Am I in menopause yet?

According to the classic textbook definition, menopause occurs when a woman fails to have her cycle for a year. The average age for the onset of menopause is 51 to 52 years.

by Dr. Sima Aidun — 

As a doctor, I see patients who wonder what is going on with them. They have symptoms of menopause, but still are menstruating every few months.

For example, they suffer from among the following symptoms:

• Hot flashes — Sudden, brief sensations of heat, often over the entire body, sometimes more intense in the face and neck area, caused by a transient dilation of the blood vessels of the skin.
• Sleeping problems — This can be due either to night sweats (nighttime version of hot flashes) that keep them from having a restful sleep, or simply being unable to fall asleep and/or stay asleep for no apparent reason.
• Mood changes — These women think they are going crazy. They cry for no reason or get irritated and angry, without knowing why.
• Fatigue — Some women feel like their days are dragging. This may be from the night sweats that keep them up, or they may just have low energy.
• Lack of a sense of well-being — This is the feeling that something has changed. They have no desire to do things that used to bring them pleasure; they are not depressed, just sad for no reason. They are not the same person they used to be, and they cannot figure out why.

Some women suffer from all of the above symptoms, but they are still menstruating. Infrequent menstruation, however, adds to the confusion. So what is going on? To understand the situation we have to travel a timeline.

When women begin menstruating, it is normal to have infrequent cycles for the first two to three years, sometimes as infrequent as every three to six months. This is normal. You can think of it as “reverse menopause.”

Then there comes the period known as the “reproductive years.” In a perfect scenario, women have their cycle regularly, every 26 to 30 days. During the first half of the cycle, estrogen (the primary hormone responsible for the cyclical tissue buildup in the uterus) is dominant; for the second half of the cycle, progesterone is the dominant hormone. Our bodies naturally produce enough of each hormone, in the proper ratio to each other.

Once women begin heading toward their mid-40s to early 50s, their cycles become less regular again. The ovaries are exhausting their reserves for creating estrogen and progesterone and, as a result, the levels of these hormones drop. These reduced levels of estrogen and progesterone are why some women experience hot flashes, fatigue and lack of sleep for no reason, among other symptoms.

Women at this stage still bleed because, although the level of estrogen drops compared to the reproductive years, there is still enough estrogen present to stimulate the uterine lining to create the tissue that causes menstruation. These women still have their cycles, but they become irregular, since the rhythm of hormonal interactions and fluctuations has changed.

The last stop is menopause. According to the classic textbook definition, menopause occurs when a woman fails to have her cycle for a year. The average age for the onset of menopause is 51 to 52 years. No one can predict when a woman will experience menopause or how long the transition from pre-menopause to menopause will take. This process is highly individualized. Family history may be something of an indicator, but it cannot predict with certainty when you will begin menopause. If your mother or older sister(s) experienced early natural menopause, there is some likelihood that this might happen to you, too.

During menopause, the ovaries stop producing estrogen and progesterone; however, this does not mean your body will completely cease production of these hormones. During menopause, the adrenal glands take over. The adrenals produce testosterone, which is converted to estrone, a type of estrogen produced mainly during menopause in the peripheral fat cells.

What is the solution for menopausal symptoms? If you are still menstruating, are in your mid-40s to early 50s and suffer from the above-listed symptoms, so much so that they affect your daily interactions, you are most probably in the pre-menopausal stage. Your blood hormone level should be measured on the optimal day — typically, day 19 to 22 of your cycle. If you have not had a cycle for two to three months, a random test is in order.

Based on the blood test, hormonal imbalances will likely show up. The imbalances can be addressed by correcting the deficiencies of estrogen and/or progesterone with bio-identical hormones; or you can supplement with herbs, clinical nutrients and acupuncture to assist you in making this life transition naturally. The choice is yours.

Dr. Sima Aidun is a naturopathic medical doctor focusing on women’s healthcare, with an emphasis on bio-identical hormones, clinical nutrition, acupuncture and botanical medicine. 480-281-1462 or draidun@cox.net.

Reprinted from AzNetNews, Volume 25, Number 6, December 2006/January 2007.