Confused about perimenopause?

It’s that betwixt and between time

Perimenopause is a medical term that refers to the time around the menopause (“peri” means “around” in Latin). It’s that in-between phase between full fertility with regular monthly cycles (pre-menopause) and infertility with no menstrual cycle and no monthly bleeding (post-menopause).

The easiest way to think of it, is as the life phase from when your periods start to have a different pattern from usual (frequency, flow, length) until about one year after your last period.

Of course … this isn’t so easy, since many women have irregular or unpredictable cycles way before they get anywhere near menopause, and nobody can say for sure which was your last period … until one year has passed without one …

And the plot thickens…

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Uncertain boundaries

When you start to try and unpick the detail of the definition, it all gets a bit muddled. This is partly because women’s bodies aren’t machines. Each woman’s body is a world unto itself, and this makes our midlife transition a bit unpredictable. It’s also partly because the actual menopause – ie the last menstrual period – is impossible to identify until after 12 months have passed.

Although the term perimenopause refers to a normal physiological phase, there is disagreement about its start and finish.

See if you can spot the difference between these two medical definitions:

This is the North American Menopause Society’s definition:

"Perimenopause. A span of time typically lasting 6 years or more that begins with the onset of menstrual cycle changes and other menopause-related symptoms and extends through menopause (the last menstrual period) to 1 year after menopause. Perimenopause is experienced only with spontaneous (natural) menopause, not induced menopause. Also called the menopause transition."

Source: North American Menopause Society online glossary


Now take a look at what the Australian Menopause Society’s glossary says:

"Peri-menopause. Peri-menopause refers to the time from the onset of menopausal symptoms through to the last menstrual period particularly from the onset of irregular periods. It can last on an average of 4-6 years before the periods finally stop."

Source: Australian Menopause Society online glossary


Spotting the difference

While both societies agree in general terms that peri-menopause can last for up to 6 years or so, in North America the phase lasts until 1 year after your last ever period, (1 year after menopause), whereas in Australia your peri-menopause stops on the actual day of your menopause (the day of your last ever period).

Many doctors feel that the term perimenopause is so inexact that it should not be used in medical contexts any more as it just causes confusion. The North American Menopause Society recommends the use of the term menopausal transition for the in-between phase. Perhaps using the word transition implies some vagueness about when it all starts and finishes.


Common sense approach

It’s best not to get too concerned about exactness of definitions for this time of life, because once you delve into the detail you will find that even medics haven’t got the matter firmly taped, although a recent statement has clarified matters considerably (1).

The reason for having a term for the “in-between phase is because typically this is the time when women may experience a number of discomforts as their bodies adjust to their new hormonal balance.

There’s lots of talk about menopause, hormone changes and symptoms, but as far as the firm scientific evidence goes, it’s very difficult to blame hormone imbalance for anything other than hot flashes and vaginal dryness. Some insomnia may be caused by night sweats and flushing but all the other so-called menopause symptoms are just as likely to be related to age changes rather than hormone changes. Men get discomforts at midlife too!

You can read more about midlife symptoms and their relation to hormone changes here: Hormone changes and menopause symptoms


Lived experience

Although peri-menopause is a medical term – strictly speaking it refers only to the biological aspect of midlife – it is often used as a synonym to that older term climacteric.

Climacteric is a more descriptive word that refers to the whole process of transition that people go through at midlife. Climacteric is not a medical term and does not appear in the online glossaries of either the North American or the Australian menopause societies.

The transition referred to by the word climacteric usually includes biological menopause but more importantly, the term also refers to a much more general and broad transformation that includes emotional, psychological, emotional, social and relationship changes too. Climacteric was once used for men too but it’s seems to have become an exclusively female term in modern times.

You can read more here about climacteric, how it was once a term for men’s midlife crisis and how other cultures have similar terms: Climacteric.


Reference

1) Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012 Apr;19(4):387-95.



Published February 2010. Re-written August 2012


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