Periods and Menopause

Almost every female between the ages of 15 and 50 is familiar with the feeling, “Is it that time of the month already?”

While this could be associated with the monthly bills, it generally is associated with that monthly scourge, known as the “period.” But every woman does reach a time when these periods do end and that generally is menopause. For many women, particularly in America, menopause is not seen as simply an end of the periods, but an end of youth, attractiveness, and usefulness. It is often approached with fear and concern; but it can also be a change to be embraced and even welcomed – an opportunity for more freedom and grace.

Menopause comes from the Greek words mens, meaning monthly, and pauses, meaning cessation and so literally means the cessation of menses, or menstruation or simply periods. However, the term often refers to the one and a half to two years before and after the end of the period. More recently, perimenopause has been added to the vocabulary to focus on the time prior to actual menopause – the transition during which a woman’s body prepares to enter menopause.

One of the questions many women ask is “When will perimenopause/menopause begin? Unfortunately, like it was with the beginning of periods, so it is with the end – it varies from person to person. Probably the most common method of predicting menopause is to look at the family history – specifically when the woman’s mother entered menopause. However, factors such as diet and smoking can cause menopause to start earlier or later.

Menopause, medically speaking, is defined as the first 12 months during which a woman does not have a period. But periods generally don’t simply stop overnight – it occurs gradually during perimenopause. And, like when they started, during this time, periods can vary in duration, heaviness of flow, and occurrence. Before talking about the changes that occur in a woman’s period during this time, let’s review the menstrual cycle, of which the period is but a part.

Menstrual cycles are the result of hormone release by various endocrine glands. It first starts with the release of GnRH (gonadotropin-releasing hormone) by the hypothalamus in the brain. The release of this hormone signals the pituitary gland to secret FSH (follicle-stimulating hormone) and LH (luteinizing hormone) which act on the ovaries to coordinate the menstrual cycle.

At the beginning of the cycle, called the proliferative phase, the pituitary gland releases more FSH than LH causing the follicles of the ovaries to grow and secrete estrogen. When the estrogen level in the bloodstream reaches a certain level, the pituitary gland increases the amount of LH released. By this time, the egg is mature, so the follicle ruptures, releasing the egg into the fallopian tube. This is ovulation and generally occurs around 14 days before the period starts.

Next the luteal phase of the cycle begins. Shortly after the egg is released, the cells lining the follicle will transform into the corpus luteum and within hours, begin secreting small amounts of estrogen and large amounts of progesterone to cause the lining of the uterus, or endometrium, to thicken. But the corpus luteum also produces another hormone, inhibin that, with the estrogen and progesterone, sends a signal to the pituitary gland to stop secreting FSH and LH.

If the egg is fertilized by a sperm, it implants in the uterus and begins its development into an embryo. If it is not fertilized, the corpus luteum crumbles and the amounts of estrogen and progesterone released drop significantly. This, in turn, causes the endometrium to break down and a day or two later, this uterine lining is shed and the period begins.

The most common sign that a woman is in perimenopause is that the periods become irregular. Again what “irregular” means differs from woman to woman. Some women will see shorter periods, while others will have longer ones, or the periods can vary. It is not uncommon for periods to be spaced further apart. Flows can be heavier or lighter. After years of relatively regular cycles, periods can become very unpredictable. Women are encouraged to track their periods on a calendar to try and identify new cycles or patterns that emerge.
Why is this happening? While researchers don’t yet know exactly what starts the change, they do know that changes in the hormone levels that control the cycle start occurring. However, contrary to what many once believed, the first hormone to see changes is not estrogen, but progesterone. The ovaries produce lower levels of progesterone, while maintaining estrogen levels. As progesterone levels decline, the uterine wall or endometrium doesn’t thicken as much, and therefore, there is little lining to be broken down and periods are lighter.

Because progesterone and estrogen are meant to act in coordination, when the progesterone levels drop, estrogen is unbalanced. The body attempts to adjust to this, causing symptoms such as water retention, swelling and tenderness in the breasts, and irritability. Over time, as the progesterone levels continue to drop, the estrogen levels begin to vary widely as do the levels of FSH and LH. At times, the ovaries seem to kick into high gear, like they are in a rush to get the eggs out, causing estrogen levels to go up. At these times, excess estrogen can also cause a build up of the uterine lining, resulting in heavy flows, sometimes with clots. Other times, the ovaries will skip ovulations and a woman can go a month or two without a period.

As a woman’s body moves closer to menopause, hormone levels start to stabilize. The levels of FSH and LH actually climb to new highs at which they remain for the balance of the woman’s life. Because of this fact, doctors commonly test for FSH levels to determine if a woman is in or near menopause.

A woman in her 40s and 50s, however, should not assume that irregular periods mean that she is in perimenopause. Irregular bleeding can be a symptom of other uterine problems or possibly thyroid problems. A woman should consult her doctor if bleeding is coupled with pain, urinary or bowel changes, or other unusual symptoms or if a period lasts longer than 10-14 days. Similarly, a woman who is in her 40s and 50s and is still sexually active, but is not practicing effective birth control should not assume that missing a period or two means she is perimenopausal. Pregnancy is still a real possibility.

In summary, periods are a part of the menstrual cycle, which is controlled by various hormones. As a woman enters her 40s and 50s, her hormone levels begin to change causing her periods to vary in duration, flow and occurrence, as well as other possible physical, emotional and mental changes.

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