Past Tense

There is a great misunderstanding about the terms used to elucidate the experience of menopause. The word itself is widely employed to describe the entire period in which women undergo symptoms due to their hormones being in flux. In reality, the word “menopause” refers simply to the final period of menstruation, in the same manner that “menarche” indicates the initial.

The period of regular menstruation cycle and before the decline of hormone levels is called by some as premenopause. The time before the last period is called by some as perimenopause.

Perimenopause includes the whole time before and after the last actual menstrual bleed - after hormone levels have started to fluctuate and before they settle, and there are no more symptoms due to this fluctuation. This is the same time span as the ‘climacteric’. It is more and more usual for women to refer to this time as their menopause.

The term “postmenopause” covers anything after the final menstrual period. It overlaps with “perimenopause”. A woman is described as postmenopausal following her final bleed, though the term is not used until a year has passed, to give time to be sure which period is the very last. Nine out of ten women who are in perimenopause and have not had a period in six months will not menstruate again.

Menopause and Estrogen

Estrogen and progesterone are created and released during an approximate 28-day cycle, that is, until the onset of menopause. The production of these hormones then becomes quite variable as the number of eggs diminish during midlife, along with their quality. As menopause approaches, there is a decrease in the levels of progesterone and estrogen.

Pre-menopausal. Leading up to ovulation is when estrogen levels reach their peak, but quickly decline afterwards. During this second half of the menstrual cycle is when progesterone starts to rise. If the ovulated egg is not fertilized, levels of both these hormones drops, which in turn signals the body to start menstrual bleeding.

Perimenopausal. During perimenopause, your body is still producing estrogen, but ovulation is much less regular. This means that progesterone is not created during every cycle, and hence during these cycles there will be no bleeding.

Postmenopausal. The small amount of estrogen now present is mainly produced by fat cells breaking down and converting the male hormone androstenedione.

Osteoporosis and Bone Health

In the western world 50% the women at the age of seventy are seriously affected by osteoporosis, and just only 10 years after the average age of menopause i.e. around the age of sixty nearly 25% of women will have already brittle bones. This is clearly due to the level of estrogen circulating the blood stream. The increased risk of osteoporosis is a good enough reason to find menopause treatments, of some kind, to help protect your health well into old age.

The metabolism of calcium, the mineral mainly involved in bone building, is in part dependent on estrogen and there are estrogen receptors in the osteoclasts and osteoblasts. The levels of available calcium circulating in the bloodstream are partly controlled by the hormones calcitonin and parathyroid hormone.

Our bones store most of the calcium, and if at all blood calcium levels come down the parathyroid hormone will cause the bone and release calcium into the blood. After menopause, low estrogen levels make bone more sensitive to parathyroid hormone, making it more fragile.