Pre-menopause, Peri-menopause, and Post-menopause - The Difference
Women experience many changes in the body that our minds have to understand and process. Menopause is one of them. While it is a normal part of a woman's life, there are still areas that confuse some people, such as the difference between pre-menopause, peri-menopause, post-menopause and menopause itself.
If you are concerned about these, including the signs and symptoms of menopause and what it means when you experience it, then it is time to get educated. Below are the basics about pre-menopause, peri-menopause, and post-menopause, as well as frequently asked questions about them.
Remember, the first step in understanding these events (changes before the change) in women's lives is learning what they are and how they might affect an individual.
So, what are pre-menopause, peri-menopause, and post-menopause?
You may have heard menopause before, but these three words may be new to you. So, here are the difference between PRE-MENOPAUSE, PERI-MENOPAUSE, AND POST MENOPAUSE.
Pre-menopause and peri-menopause may seem very similar terms as they sometimes used in place of each other. Medically, the prefix "pre" means "before", so, deriving from this definition, a woman in pre-menopause means a woman before she enters menopause.
If you are wondering when it happens, just think of it as the period of time that comes before and after menopause itself. In fact, the prefix peri- means near or around. Added to the word menopause, it means the stage or process of change that leads up to menopause and after menopause. It can start as early as the late 30s or as late as the early 50s. In some countries, it occurs between ages 45 to 55 or may last one to four years. But its actual duration varies from one person to another. In some cases, it can last as little as a few months, but other times it may last as long as a couple of years.
Sometimes called the "menopause transition", perimenopause is the stage when a woman usually starts having irregular periods, hot flashes, or other symptoms because the hormones begin to fluctuate or go up and down. Each month the periods become more irregular, and different symptoms may or may not show up until they are on the way to full menopause.
However, keep in mind that if you are in peri-menopause, the symptoms you may have can be highly variable during this time. The most common perimenopausal symptoms may include changes in period cycle, hot flashes, mood swings, and sleep disturbances.
What hormonal changes occur during perimenopause?
During a woman's monthly cycle, the body produces two primary hormones - estrogen and progesterone. Both of these hormones are produced from the cells which surround the eggs.
The estrogen helps the uterine lining to grow, and the progesterone soars when the egg is released during ovulation. Progesterone (the ovulation hormone) also works for pregnancy and is also an essential hormone to control the uterine lining's growth.
When there is too much estrogen (period of excess estrogen), the menstruation can become too heavy, too long, or erratic. Bloating and breast tenderness may also be experienced, as well as headaches. On the other hand, too little progesterone (period of progesterone deficiency), and the uterine lining can become thicker, causing heavier menstruation.
In essence, estrogen is what makes the endometrial (uterine) lining thick like what fertilizer is on the grass. On the other hand, progesterone works the opposite role (it's like a lawnmower that cuts the grass).
Sometime during the menopausal transition, the estrogen levels decrease, and the endometrial lining then becomes thinner. Moreover, the ovulation becomes infrequent (which is why a menopausal woman can't conceive). In the last years before bleeding stops or during the final menstrual period), the periods become more infrequent, lighter, and then finally cease. This is a time of estrogen deficiency.
What are the possible symptoms of perimenopause?
The signs and symptoms of peri-menopause vary depending on which hormones go up or go down. Changes in these hormone levels can affect women differently and cause varied physical or emotional symptoms.
Here are different possible combinations of the peri-menopause symptoms below, and to varying degrees per hormone issue:
Estrogen Excess Symptoms
- Bleeding (erratic, too long, too much, too soon)
- Breast tenderness
- Vaginal discharge
- Weight gain
Estrogen Deficiency Symptoms
- Heat intolerance
- Hot flushes
- Night sweats
- Vaginal dryness
Progesterone Deficiency Symptoms
- Bleeding (Heavier flow than usual, premenstrual spotting, shorter cycle than usual)
- Premenstrual Syndrome (PMS) – often seen during pre-menopause
- Difficulty concentrating
- Hot flushes
- Menstrual migraine or headaches
Pre-menopause and peri-menopause may be confusing at times. Some used them interchangeably, but technically, pre-menopause and peri-menopause have different meanings.
Post-menopause, also known as the full menopause stage, is when a woman has not had a period for twelve months and the rest of the years after going through menopause. During this stage, estrogen level decreases and some menopausal symptoms may ease and cease for many women. But, some individuals may still experience dry skin, low libido, mood swings, and vaginal dryness.
As a result of lower estrogen levels, women in the post-menopausal stage are at increased risk for several health conditions, including osteoporosis or heart disease. Medications ad supplements such as hormonal therapy and/or specific healthy lifestyle changes may help prevent these conditions or reduce the risk at least. Since every woman's condition, overall health, and risk factors are different, and it is better to talk to a primary physician to know what specific steps to take and reduce individual risk.
