A reader commented in my recent post that she was just a tad insulted when her doc implied that she was “in menopause”.
“Menopause! I had the period from HELL last week!”
She then goes on to wonder just what the difference is between menopause and peri-menopause, and asked that I address these definitions for her and her friends, because they are all a bit confused.
Happy to oblige, Sea Spray. The reason you’re confused is that it’s, well, confusing. Not to mention the fact that the terminology around menopause has recently changed.
But let’s see if I can make it simple.
By definition, menopause is the date of the final menses. But you don’t get to call it your final menses until 12 months have passed with no intervening bleeding. Then, you get to look back and say “That was the date of my menopause!”. Of course, it’s a bit anti-climactic at that point…
If you have what you think is going to be your last period, and then you bleed again in the subsequent 12 months, then the clock resets at that new bleeding episode and we start the 12 month countdown all over again.
As to what to call yourself, you are not “menopausal”. You are either in your reproductive years, peri-menopausal or post-menopausal. The chart below may help you understand these terms.
Once it has been 12 months since your last menses, you are officially post-menopausal.
So what are you in that year while you are waiting to find out if that was your last period? You are peri-menopausal.
You are perimenopausal from the time from when you first start having variation in your menstrual cycle length to one year after the last menses. Other terms for the perimenopause are “menopause transition” or “climacteric”.
For some women, perimenopause is very short. For others, it encompasses a good deal of their forties and early fifties.
Hormonally, the perimenopause is characterized by fluctuating hormone levels and rising FSH levels. Cycles can range from textbook normal to skipping months at a time to occurring every few weeks. PMS can worsen. Periods can become very heavy and erratic. Mood swings can be problematic. Breast tenderness can be a bitch. And you can have hot flashes even while you are still having menses.
A simple way to remember the perimenopause is this – “Perimenopause is hell”.
This one’s easy. It’s the years from menarche to the onset of the perimenopause.
The problem with this term is that it implies that the perimenopausal years are not reproductive. Tell that to the woman who gets pregnant in her perimenopause. Which definitely happens, by the way, so use birth control till you are post menopauseal.
What about the word Premenopausal ?
By definition, you are premenopausal for your whole reproductive life, until your final period.
Premenopausal is not really a helpful word, because it not distinguish the perimenopausal years. But it can occasionally be used to describe all those women out there who are still menstruating.
What about the word Menopausal?
When docs use that, they usually mean perimenopausal.
What does Menopause really mean?
The use of the last menstrual period as a defining moment in a women’s life is really an artificial construct based on the only outwardly measurable event we have marking the decline in ovarian function – the last episode of bleeding.
But it’s not like the ovaries give up the ghost at the final period. Many women’s ovaries keep chugging along for quite some time after the last menses, but in general cycling in an increasingly erratic fashion that is characterized by a lack of ovulation, absence of bleeding and lower and lower estrogen levels over time.
But this continuing ovarian function can make the perimenopause and early post-menopausal years a bit less predictable than some think. Not infrequently, my post-menopausal patients will complain of episodes of breast tenderness or PMS, and swear they are going to get a menses, but then nothing comes. And some women, even after 12months of amenorrhea, will occasionally have a full blown normal menses.
Take me, for example.
My Post-Menopausal Period
Just last month, a full 14 months since my last period, I had a miserable 3-4 weeks of bloating, breast tenderness, crankiness and a 5 pound weight gain, along with a pleasant little blip in libido, followed by a whopping migraine the likes of which I had not had for months, followed by a week long episode of vaginal bleeding.
Officially, this was an episode of post-menopausal bleeding. Not something to be ignored, since post-menopausal bleeding can be an early sign of uterine cancer. So I had a sonogram, which was normal. I didn’t have uterine cancer. It was, simply, a period. Just my ovaries popping up to say “We’re not dead yet!”
It’s all normal, because menopause is really a period of time, not a magic day. An episode of transition that can last for days, weeks, months and even years.
Which Reminds me of a Joke
A woman goes to her gynecologist for a check up. “Doctor”, she complains, “There are pennies coming out of my vagina.”
“Take this medicine”, says the doctor, “It should stop the problem.”
Two weeks later, the woman is back. “Well, the pennies stopped, but today I found a nickel.”
“Let’s increase the dose”, says the doctor, and writes her a new prescription.
Two weeks later, she’s back. “Now it’s dimes”, she complains.
The doctor reaches for his prescription pad.
“But doctor,” cries the woman. “What is wrong with me?”
“Nothing,” he says. “In fact, it’s completely natural. You’re just going through your change.”
For information on Menopause, see
- The website of The North American Menopause Society.
- Is it Hot in Here? Or Is It Me? – Nicely done, well-written, up to date and medically correct. Modeled after the What to Expect Guides.
- The Wisdom of Menopause – Well-written and medically on target. A bit touchy-feeling and whoo-whoo. Good if you like that kind of stuff.
Cartoon copyrighted and used with permission from cartoonstock.com.
Chart from Straw (Stagng of reproductive aging workshop). J Clin Endocrinol Metab. 2007 Aug;92(8):3060-7. Epub 2007 Jun 5.