Learning August 14, 2019

Talking the talk.

Let’s talk about the talk (i.e., terminology)

Menopause is challenging enough. The language used to describe it shouldn’t make it harder. As it stands, the terminology and usage related to menopause is quite muddled. So, let’s clear it up.

Menopause. Menopause is derived from two roots from Greek, men or meno for month and pausis meaning to pause or cease (Menstruation uses the same root).
Menopause is technically a point in time. That point in time is when a woman has gone 12 consecutive months without a menstrual cycle. Common uses are “hit menopause, reach menopause, through menopause”. For a young girl, puberty is marked by the first menstrual cycle. Menopause is marked by its cessation.

Menopause is also used to describe the entire multi-year transition through which a woman’s hormonal profile shifts from one to another. And throughout the transition, hormones are fluctuating on their way to a new normal. Through that transition there are terms for the different phases: pre-, peri-, early post-, late post-. Pre and peri- get confused. Early post- and later post- get lumped conceptually into one thing. Let’s sort that out.

Pre-menopause. Anything before you hit menopause could technically be considered “pre” and generally refers to the time in your 40s leading up to menopause (the average age is 51 in the US and UK). For example, a woman in her 30s is technically pre-menopause but is not that relevant to her so it’s not really used to describe her situation.

Perimenopause. The prefix “peri” means “around” so perimenopause technically means the time around menopause. However, its common usage refers to the time before menopause when symptoms arise due to hormonal changes. It’s used in phrases such as “in perimenopause”, “experiencing perimenopause” or “I am perimenopause”. If you’re still having periods without noticeable changes and you’re in your 40s, you’d be pre-menopause. If your periods are changing (typically cycles shorten and get heavier) or you’re starting to experience symptoms (more emotional volatility and some hot flashes), you are technically still in pre-menopause (because you are still menstruating) but you are now also in perimenopause. Hormones start to get out of whack and can cause symptoms.

Post-menopause. Post is any time after you’ve marked those 12 consecutive months without a period. The time after can be separated into two phases: early post-menopause and late post-menopause. Early post-menopause is when your body is working towards its new normal, ovaries have ceased ovulation and estrogen levels are falling. Late post-menopause is when your body has found a new normal with essentially no estrogen production and generally (generally!) symptoms go away. Late post-menopause is what commonly think of when we talk about menopause.

The distinction between peri, early post- and later post- is a not a matter of linguistic gymnastics. They are distinct because the underlying hormonal profiles are distinct. It is a critical categorization that will help foster self-awareness and guide treatment of symptoms. The more consistent we get, the better we all are.

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