In short, menopause is the reverse of puberty. Our ability to bear children is being reversed. And that can be just as turbulent physically and psychologically as the development of everything associated with femininity used to be. Is it an illness? No, just as little as puberty is one. Can it drive us and those around us to the brink of insanity? Yes. Absolutely. It is no coincidence that most suicides among women in Germany occur between the ages of 50 and 55. I’m not writing this to incite panic, it just goes to show that there’s a lot that can come together in midlife.
“Like a woman, the most undepressed, optimistic, confident woman I know, woke up one morning and went straight to the kitchen and grabbed a butcher knife (she’s an excellent cook) to stab it in her heart. That was the menopause.”
Mary Ruefle, “Pause” in Granta
Menopause is only ONE day in a woman’s life. Namely, retrospectively the day after which we had no more menstrual bleeding for 12 months. Yes, you read that right: if you haven’t had a menstrual period for 12 months, you can retrospectively say that you’ve experienced menopause. It can also happen that you miss your period for a few months. This can then be followed by long-lasting bleeding that won’t stop. Your cycle gets out of rhythm. While your sex hormones regularly coordinate with each other every month, they can now fluctuate greatly. That’s no reason to panic. In any case, please consult your doctor in this situation.
AM I IN ALREADY?
My gynecologist, whom I respect very much, only smiled mildly when I asked him in my mid-forties whether I was already going through menopause. He then asked back if I still had a regular cycle. When I said yes, he said, “You haven’t gone through menopause yet.” But he didn’t tell me that I was already in the middle of perimenopause and that my symptoms, such as the sleep disorders, could have been related to it, and neither did my family doctor. Perimenopause begins with the drop or the fluctuation of our sex hormones and lasts up to 12 months after menopause. This can start between 35 and 50 years and last up to 10 years.
“Peri” comes from Greek and means “around, around, beyond.” This phase almost encloses Menopause. After that, we are in Postmenopause. And the time from the first menstrual period to the onset of Perimenopause is called Premenopause¹—quite a lot of terms. The most important for me is Perimenopause.
The sex hormones during the premenopause, the perimenopause and the (post)menopause – shown schematically; Source: Harvard Women’s Health Watch, 1999
Perimenopause begins around the mid-forties. In rare cases, this can also happen in the mid-30s. First, the progesterone level drops noticeably in women, followed by a drop in estrogen levels. The whole thing can drag on for years, and the hormones can fluctuate monthly.
After our sex hormones peaked at around 25 years of age, they are now continuously falling. And somewhere between our late 30s and early 40s, we might still have a regular cycle, but things don’t go quite right anymore. This is because the number of eggs and their quality decreases. From around the mid-40s, this can have greater physical and psychological effects; over 30 symptoms are associated with menopause. The most typical of these are mood swings, trouble sleeping, weight gain, hot flashes, decreased libido, and irritability.
WHAT ARE THE SIGNS OF MENOPAUSE?
In Germany, about a third of women have no symptoms during menopause. Two-thirds have symptoms, and half of them are severely affected. However, I see a need for research here because I have not been able to locate the source of this distribution so far.
You realize that you could be in perimenopause the more of the following statements apply to you:
- you no longer have the same energy as in your thirties
- suddenly, you can’t remember names and words, and you might even suspect that there is an early form of dementia or a brain tumor behind it
- the interest in your appearance decreases with you, you wear, e.g. only your favorite jeans
- social contacts are not that important to you anymore; you tend to withdraw socially
- your bleedings become irregular; they are stronger or weaker than before
- your desire for sex goes down
- falling asleep suddenly causes you problems
- Sport no longer has the effect at all that it once had
- you gain weight around the hips and undo the button of your pants more and more often
- at night, you wake up drenched in sweat
- and suddenly, there is this sadness in you that you have never experienced before
- Exhaustion is your normal state
- you wake up at night, and your thoughts are circling; it is difficult for you to fall asleep again
- more and more often, your nerves are on the edge
YOU ARE NOT ALONE
You are not alone in all of this. All women go through menopause sooner or later, and perimenopause is where it all begins. Instead of reliably producing estrogen and progesterone regularly every month, our ovaries slowly decrease their activity until, eventually they stop producing hormones altogether. All of this is natural. But that doesn’t mean you have to endure all these symptoms. And it also doesn’t mean you have to go through this phase alone. We are here to provide sharing, networking, expert opinions, scientific findings, and offers of help. Sign up for “SOMEBODYTOLDME” and you’ll learn more about #allthingsmenopause soon.
¹) One finds little to nothing about the term premenopause. I went through several classics of menopause literature and the guidelines of NAMS (US), NICE (UK), and the German policies, and one finds the term not at all hardly described.
The North American Menopause Society – NAMS – defines premenopause as follows: “Premenopause. The period from puberty (onset of menstrual periods) to perimenopause.” NAM
Sheila de Liz devotes a chapter to premenopause, writing, “Premenopause may last five to ten years and merge imperceptibly into perimenopause.” (Sheila de Liz, Woman on Fire, p. 40 – Amazon affiliate link)
Wikipedia has a similar definition as Sheila de Liz