First signs of menopause - beginning the journey

You're hot and sweaty and can't sleep - are these the first signs of menopause?

The most important early sign of menopause is a disruption in the usual monthly cycle in a woman over the age of 40.

For example:

• the cycle (time between periods) may become longer or shorter than usual or...

• the bleed may be lighter or heavier or...

• the period may not come at all.

Hot flushes, night sweats and insomnia may be early signs of menopause but they can all happen for other reasons too. Read about symptoms of menopause.

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If periods stop for good between the ages of 40 and 45 this is called early menopause and is usually completely normal. If periods stop permanently before the age of 40 this is not normal menopause. Read more about early menopause.

The first signs of normal menopause often (but not always) fall into 2 phases:

Two phases in the normal menopause transition

i) Early menopause transition.

This is the phase when a woman notices the first signs of menopause - namely that her normal cycle varies by at least 7 days either way. This means that either her period comes more than 7 days earlier than expected or it comes more than 7 days later. Of course, this variation can happen for other reasons than menopause – including pregnancy.

At this early stage of the menopause transition, ovulation is still taking place so conception is still possible and birth control must be used if you don't want to get pregnant. Other first signs of menopause include periods that are lighter than usual, or sometimes the flow may be heavier than usual.

ii) Late menopause transition

In this second phase of normal menopause, periods become much less frequent. There may be a gap of 60 or more days between one bleed and the next, two or more periods may be missed and then suddenly another comes along unexpectedly. Also there may be spotting or occasionally flooding.


Crossing the invisible rubicon

It's difficult to predict exactly when you will reach your menopause age but one day, after some months of this on-off time, the period simply doesn't come at all and it never comes again!

After 12 months of no further bleeding you can be fairly certain that you have passed the menopause. But in women younger than 50 it is as well to wait another 12 months before you can be really certain that you are post-menopausal (keep using birth control until you are sure).

Any new bleeding in a woman over 50 who has gone a year or more without a period is unusual and you should always talk to your doctor about this.


What about other early signs of menopause?

Many women in their forties experience some of the discomforts that are popularly regarded as menopause symptoms: hot flushes (hot flashes), night sweats, insomnia, mood changes and perhaps a reduced interest in sex.

First signs of menopause may include:

hot flashes and night sweats

dry vagina

insomnia


But these symptoms can happen for other reasons may or may not be first signs of menopause.

Some symptoms often blamed on menopause are simply signs of aging. Is it menopause or age?

Remember that NONE of these symptoms tells you that you are definitely entering your menopause, because all of them may occur for other reasons.

Nevertheless the occurrence of one or more of these typical menopause symptoms in a 40- or 50-something woman who has never had them before and who is also experiencing menstrual irregularity is a sign that the menopause may be on its way and that she is entering the menopause transition.


Is there a blood test to confirm that menopause has arrived or is on its way?

No. Why predicting menopause age is difficult.

You may hear people talk about FSH levels. FSH is short for Follicle Stimulating Hormone and is a hormone released by the pituitary gland (in the brain) in response to a feedback from the ovary. When levels of oestrogen (produced by the ovary) go down this stimulates the pituitary to produce FSH and a blood or urine test will show higher levels of FSH. But FSH levels vary a lot in the months preceding your last period and neither a measurement of FSH nor oestrogen can diagnose menopause because the next month these levels might change again.

The same goes for the months after menopause: there are huge variations in oestrogen and FSH blood levels between different women and even in the same woman. So it's very difficult for your doctor to definitively diagnose menopause until those 12, no-period months have gone by.


Is there anything that makes menopause occur earlier?

Smoking!

If you're worried about first signs of menopause, you'd better stub out that cigarette! Because studies have consistently shown that early menopause occurs more often in smokers than non-smokers.

Read more about smoking and menopause.


Predicting when you will have your menopause

It may seem quite extraordinary, but in spite of 21st century technical wizardry, we are still not able to predict the exact age of menopause of any individual woman. There is lots of research going on to try and pinpoint the first signs of menopause more exactly but there is still no test that can accurately predict the start of the menopausal transition with reliability.

Scientists are exploring a range of possibilities including combinations of hormone measurements or even genetic profiles but they still haven't reached any firm conclusions.


Trust yourself!

It may be the 21st century but doctors still have a lot to learn about the details of our remarkable menopausal physiology.

So if you think you are getting the first signs of menopause, you're best to trust your own intuitions and observations.

Because no-one can tell you for sure whether your menopause is about to happen, or even if it has already happened ... until those magic 12 no-period months have passed!


Bibliography

Burger H et al. A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women’s Midlife Health Project. Human Reproduction Update. 2007;13: 559-65.

Lambalk CB et al. Testing ovarian reserve to predict age at menopause. Maturitas 2009; 63:280-291

First published January 2010. Updated August 2012


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