What Is Menopause

November 2, 2020


Dr. Keira Barr

What Is Menopause?

When you hear the word menopause how does it make you feel? Scared, confused, overwhelmed, irritable?

I hear you.

At age 39 when my periods got heavier, my breasts became so tender I couldn’t hug my kids without wincing and I found myself feeling more anxious and exhausted than ever before, I thought there was something seriously wrong with me and I was starting to lose my mind.

Turns out, I was just entering perimenopause.

The problem was, I had no idea what that really meant. And if as a physician, I felt confused, how were all my female patients,colleagues and friends at the same stage of life supposed to know what was going on.

So that’s why I want to break it down here and 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 our lives in a sex-hormone deficient state, which 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.

So what is menopause?

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, absence of a period for an entire year is typically all the confirmation a woman needs to know she’s officially reached full-on menopause.

Menopause is a natural, normal and inevitable phase of life that signifies the end of our reproductive years. One one hand you may be celebrating…no more pms,no more pads or tampons, sex without worries about pregnacy and on the other, it can be a time to grieve…the end of fertility, the end of a phase of life).

But menopause isn’t just limited to the one day that marks the end of your period. In more broad terms, “menopause” is applied to the one-third of our lives that we live in the years leading up to, during and after our periods end. This significant portion of our lives can be further defined as Perimenopause, Menopause and Post-Menopause which I’ll detail below.

There’s a special circumstance I want to highlight which is premature menopause, which is defined as reaching menopause ( 12 months without a period) – before the age of 40. While this can occur naturally, it also occurs immediately after any procedure that removes the ovaries, and this circumstance is referred to as surgical menopause.

While 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?

While this varies from woman to woman, the phase leading up to menopause, known as perimenopause, typically starts around age 45 ( though for some women it can start in their mid-late 30’s and last 10 to 12 years). In the United States, the average age of menopause is 51.

Think about it this way, during your fertile years, once a month your ovaries release an egg from the stockpile in your ovaries during ovulaton. Perimenopause is the phase when ovulation slows, then stops, and along with it, your period.

Menopause is more than just a phase, in fact it’s three:

1. Phase One, Perimenopause: Perimenopause can last 10 to 12 (average 7-10) 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. This is also when signs and symptoms tend to be the most bothersome and intense, due to both the fluctuations in hormone levels as well as the relative imbalances between them. Even though your hormones levels are declining, they don’t decline at the same rate which 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.

The most important thing to remember are these three words: YOU ARE CRAZY.

Followed by these three words: YOU ARE NOT ALONE

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

2. Phase Two, Menopause: This is when you draw a line in the proverbial sand and cross over it. The day AFTER you’ve gone 12 full months without a period, is the day you’re officially in menopause.

3. 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 didn’t expect when expecting: Menopause (Perimenopause & Beyond) & Why It Can Be So Tough

During perimenopause, it’s not just your estrogen levels that fluctuate wildly, causing symptoms to be intense. There’s a whole symphony of hormones that are trying to work together to create beautiful music, but some of the instruments are out of tune, out of balance and wreaking 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’re not alone and you definately don’t have to just “suck it up buttercup.” Hell no. There are solutions.

From outfitting your bed with a Chili pad to help create your sleep sanctuary to boosting your skin and joints with the right supplements and 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 don’t need to figure this out by yourself!

What you may experience during perimenopause and beyond:

    • Lower progesterone levels: Levels of progesterone start to decrease in your mid-late 30’s 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 may vary along with increasing symptoms like breast tenderness, cramps and headaches.
    • Fluctating estrogen levels: While overall your estrogen level is diminishing as your ovaries start making less of this hormone, due to the more rapid rate of progesterone decline, you may experience symptoms of relative estrogen dominance. This 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 body’s circadian rhythm causing imbalances in your other hormones which can have an impact on your mood, memory, skin and waistline.
    • Vaginal dryness, irritation, and painful sex: Estrogen is major player in skin hydration and maintaining your skin integrity and barrier. Lowered estrogen levels can result in both lack of lubrication in vaginal walls as well as thinning of the vaginal skin making it more vulnerable to irritation, and inflammation.
    • Low sex drive and decresed 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 lower levels of 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 age, lifestyle and genetics that play a role in metabolism and weight changes. Estrogen also plays a role in gut health and motility. Normal levels help maintain balance of the gut microbiome and diminishing levels may contribute to dysbiosis and bloating. What’s more is a decrease in testosterone also leads to a decrease in muscle mass creating “flabbiness.”
    • Incontinence: That decrease in muscle mass from dwindling testosterone can also affect the muscles that support your bladder and rectum. Adult diapers are a 9 Billion, yes, BILLION dollar industry for a reason. This, in addition to osteoporosis and cardiac health, is one of the most signficant reasons to consider bio-identical hormone replenishment therapy.
    • Hair in all the wrong places: Have you noticed less lush locks on your scalp, but growing ones 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. At the same time, estrogen and progesterone had been playing a role in supporting your healthy hair growth, and now with relative androgen dominance, women are more likely to see thinning hair especially after the age of 50.
    • Muscle and Bone Weakness: Diminishing levels of testosterone lead to loss of muscle mass, also known as sarcopenia, making it gradually more challenging to get up from a seated position and move around. It’s why so many elderly women need canes, walkers and worse, wind up in wheelchairs. While low estrogen levels lead to loss of bone density, aka osteoporosis which makes bones more vulnerable to fracture.
    • Skin changes: Estrogen plays a significant role in your skin health by keeping it well hydrated through hyaluronic acid production, boosting collagen production for that youthful glow and helping to maintain the integrity of your skin carrier. As estrogen diminishes, those benefits start to go with it, leaving your skin more dry, sensitive, vulnerable to itch, irritation, sagging, wrinkled and thinning. You may also notice acne and changes in tone and texture. And it’s not just the skin on your face, but also your vagina which is why you may need to use lubrication and sex may be more uncomfortable than it used to be. More on this below.
    • The kitchen sink: There is a wide and varied collection of symptoms that women may experience during this time including but not limited to heart palpitations, a racing mind, achy joints and muscles, as well as headaches and migraines that can all happen 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, and then navigating the post menopausal phase which lasts for the rest of your life can be a lot to handle. But here’s the good news: You’re not alone. We are in this together.

As a physician and as a woman going through this transition myself, I know exactly what it’s like. I’ve dedicated my career to supporting women just like you and me, by replenishing your hormones, reframing your mindset and recharging your energy so you can reclaim your sanity, health and happiness so that you’re not just surviving this phase of life, you’re thriving.

This blog will keep you updated with menopause-focused lifestyle, wellness and beauty ideas. We’ll 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’ve got you covered.

Ready to feel your best? Set up your FREE Consultation now.