Perimenopause and Menopause Explained

Transcript:

Jamie Forward: Dr. Ali, can you just start by defining this phase of life? What is menopause?

Dr. Nina Ali: So, menopause is defined by going one full year without having a menstrual cycle. It’s a retrospective diagnosis, and I think that’s one of the challenges of it. It signifies a transition from our reproductive phase to our menopause phase. And once a woman is in menopause, she remains in that post-menopause phase for the rest of her life. That typically is going to happen for women in our mid-40s to mid-50s. So, the defining feature remains that looking for the pattern of your period. It’s a little bit harder for someone who doesn’t have a uterus and is not having menstrual cycles.

So, in that case, we can use hormonal measures to sort of define when that happens, and we also use that timeframe.

Jamie Forward: Okay. And so, chances are, some of our viewers today are just sort of starting to experience symptoms or some of them may be well into this phase of life. So, you can hear, “I’m in perimenopause,” or “I’m menopausal.” Dr. Piasta, can you talk about perimenopause and how that’s defined and maybe how long it lasts?

Dr. Jackie Piasta: Sure. Of course. It’s my favorite subject to talk about. So, perimenopause literally just means the time around menopause. And our understanding of perimenopause has been primarily informed by actually a very long-term study called the SWAN study, or it stands for the Study of Women Across the Nation. And our current understanding is really still evolving, but literally that time around menopause. It can last from anywhere from two to four years to as long as eight to 10 or sometimes even longer. And it’s really that lead-up until your final menstrual cycle.

The important thing that I like to teach my patients is, there are often two very distinct phases of perimenopause. There’s the early phase where a lot of women don’t really experience a ton of symptoms or they don’t have a lot of abnormality in their cycles, and so that can be very variable in terms of how long that lasts. And then you have the late perimenopause stage, which really is that last one to three years leading up to that final menstrual cycle where your periods really begin to have longer excursions, spreading out longer than 60 days apart from one another. But again, it’s just really that time leading up to menopause.

Jamie Forward: Sure. And so, it sounds like obviously menopause is after 12 months without a period. So, it sounds like you’re not in menopause so much as you go right into post-menopause from perimenopause. Would that be accurate, Dr. Ali?

Dr. Nina Ali: Yeah. I mean, technically I guess it’s a time point when it’s been a year without a period. I mean, we have to have definitions.

But when you look at how we are treating our patients when a woman comes in to see me with these symptoms, a lot of times we’re looking at that person as an individual and we do want to see, “Okay. Where are you in this process?” But honestly, the way I treat someone in late perimenopause versus that first early years of menopause, it’s really a lot of menopause care and perimenopause care is navigating symptoms. So, that is honestly what matters most.

And whether someone is a year or two years post their last period, many women are – we’re not robots and we’re not machines, so you might get to 13 months and then have a period again, does that mean we’re kind of starting all over? No. We’re managing what symptoms are showing up at that time. But everybody is so different, and that’s what makes working in this space really fun and rewarding.