Menopause 101
By Jessica Schneider, MD, Hunterdon Obstetrics and Gynecology
Everybody has heard about puberty. All of the changes in your body and your brain. You grow breasts, you grow hair, you get your period, you get really moody. This is courtesy of hormones. As we continue on in our hormonal lives, the estrogen levels start to have a more predictable interplay with progesterone, luteinizing hormone, and follicle stimulating hormone, among others. At the start of each menstrual cycle, the estrogen level is low. The pituitary gland, which is located in the back of your brain, notices these low estrogen levels, and starts to push out follicle stimulating hormone. This increase in follicle stimulating hormone tells your ovaries to wake up and start getting some eggs ready for fertilization. The ovary waking up and the eggs coming to the surface causes the formation of follicles, which cause the estrogen levels to rise. One follicle gets bigger than the others, and becomes the dominant follicle. As the estrogen levels continue to rise, they tell your pituitary to stop making as much follicle stimulating hormone, so the non-dominant follicles slow down and the dominant follicle reaches its peak, so most months, we only release one egg at a time. Once the estrogen levels reach a critical point, they trigger another hormone from the pituitary, luteinizing hormone, which tells the ovary to release that egg. The cyst remaining after the release of the egg then secretes progesterone, which prepares the uterus for pregnancy. If there is no pregnancy, the lack of pregnancy hormones causes the progesterone levels to decrease, and then the lining of the uterus is shed, which causes the monthly bleeding. Then this cycle starts all over again.
We start to settle down, and learn to live with this monthly hormonal ballet. We learn what times of the month we have acne, what days we are moodier, what days we bleed, what days we are most likely to get pregnant, when we are bloated. We learn when our breasts ache, when we are more tired for no good reason. Some of us prefer to avoid the dance, and start on birth control to mitigate this. Of course, it’s once we start to have our lives together, and we feel most settled into our home life and careers, estrogen starts to dwindle, and puberty starts all over again. This time, we call it menopause.
Eventually, usually between ages 45-50, our estrogen levels decline to a point where they no longer are able to regularly trigger our follicle stimulating hormone to release our eggs, which is called ovulation. If we are not ovulating, our period is not going to come regularly. Irregular and sometimes heavy periods are one of the first things people start to notice in the approach to menopause, which is called perimenopause. Perimenopause can last up to 10 years. It is important to note that not all irregular bleeding in this age group is perimenopause. If you are having new onset irregular bleeding, please discuss it with your gynecologist or primary care physician.
The hardest part of perimenopause for many women is not the unpredictable bleeding. Along with the changes in menstrual pattern, the decreasing estrogen can also cause mood changes, hot flashes, dry skin, brittle hair and nails, lower libido, and vaginal dryness, among others.
Menopause starts after a full calendar year after your last period. Aside from the unpredictable bleeding, the symptoms of menopause are the same as those of perimenopause. The good news is, like with puberty, the farther away you get from the onset of menopause, the more manageable your symptoms become. Some other good news is that we also have some ways that we can help you improve your symptoms of menopause and perimenopause. There are non-hormonal options as well as hormonal options, including herbal remedies, antidepressant medications and hormone replacement therapy. I would recommend that you speak with your gynecologist or primary care physician about which options will be safest and most effective for you.
If you need a Gynecologist, Dr. Schneider is accepting patients in her new office Hunterdon Obstetrics and Gynecology. Her office is located at 207 Strykers Road, Phillipsburg, NJ. To schedule an appointment, please call 908-237-4279.