It can be very difficult to know which treatment option best suits an individual experiencing either premenopausal, perimenopausal, or postmenopausal signs and symptoms such as hot flashes, night sweats, muscle pains, and other troublesome manifestations. If you experience any of these symptoms, you should contact your primary health-care provider to discuss their effects and possible treatment options. Many of the associated symptoms are manageable, and there are several treatment options that would work best after a thorough assessment. You can talk with your current healthcare provider or family physician, and based on your signs and symptoms, medical history, and treatment goals; you can come up with a solution.
Here are some of the possible treatment options for hormonal issues associated with premenopausal and menopausal symptoms:
Hormone Replacement Therapy
Hormone replacement therapy, sometimes called HRT, if suggested by your
Family physician can be one of the treatment options for moderate to severe signs and symptoms of perimenopause or menopause. In fact, it remains the single most effective option for the treatment of these conditions.
If you haven’t heard of HRT before, it simply means taking medication that contains female hormones such as estrogen. Dosages of estrogen during hormone replacement therapy range from ultra-low levels to standard and, at times, higher doses depending on the needs of the client.
Hormone replacement therapy can help relieve symptoms such as hot flashes and other troublesome effects of fluctuating hormonal levels. In some cases, clients choose to undergo hormone replacement therapy to help control the symptoms of vaginal atrophy or the drying, thinning, and inflammation of the vaginal tissues and urethra because of the body’s low levels of estrogen.
Bioidentical Hormone Therapy (BHT)
Bioidentical Hormone Therapy is almost the same as HRT in terms of hormone replacement. However, BHT refers to the use of medications that contains exogenous hormones such as estrogen, progesterone, and other hormones that are chemically identical to the hormones that are produced primarily in the ovaries.
Benefits of HRT and BHT:
- Can address symptoms such as hot flashes and night sweats
- Help relieve symptoms of depression for some users.
- Improved concentration
- May aid in improving sleep quality resulting in less fatigue and irritability
- May prevent bone loss, reducing joint pain and the risk of osteoporosis and fractures.
- Shown to provide some protective benefit to the development of cardiovascular problems such as heart disease
Possible effects of HRT and BHT:
- Bleeding in the abdomen
- Breast tenderness
- Nausea and retching
- PMS-like symptoms (Premenstrual syndrome)
- Retention of fluid
- Uterine bleeding
Hormonal Support Supplements
Hormonal support supplements have been made available for women experiencing hormonal changes for quite some time now. They can be very beneficial in supporting the process of hormone cycles and reduce some of the negative physical and mental signs and symptoms of hormonal imbalances.
You can take some after knowing if it is right for you, especially if the symptoms of perimenopause and menopause are negatively affecting your quality of life.
If hormone replacement therapy (HRT) or bioidentical hormone therapy (BHT) is not for you, your primary healthcare provider may recommend trying treatments that are non-hormonal-based. For example, if the fluctuations and changes in your hormonal levels are due to conditions such as anxiety or depression, you may be prescribed with medications such as antidepressant agents. But, these medications, too, have some side effects, so consider discussing with your healthcare provider possible effects to ensure overall wellbeing and to know if such a therapy is best for you.
Other Complementary and Alternative Therapies
In addition to the treatment options written above, a collaborative approach may be necessary. Your healthcare provider may or may not suggest complementary and alternative therapies such as those delivered by acupuncturists, dietitians, kinesiologists, naturopathic doctors, herbalists, mental health care professionals, occupational therapists, psychologists, or physiotherapists.
A collaborative approach will ensure that the etiology or causes of hormonal imbalances are addressed, and possible interaction with other areas are discussed. For example, some prescription drugs may interact with natural therapies like the use of herbs.
Frequently Asked Questions Related to Premenopause, Perimenopause, and Menopause
Premenopause, Perimenopause, and Menopause are topics that encompass many health issues like body changes, their effects on daily living, and so much more. To help us understand some of these issues, let us try to answer some frequently asked questions from various websites:
Can premenopause, perimenopause, or menopause affect other areas of living?
The answer, yes. Changes not just physical, but family or social circumstances, as well as diet and nutrition, often accompany perimenopause or menopause. For this reason, it can be an excellent time to review and discuss nutritional habits with a healthcare professional.
What nutrients should be considered by a woman experiencing symptoms of premenopause, perimenopause, or menopause?
Here are the nutrients that you should take note of during these periods:
You probably know that calcium is linked with aging and menopause. As research indicates, around the time of menopause, women’s calcium requirements increase; so if you are nearing this stage of life, consider taking some calcium supplements for your bone health.
B Vitamins, particularly B12 (cobalamin), are necessary for the maintenance of red blood cell levels. Although monthly bleeding or period is not as much as premenopause, menopausal women are less likely to absorb cobalamin from food sources.
