What Is Menopause? Understand The Biology Behind Menopause And Its Phases

November 2, 2020


Dr. Keira Barr

What Is Menopause?

When you hear the word menopause, how does it make you feel? Scared? Confused and overwhelmed? Or irritable? Whatever you may be feeling, I hear you. At age 39, my periods got heavier, and my breasts became so tender I could not hug my kids without wincing. I was feeling more anxious and exhausted than ever before. I thought there was something seriously wrong with me, that I was starting to lose my mind. As it turns out, I was entering perimenopause. The problem was, I had no idea what that really meant. 

And if as a physician this was what I was feeling; then how were all my female patients, colleagues, and friends at the same stage of life supposed to know what was going on?

So that is why I want to break it down here. I will try to answer the questions surrounding this normal, natural, and inevitable phase in every woman’s life. So you can thrive, not just survive during menopause.

The Skinny: What Is Menopause?

Women spend one-third of their lives in this sex hormone-deficient state. This means we have a lot of living to do during the menopausal stage of life. Though menopause is inevitable for all women, suffering through it is optional. The more you know, the more you can take back control of your health, happiness, and hormones.

Menopause is a milestone. It is a moment in time defined as the day marking 12 months without a period. And while we can get fancy and do lab testing to determine this, in the right context the absence of a period for an entire year is typical of all the confirmation a woman needs to know. She has officially reached full-on menopause.

So, what is menopause?

Menopause is natural. A normal and inevitable phase of life that signifies the end of our reproductive years. On one hand, you may be celebrating! No more PMS, no more pads or tampons, sex without worries about pregnancy. But on the other, it can be a time to grieve. It is the end of fertility, an end of a phase of life.

But menopause is not just limited to that one day that marks the end of your period. In more broad terms, ‘menopause’ is applied to one-third of our lives. The years we live leading up to, during, and after our period’s end. 

We can further define this significant portion of our life into three phases, perimenopause, menopause, and post-menopause. Three phases that transition into one another, marked by hormone fluctuations. 

However, there is a special circumstance that I want to highlight, and that is premature menopause. Premature menopause is defined as reaching menopause before the age of 40. While this can occur naturally, it can also occur immediately after any procedure that removes the ovaries. In this circumstance, it is referred to as surgical menopause.

While the transition to natural menopause can span 10 to 12 years (or more), surgical menopause is immediate. The sudden disruption of hormones can make typical menopause symptoms like hot flashes, brain fog, mood swings, and memory loss more severe.

Why and When Does Menopause Start?

Now that we know a little bit about what menopause is, let us find out about when it happens, and why? The start of menopause varies from woman to woman. The phase leading up to menopause, known as perimenopause, typically starts around age 45. Although for some women, it can begin in their mid-late thirties and last 10 to 12 years. In the United States, the average age of menopause is 51.

Think about it this way; once a month during ovulation, the ovaries release an egg from its stockpile. Perimenopause is the phase when ovulation slows. And what is menopause? When ovulation completely stops, and along with it, your periods. 

Menopause is more than just a phase. It is three phases!

Phase One: Perimenopause

Perimenopause can last 10 to 12 years before you enter menopause. As your ovaries gradually start making less estrogen and progesterone, your periods will become increasingly irregular. What you may notice during this phase is changes in flow, duration, frequency, and consistency. During this phase, the signs and symptoms tend to be the most bothersome and intense. Mainly due to both the fluctuations in hormonal levels as well as the relative imbalances between them.

Even though your hormone levels are declining, they do not decline at the same rate. This means you may have signs and symptoms of estrogen or androgen dominance like headaches, weight gain, and acne, even though the levels overall are low. While this will be different for everyone, hot flashes, mood swings, and brain fog are at the top of the list for many. Perimenopause is part of the answer to ‘what is menopause?’ Because even though menses do not come to a complete halt, symptoms of menopause begin to manifest. 

The most important thing to remember are these three words: YOU ARE NOT CRAZY.

Followed by these three words: YOU ARE NOT ALONE

What you are experiencing is real. It can be frustrating, stressful, and confusing. You deserve to be seen, heard, and understood. Most clinicians are not trained to recognize and manage the signs and symptoms of menopause. Thus, finding a menopause specialist like myself who understands what you are experiencing and can help you manage this transition is crucial.

Phase Two: Menopause

This is what is menopause when people talk about it. This is when you draw a line in the proverbial sand and cross over it. The day AFTER you have gone 12 full months without a period, is the day you’re officially in menopause.

Phase Three: Post-Menopause

Starting the day after you reach menopause, you enter the post-menopausal phase which essentially lasts for the rest of your life. The good news is that for most women, as hormone levels stabilize, symptoms experienced during perimenopause tend to subside. That said, with diminished levels of estrogen (and testosterone) there is a higher risk of osteoporosis, heart disease, cognitive decline, sarcopenia, and changes to the vagina and bladder. Making long-term changes to your diet and lifestyle can help minimize these risks, but they are not enough. Hormone replenishment therapy can offer profound and sustained benefits to decrease these risks. Make it a priority to work with a menopause specialist to create your roadmap for resilient health in menopause.

What you did not expect when expecting: Menopause (Perimenopause & Beyond) & Why It Can Be So Tough

During perimenopause, there is a wild fluctuation in estrogen levels causing symptoms to be intense. However, estrogen should not take the entire blame for these symptoms. 

There is a whole symphony of hormones trying to work together to create beautiful music. But some of the instruments are out of tune or out of balance. For this reason, this disharmony of hormones wreaks havoc on your energy, mood, skin, and waistline.

