Perimenopause - An Overview
An overview of the the basics of what’s going on during perimenopause (aka the menopause transition) from a physiological perspective.
…However, before we go any further I should point out that I am not an expert in reproductive hormones or an endocrinologist; I am not a medical practitioner nor am I a healthcare provider.
I am a Priestess, writer and meditation guide sharing soul care practices for the midlife transition (through your forties and perimenopause).
That said, I consider it’s important to help educate around some of the basics of peri/menopause, because so many of us simply do not know what’s occurring.
It’s not something that’s much talked about, we don’t learn about it in school and many GPs have received woefully inadequate training in this area, considering it’s going to be experienced by 50% of the population! (1)
So, based on the reading and research I’ve carried out over the last couple of years, here’s an overview.
Terminology
OK, so let’s clarify some terms.
In this guide and in my work, this is what I’m meaning when I use the following terms:
Menarche
The day of your first menstrual bleed.
Pre-menopause
Your menstruating years, where your menstrual cycle is ticking along regularly – or whatever your version of regular is.
During this phase of your life, you may also experience pregnancy, childbirth, miscarriage and/or abortion.
Your experience may also include taking hormonal contraception.
Perimenopause
The years when your body's production of the hormones oestrogen and progesterone fluctuates, and eventually decreases.
This is caused by your ovaries slowly stopping the production of eggs. Ovulation becomes erratic and eventually will stop.
At some point during this process, you will likely start to experience changes in your menstrual cycle. It may become shorter or longer, lighter or heavier – or an unpredictable mix of all of that!
This can begin in your late 30s, but certainly as you move through your 40s this shift is happening.
The word ‘perimenopause’ means ‘around menopause’.
Menopause
Technically this only lasts one day: it’s a year to the day after your last menstrual bleed. The average age that menopause occurs is 51.
The word ‘menopause’ means ‘end of monthly cycles’ and was a term coined in the early 19th century by a French doctor.
Post-menopause
The years when you no longer have a menstrual cycle.
Some call this your ‘second spring’.
Peri/menopause
The combination term I use to refer to the whole process of the perimenopause and menopause transition.
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I feel it’s important to reiterate that in my work, I am specifically focusing on the perimenopause transition.
That’s because I am in perimenopause (I’m 46 – and 2/3rds! – at the time of writing this in autumn 2021) and have not yet walked through the gateway of menopause. I do not teach about what I have no experience of, so I do not yet consider myself qualified to teach about the specific time of menopause itself and the immediate post-menopause experience.
How Do You Know If You’re In Perimenopause?
There’s no clear and definite sign that you’re in perimenopause. And you can’t reliably test for it (because your hormone levels fluctuate daily anyway).
That said, the most obvious sign is a change to the length of time between menstrual bleeds and becomes obvious if you’ve previously had fairly regular menstrual cycles.
Experiencing hot flushes and/or night sweats is a telltale sign. (These ‘vasomotor symptoms’ are arguably the only physical “symptom”(2) widely agreed by researchers to be caused by the hormonal shifts of peri/menopause alone. Other experiences could be a result of the impacts of lifestyle and ageing.)
Feeling inexplicably (or justifiably!) more irritable, angry even rageful … well, that seems to be a pretty common indicator of being in this transition (it certainly has been for me).
Feeling more emotionally up and down – anxiety, depressive feelings, doom, teary-ness: they’re some more signs. You might feel you’re going mad (you’re not, by the way).
Experiencing the ‘burn the house’ moment is another indication of having entered the soul forge of perimenopause. This is an urgent, radical calling to make fundamental changes to your life. (Yup, I’ve ticked that box too.)(3)
But the biggest indicator? Basically, if you’re in or around your forties and you have ovaries , yup, you’re highly likely to be somewhere on the perimenopause journey whether you realize it or not!
Now, some doctors / healthcare professionals / strangers on the internet might tell you that you’re not the right age to be in perimenopause, or that perimenopause doesn’t even exist (!). Be wary.
Your experience and intuitive sense are the truth-tellers here.
If you feel changes in your body, if you feel shifts in the tides of your emotions and moods, if you can detect an underlying felt sense that something deep is changing within you then trust it.
And welcome to the journey!
Routes to Menopause
Please note: in the psycho-spiritual approach to this transition that I’m sharing, we’re working with the revolution occurring in your psyche during your forties as you transition into the archetypal energy of the Queen. What I share below is based on the physiological-medical approach, which may or may not clearly map to this soul journey.
Gradual Menopause (aka Natural Menopause)
The term “natural menopause” is often used to refer to peri/menopause that happens because of ageing.
However, I don’t like that term. It has an unfortunate and damaging side-effect of suggesting any other experience of the peri/menopause process is unnatural. There’s enough shame around the whole thing without adding a suggestion that you’re not experiencing it properly!
So, inspired by the writer Heather Corinna (4), I’m using the term gradual menopause.
Gradual menopause can last anything from a few months to twenty years (!). But the more average experience (if there is such a thing) is thought to last between 5 and 15 years.
During this experience of perimenopause, the body’s production of oestrogen and progesterone fluctuate.
The general direction of travel is that oestrogen tails off over time and the production of progesterone fluctuates (and does pretty-wildly) but it is also being produced less and less.
Post-menopause levels of both oestrogen and progesterone are low and remain low, but stably so, for the rest of your life, i.e. your body finds its new hormonal equilibrium.
Sudden Menopause (aka Surgical or Induced Menopause)
This is sudden onset-menopause which occurs following surgery such as a radical hysterectomy (removal of both the uterus and ovaries) or bilateral oophorectomy (removal of both ovaries), and permanent or temporary menopause occurring as a result of some medical treatments such as chemotherapy or medications like tamoxifen.
I use the term ‘Sudden Menopause’.
Again, Heather Corinna offers sound guidance on this as they astutely comment:
“Many people who experience menopause because of surgeries or treatments didn’t have those surgeries expressly to make menopause happen, and can have some hard feelings about menopause as an outcome, which that terminology [i.e. ‘surgical menopause’] can feel unsupportive of”.
Primary Ovarian Insufficiency (POI) (aka Premature Menopause)
This occurs when people reach menopause much earlier than the average age of 51 e.g. experiencing perimenopause in their twenties or early thirties.
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Now, at this point you might expect to read a long list of all the grim and gory symptoms of peri/menopause.
But I’ve made a deliberate decision not to include them here.
I do not deny that you may well experience or be experiencing very real and challenging physical, emotional and mental impacts in this process.
I am not for one moment downplaying their effect on your life, nor am I suggesting you shouldn’t seek help and support for dealing with them.
There are many books, blogs, social media posts, teachers, health gurus and doctors out there who talk about symptoms and alleviation of symptoms.
But, as I said above, my work is about approaching perimenopause as a sacred rite of passage for your psycho-spiritual self: a process of soul initiation.
So this is my focus.
References
1- https://menopausesupport.co.uk/?p=14434 [accessed 4 October 2021] This is from a UK perspective, where it is estimated that there are currently 13 million perimenopausal or post-menopausal people.
2 - I put “symptom” in inverted commas as it’s language which is commonly used but I don’t find helpful. Perimenopause is not a medical condition, but use of the word ‘symptom’ implies it is. I prefer words like ‘experiences’ or ‘impacts’, because they don’t invoke the idea that peri/menopause is a condition to be treated or cured.
3 - A phrase coined by Alexandra Pope and Sjanie Hugo-Wurlitzer of Red School to describe this feeling in perimenopause
4 - In What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You by Heather Corinna