Vitamin D increases the absorption of calcium. It is also essential to bone health. Since during these periods, the risk of fractures, joint pain, and other bone issues are high, so in order to improve bone health, you may take vitamin D supplements, the dosage or frequency of which is recommended by your healthcare provider.
Iron and Magnesium
Body stores of nutrients, like iron and magnesium, can also be affected by hormone-related health changes. But, it might be a good idea to have your family physician assess your iron and magnesium needs and general nutrition status before considering any supplementation.
When does menopause usually happen? How will I know if I am after menopause?
Menopause is when women experience 12 months without a period in a row. The average age of menopause is fifty years old. Another way to tell when you are about to go through menopause is by knowing the age when your mother went through it.
However, it may happen earlier if you never had children or if you smoke. Studies say that smoking may cause you to experience menopause up to two years earlier (compared to women who don’t smoke). Certain health conditions may also cause early menopause. If you have had taken chemotherapeutic drugs or had surgery to remove both ovaries, you should expect early menopause.
Am I more at risk for osteoporosis after menopause?
There are several health risks associated with menopause, most notably, brittle bone or osteoporosis. Because of the hormonal changes, the density and quality of the bone decrease after menopause, which can lead to an increased risk of brittle or porous bones. It often affects the bones in the back (spinal column) and the bones in the leg, which is why hip fractures are common after menopause. What’s worse is that these fractures may occur without your knowledge, unless you notice signs as loss of height or increased curvature of your spine.
Also, it is vital not to dismiss recurring or persistent body aches and pains to avoid other complications. Be sure to have them checked by your healthcare provider.
What are the ways to reduce the risk of osteoporosis after menopause?
To decrease the risk of osteoporosis after menopause:
- Avoid smoking tobacco.
- Be active and try incorporating some weight-bearing exercises into your daily routine.
- Discuss with your healthcare provider other options to assess your specific needs.
- Do certain measures to reduce risks for fractures and falls.
- Have your bone mineral density (BMD) checked. BMD is the standard for assessing bone strength and predicting possible fracture risks.
- Know how to prevent falls and fractures
- Take adequate amounts of vitamin C and Vitamin D. It will help the bones to absorb calcium.
When I reach the menopausal stage, what can I do about the symptoms on aging skin?
Irregular periods, hot flashes, vaginal dryness, moodiness, sleeping problems, depression, and memory problems are not the only symptoms linked with the menopausal stage. As women age and go through menopause, the skin changes, including loss of collagen. This loss of structural proteins results in the sagging of the skin and formation of wrinkles due to loss of elasticity from decreased collagen levels. The skin also becomes less able to keep the moisture of the skin, causing increased dryness. These symptoms are just some of the reasons why we should give particular attention to the aging skin. Beyond these changes, a number of other symptoms may also manifest and become more pronounced for long-time smokers and heavy alcoholic beverage drinkers.
So, in order to avoid these symptoms, there are a couple of skincare habits that you can do. In particular, for women with diminished hormone levels, hormone supplements can help since low levels of estrogen during menopause contribute to a thinner skin and a decline in collagen levels.
And since ultraviolet (UV) light from the sunlight and other sources can worsen skin issues, a good sunscreen use can be very beneficial besides avoiding sun exposure from 11 am to 3 pm or during peak hours. You can also wear solar protective clothing or broad-brimmed hats for extra protection. Other skincare habits include getting adequate sleep, staying hydrated, and eating a well-balanced diet. For extra precautions in preventing water loss from the skin, moisturizers can be used as well.
How can I find a menopause specialist practitioner or health care provider?
Besides asking a referral from your family physician, you can visit the site of the North American Menopause Society. They have a search feature on their website that can help those women in Canada or the United States who are looking for a healthcare expert regarding perimenopause or menopause. Healthcare specialists who have passed a competency examination and have a credential of NAMS Certified Menopause Practitioner will show up in the results. These experts are highly interested in helping women maintain and manage health through menopause and even beyond.
What are other online sources I can utilize to know more about premenopause, perimenopause, or menopause?
If you want to do more reading about these events in women’s lives, you can visit the following external links:
- Canadian Menopause Society – www.sigmamenopause.com
- Centre for Menstrual Cycle and Ovulation Research – www.cemcor.ca
- Canadian Women’s Health Network (CWHN) – https://cwhn.ca/en/faq/menopause
- Harvard Health Publishing, Harvard Medical School Blog – https://www.health.harvard.edu/a_to_z/menopause-and-perimenopause-a-to-z
- MayoClinic.org – https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
- Menopause & U – www.menopauseandu.ca
- National Center for Biotechnology Information – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096694/
- North American Menopause Society – www.menopause.org
- Office of Women’s Health – https://www.womenshealth.gov/menopause
- The Society of Obstetricians and Gynecologists of Canada – https://sogc.org/publications-resources/publicinformation-pamphlets.html?id=15
- The International Menopause Society – http://www.imsociety.org/
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