And while this stage can last a decade or even more, I want you to remember you are not alone! And you do not have to tell yourself ‘just suck it up buttercup.’ Hell no! There are solutions. Now that you know what menopause is, you will now find out how to conquer it!

From outfitting your bed with a Chili pad to help create your sleep sanctuary to boosting your skin and joints with the right supplements. Or maybe replenishing your hormones to get that symphony back in tune with bio-identical hormone therapy; there are tools to support you. 

As a Menopause Specialist, I have made it my mission to help you thrive, not just survive this time of your life. You do not need to figure this out by yourself!

What you may experience during perimenopause and beyond:

Lower progesterone levels

In your mid-late thirties, progesterone levels start to decrease. Consequently, contributing to an increase in sleep issues, anxiety, and changes in your period.

Irregular cycles and the return of PMS

The frequency, duration, flow, and consistency of your menstrual cycles may vary. Along with that, there will be an increase in symptoms like breast tenderness, cramps, and headaches.

Fluctuating estrogen levels

Even though the estrogen levels diminish as your ovaries start making less of it, you may still experience symptoms of relative estrogen dominance. The reason for this is due to the rapid rate of progesterone decline as compared to the rate of estrogen decline. Thus, estrogen dominance may show up as breast tenderness, fatigue, and irritability.

Tumultuous Temperatures

You may yo-yo between experiencing hot flashes and night sweats, coupled with a plummet in body temperature. While hot flashes make us sweat, those cold flashes can make you shiver!

Sleepless nights and fatigue

All those tumultuous temperature issues can disrupt your circadian rhythm. As a result, this causes imbalances in your other hormones affecting your mood, memory, skin, and waistline.

Vaginal dryness, irritation, and painful sex

Estrogen is a major player in skin hydration and maintaining your skin integrity and barrier. Low estrogen levels can result in a lack of lubrication in vaginal walls and thinning of the vaginal skin. Due to this, the vaginal tissue is more vulnerable to irritation and inflammation.

Low sex drive and decreased sexual desire

As estrogen and your androgens (aka testosterone) decrease, so can your libido. Add that to the impact of sleepless nights on your energy and mood, and it can be tough to get ‘in the mood.’

Mood and memory changes

Sleep issues aside, the low estrogen can leave you feeling moody, irritable, anxious, or depressed. You may also experience brain fog, poor concentration, and memory issues.

Bloating and Weight Gain

Eating the same things as always, but your waistline is blossoming, and your pants are snug? Hormonal changes can make you more likely to gain weight around your abdomen. Along with hormonal changes, age, lifestyle, and genetics determine the body’s metabolism and weight changes. Estrogen also plays a role in gut health and motility. Normal levels help maintain the balance of the gut microbiome, and diminishing levels may contribute to dysbiosis and bloating. Additionally, a decrease in testosterone also decreases muscle mass creating ‘flabbiness.’


The dwindling testosterone levels can also affect the muscles that support your bladder and rectum. Adult diapers are a 9 Billion, yes, BILLION dollar industry for a reason. Along with this, osteoporosis and cardiac health are one of the most significant reasons to consider bio-identical hormone replenishment therapy.

Hair in all the wrong places

Have you noticed less lush locks on your scalp? But excess hair growth on your face or elsewhere? Hormonal changes also affect hair. With less estrogen to oppose testosterone, women are more likely to get hair in areas men typically have it. Estrogen and progesterone have been playing a role in supporting your healthy hair growth. But now, with relative androgen dominance, women are more likely to see thinning of hair, especially after the age of 50.

Muscle and Bone Weakness

Diminishing testosterone leads to loss of muscle mass, also known as sarcopenia. Sarcopenia makes it gradually more challenging to get up from a seated position and move around. This is the reason why so many elderly women need canes, walkers, and worse, wind up in wheelchairs. On the other hand, low estrogen levels lead to loss of bone density, aka osteoporosis. Osteoporosis makes bones more vulnerable to fracture.

Skin changes

Estrogen plays a significant role in your skin health. The hormone keeps it well hydrated through hyaluronic acid production, boosts collagen production, and helps maintain the integrity of your skin barrier, all for that youthful glow. As estrogen diminishes, those benefits start to go with it. Your skin becomes drier, sensitive, and vulnerable to irritation. It begins to sag, wrinkle, and becomes thin. You may also notice acne and changes in tone and texture. And it is not just the skin on your face but also your vagina. For this reason, you may need to use lubrication because sex may be more uncomfortable than it used to be. More on this here.

The kitchen sink

There are a myriad of symptoms that women may experience during this time. This includes but is not limited to heart palpitations, a racing mind, achy joints, and muscles. In addition to this medley, headaches and migraines can occur throughout menopause too.

Together We Rise: Why You Need A Menopause Specialist

Going through the transition to menopause that can span more than a decade is challenging enough. But having to navigate the post-menopausal phase that lasts for the rest of your life can be a lot to handle. 

But here is the good news: You are not alone. We are in this together.

As a physician and as a woman going through this transition myself, I know exactly what it is like. I have dedicated my career to supporting women just like you and me. By replenishing your hormones, reframing your mindset, and recharging your energy, you can reclaim your sanity, health, and happiness. So that you are not just surviving this phase of life instead thriving.

Now that you know precisely what menopause is, this blog will keep you updated with menopause-focused lifestyle, wellness, and beauty ideas. We will strip away the obstacles that can stand in your way of feeling and looking your best in menopause. And when it comes to your hot flashes, mood swings, and your skin, you bet that beautiful bottom, I have got you covered.