychological counseling and therapy can help with emotional troubles. Lifestyle changes to promote quality sleep, good nutrition, and exercise are important and known to decrease menopausal transition symptoms.

 

No, about 20% of women have mild or no symptoms, or don’t seek medical care. About 40% of women have mild to moderate symptoms and seek medical care. Another 20 % have intense symptoms and need medical care.

Generally, women who have a high BMI and chronic stress in their lives tend to have more menopausal symptoms and those symptoms last for longer periods of time. Genetics may also impact your perimenopausal symptoms. There is a good correlation between the length and intensity of your menopausal transition and your mother’s menopausal transition.

 

No! Menopause is the life stage after the reproductive years. It is marked by the end of a woman’s menstrual cycles and is recognized when a woman hasn’t had a period for 12 months.

No! Perimenopause, also known as the menopause transition, is not a disease or a hormone deficiency disorder. All women go through this transition phase later in life (although the timing of onset does vary) and many have similar symptoms.

With medical support and the appropriate treatments many unpleasant and quality of life-impacting ‘symptoms’ can be managed. Talk to your health care provider if you are bothered by the changes you are experiencing.