Menopause

Menopause is the permanent cessation of menstruation. Women are postmenopausal a year after their last menstruation, irregular bleeding or spotting. The average age that women in the US go through menopause is 52. It is not unusual for women who contact HERS to be postmenopausal in their mid to late 20s or just beginning to experience menopausal symptoms in their mid to late 60s. 

Perimenopause is the transitional period before menopause when the ovaries begin to produce less estrogen and more androgens. Some women experience no perimenopausal symptoms, menstruation just stops, and a year from the date that it stops they are postmenopausal. Some women experience severe symptoms that include extreme mood swings, irritability, memory loss, high anxiety and hot flashes, which can continue throughout the day and night. Most women experience irregular periods and spotting occasionally for two to three months and many up to a year before menstruation stops. Other women experience continuous bleeding for months before all bleeding stops. 

Some women find it helpful to know approximately when they are likely to be postmenopausal because they have symptoms they feel they could tolerate if they knew approximately when their symptoms will end. Women who do not want to conceive might think that if their periods stopped for a few months they will not be able to conceive, but if their follicle stimulating hormone (FSH) level is below 40 they might decide to use contraception. A simple blood test can measure the level of FSH in the bloodstream. It is important that the blood be drawn the first or second day after menstruation begins; if the blood is drawn at any other time the test results will not be accurate. Each lab sets their own norm, so there is no universal standard for the results of the test. Some labs say an FSH of 35 means you are postmenopausal, others say an FSH of 45 indicates you are postmenopausal. The average level of FSH considered to be menopausal is 40. If your FSH is 40 or higher, you are menopausal. If your FSH is 30-40, menopause will be soon. Between 20-30 means menopause is a couple of years away. Under 20 means menopause is more than a couple of years away. FSH can estimate approximately when menopause will occur, but it cannot predict the exact date. 

Women are considered menopausal when it has been a full year since any amount of spotting or bleeding. The blood can be pink, bright red or brownish. If the bleeding is watery and continues to stay that way, a pelvic and transvaginal ultrasound (in the Radiology Department of a good hospital, not in a doctor’s office) to see if the endometrium (the lining of the inside layer of the uterus that sheds during menstruation) is abnormally thickened. Vaginal bleeding in a postmenopausal woman may be an indication that the endometrium is abnormally thick. In a premenopausal woman, the endometrium is thickest right before menstruation begins, up to 1.5cm-2cm thick. The endometrium is thinnest right after menstruation ends because the endometrial tissue sheds during menstruation. Depending upon how long you have been postmenopausal, a thickened endometrium may be an indication of endometrial hyperplasia. Endometrial hyperplasia is common in perimenopausal women and it usually, but not always, spontaneously reverts to normal. (See the link on this website to Endometrial Hyperplasia.) 

Doctors often refer to hysterectomy and oophorectomy (removal of the ovaries) as “surgical menopause.” Surgical menopause is an oxymoron–it’s a figure of speech that contradicts itself. There is no such thing as surgical menopause. Naturally menopausal women have female organs that continue to function all of their life. The ovaries continue to produce hormones when they are needed in the quantity they are needed and release them directly into the blood stream. Adolescent and young women’s ovaries produce more estrogens and less androgens. As the body ages, more androgens are needed so the ovaries produce less estrogens and more androgens. When the ovaries are removed, the ovarian production of hormones ceases. When the ovaries are not removed, 35-40% of women experience loss of function in one or both ovaries because of damage to the blood supply to the ovaries during hysterectomy. Loss of ovarian function caused by hysterectomy without removal of the ovaries is de facto castration. (See the link on this website to Female Anatomy Video.) 

The same blood supply and nerves that convey impulses of sensation to the uterus also provide blood flow and nerves to other organs. The uterus is a hormone-responsive reproductive sex organ that provides structural support to the pelvis and pelvic organs throughout a woman’s life.