Menopause Terminology

A woman’s reproductive phase undergoes several changes. The stages of a woman’s reproductive period are:-

• Puberty
• Premenopause
• Perimenopause
• Menopause
• Postmenopause

Puberty

This occurs during adolescence and results from an increase in secretion of the female hormones like estrogen and progesterone. This leads to physical changes in her body such as development of breasts, development of secondary sexual characteristics like pubic and underarm hair etc. During this time her menstrual cycle begins. The first period occurs generally around the age of 12 to 14 years. This is known as menarche.

Premenopause

These are years between puberty and menopause. Effectively premenopause is the reproductive phase in a woman’s life. With most normal women the production of female hormones is regular and periods come at predictable monthly cycles.

At the middle of each cycle the ovary releases an ovum that waits to be fertilized. If this fails the monthly period ensues at the end of the cycle with the shedding of the inner walls and linings of the womb as blood and tissues of the menstrual period.

Perimenopause

This phase was earlier termed as climacteric. It starts before menopause. The body begins to undergo several physical, emotional and hormonal changes. The symptoms associated with menopause including hot flashes and irregular menstrual cycles may start to appear. On an average this phase lasts for around 3 to 4 years. It continues, by definition, through the 12 months after the last period.

During this period, fertility diminishes, but is not considered to reach zero until menopause is reached. Signs and effects of the menopause transition can begin as early as age 35, although most women become aware of the transition in their mid to late 40s. This may be years after onset of perimenopause. The actual duration and severity of perimenopause cannot be predicted in advance.

There are clinically observable effects such as hot flushes - a sudden temporary increase in body temperature. The hot sensation is not the initial temperature rise but is a slow reaction of the body to normalize the temperature. Hot flashes may leave the person feeling weak and leave them sweating. Despite the discomfort to the woman, hot flashes are not considered harmful. Other common effects mood changes, lack of sleep, fatigue, and memory problems.

Menopause

This phase begins after the last menstrual period. Menopause is defined after one year of spontaneously missed periods. This means there are no abnormalities, disease or disorders that leads to stoppage of periods. Thus there should be 1 year free from pregnancy, breast feeding, or using certain medicines that alter menstrual cycles.

Natural menopause usually occurs sometime between the age of 45 and 55. Surgical menopause may occur before the usual time after surgical removal of the ovaries or uterus due to some pathology.

Premature menopause

Premature menopause is menopause that occurs before the age of 40. There are certain natural causes of premature menopause. Thinner women, and African American and Hispanic women and those with a genetic predisposition may undergo menopause earlier.

Women who smoke are also at risk of premature menopause. Women using oral contraceptives or birth control pills and those who have had children may undergo menopause later than others.

Postmenopause

This is a stage after menopause. It begins with the last period and continues for the rest of the life. With increase in life expectancy most girls now probably live a third of her life after menopause. At this point a woman is considered infertile. However, the possibility of a pregnancy is low but not zero for several years after menopause.

In women who have no uterus, and therefore have no periods, post-menopause means certain infertility. Menopause can be detected by a blood test which can reveal the very high levels of Follicle Stimulating Hormone (FSH).