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What Do Women Actually Know About Menopause?
In a 2023 survey of 829 post-menopausal women, nearly 50% of respondents indicated that they felt ‘not informed at all’ about menopause. To make matters worse, 60% of respondents reported that they only began to search for information about menopause when they started experiencing symptoms.
In Australia, the average age of menopause is 51, and most women experience their first menstrual cycle at 12 years old. That means that, on average, women spend the majority of their lives without any knowledge about the process of menopause — despite the fact that it is an almost inevitable biological process.
This article will try to fix that — as a sort of menopause 101.
What Does “Menopause” Actually Mean? Clarifying the Terminology
Most people, when they hear the word menopause, think of a list of symptoms and issues associated with no longer having a menstrual period — including things like hot flushes, sweats, memory loss, tiredness, and even increased anxiety.
However, if we break the word menopause down into its Greek origins — menos, meaning month, and pausis, meaning to stop or cease — we begin to realise that “menopause” itself specifically refers to the last ever menstrual period, that takes place after at least a year of not having a period at all.
This confusion in terminology makes sense — even the World Health Organisation (WHO) defines menopause as the permanent cessation of menstruation resulting from loss of ovarian follicular activity. However, in terms of accurate medical terminology, the signs and symptoms associated with “menopause” are more accurately associated with what is referred to as perimenopause, or the menopausal transition — the period between having a regular menstrual cycle and the eventual final menstrual cycle.
The Three Stages of Reproductive Ageing
If we think about a timeline from the first menstruation (menarche) until the final menstruation (menopause), we can get a better understanding of reproductive ageing throughout life. There are three key stages to understand:
1. The Reproductive Stage
The most obvious and easy to understand, the reproductive stage begins at the onset of the first menstrual period. During this phase, the menstrual cycle is pretty regular and consistent. In the later stages, subtle changes in the menstrual cycle — like decreased cycle length or changes in flow — can begin to occur, signifying the start of the menopausal transition.
2. The Menopausal Transition (Perimenopause)
The menopausal transition phase is what is commonly (and inaccurately) described as ‘menopause’. As oestrogen levels decline, women often begin to experience many of the symptoms we associate with or refer to as ‘menopause’. Perimenopause is characterised by gradual changes to the menstrual cycle — generally variable cycle length and much longer gaps between cycles (more than 7 days). Eventually, when there is no menstrual bleeding for 60 days or longer, this signifies the end of the menopausal transition phase.
3. Postmenopause
Menopause itself is defined as your final menstrual period, following at least a year without any menstrual bleeding. Everything following the final menstrual period is considered postmenopausal.
What Causes Perimenopausal Symptoms?
Most of the symptoms experienced during perimenopause occur as a result of changing hormone levels — specifically a decline in oestrogen. In fact, declining oestrogen levels underpin almost every aspect of perimenopausal and postmenopausal symptoms experienced by women.
Hot Flushes and Night Sweats (Vasomotor Symptoms)
The exact mechanism of vasomotor symptoms — hot flushes and night sweats — is still unknown, but the current prevailing theory involves changes in the body’s sensitivity within the ‘thermoneutral zone’. This is essentially the range of environmental temperatures in which a human can maintain a normal core body temperature without expending energy. Usually, minor fluctuations within this zone do not trigger physiological responses like sweating or skin flushing.
However, it is believed that in perimenopause, the body’s tolerance for changes within this window narrows — so a minor shift in temperature (previously tolerated) now causes a physiological response to ‘cool down’. It’s kind of like having an oversensitive fire alarm where something as minor as burnt toast sets off the alarm.
Genitourinary Syndrome of Menopause (GSM): The Symptoms No One Talks About
An incredibly common yet rarely discussed aspect of perimenopause and postmenopause is the range of genitourinary symptoms women experience. Many anatomical and physiological changes in the female reproductive tract occur due to oestrogen loss — including thinning of the vaginal epithelium, reduced elasticity and blood flow, loss of collagen and elastin, and changes in smooth muscle functioning.
Genitourinary Syndrome of Menopause (GSM) — previously referred to as vulvovaginal atrophy — is the clinical terminology for this collection of symptoms. These can include:
- Vaginal dryness and reduced lubrication
- Vaginal wall prolapse
- Pain during intercourse (dyspareunia)
- Vulval dryness, burning, irritation, or itching
- Recurrent urinary tract infections
- Urinary incontinence
- Pain during urination (dysuria)
Studies show that while only 4% of women report vaginal dryness during early perimenopause, this increases to 25% within one year post-menopause, and jumps again to 47% three years post-menopause.
Many women feel they must simply endure these symptoms as a normal part of ageing — this is absolutely not the case. A range of hormonal and non-hormonal therapies are available to manage symptoms and improve quality of life.
What’s Next: The Menopausal Microbiome
Hopefully you now have a better understanding of what happens during reproductive ageing, from perimenopause to postmenopause and the menopausal transition in between. In our next blog post, we will delve into the research around the menopausal microbiome — and how changes in the gut and vaginal microbiome intersect with everything discussed above.
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