A menopause definition that covers the three phases of adult women’s lives

In an attempt to further refine the World Health Organisation's menopause definition, the group of menopause experts known as the STRAW group (1), divided what they termed "normal reproductive aging", into three categories:

i) Pre menopause

This is our reproductive phase, and is divided into early, peak and late phases.

ii) Menopausal transition

This is when we enter our menopausal years. This phase is characterised by irregular cycles and is divided into early and late phases.

iii) Post menopause

This phase starts at the end of the final menstrual period and also is divided into early and late phases.

Of course our last period doesn’t come with a big red flag announcing that it is our last one, so this phase is not recognised until at least 12 months have gone by without menstruating (12 months of amenorrhoea).

But even the expert STRAW report is ambiguous in places and these extensions of the menopause definition have been interpreted differently. For instance there is confusion about when pre menopause ends and when perimenopause begins. It is also debated when the menopausal transition begins, how exactly the early and late phases are defined and what the limits of perimenopause are.

So what happens to women’s bodies at menopause?

Although menopause facts are still not fully understood, the medical menopause definition recognises the process as the end of monthly ovulation with its associated monthly bleed and the start of post-reproductive life.

But natural science still has a limited understanding of the biochemistry of the menopausal process.

What is known is that there is a change in the delicate balance between the hormones released in the brain and the hormones that are directly released from the ovary.

Hormone changes

In a fertile, premenopausal woman, these hormones work together in a kind of dance: the brain hormones stimulate ovulation and the ovarian hormones (oestrogen* and progesterone) provide a feedback signal that tells the brain when to shut down the release of the stimulating hormones.

During perimenopause this balance changes and there is a dramatic drop in the production of the hormone oestrogen by the ovaries and an increase in the stimulating hormones from the brain. After the menopause very little oestrogen is made by the ovaries but some is made by fat tissue.

(*Note: Oestrogen is spelt with an O in British English and with an E - Estrogen in the USA and Canada.)

Falling levels of oestrogen are thought to play a role in causing the hot flushes and vaginal dryness that many women experience while their bodies adjust to a new, but equally delicate balance of hormones that will accompany them for the rest of their lives.

But even though you can find much more detail about these changes in the scientific literature, it’s worth knowing that:

The exact relationship of menopausal hormonal changes to midlife discomforts is still not fully understood by scientists.

Medical menopause definition is not as solid as it seems

The nature of medical language is to sound definite and positive because in science there is no room for uncertainty and blurred lines.

But many people do not realise that medical knowledge about menopause is still quite limited – and this creates a lot of misunderstanding.

In fact not only has majority medical opinion changed quite radically in the last few decades and is continuing to change almost daily, but within medicine itself there is still argument about the nature of menopause and its need or not for "treatment".

Still no definitive test for menopause!

The situation is also confusing because there is no easy objective way of determining where a woman is in the whole process:

Contrary to popular belief, there is still no simple blood or urine test that can confirm at what stage a woman is at in her journey through menopause.

Without taking a series of tests over many cycles, which is usually impractical, doctors cannot say for definite whether a woman has had her final period until at least 12 months have past since her last bleed.

This is because there is so much variation not only between different women but also in the same woman from one cycle to another.

An uncharted adventure

So the journey through perimenopause, past the last menstruation lighthouse that signifies menopause and onto the open water of post menopause is a voyage of discovery for every woman - there are no fixed charts to mark her way.

Bibliography

1. The STRAW Report: Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Climacteric. 2001 Dec;4(4):267-272.

2. Centre for Menstrual Cycle and Ovulation Research CeMCOR. Provides information for women about changes through the life cycle, from adolescence to menopause. CeMCOR'S goal is to do good science that honours the voices and experiences of women.

Published March 2010 Updated 4/3/2010

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