The Menopause Transition

5 June 2021

The Menopause Transition

Are you unsure what stage of menopause you’re in - pre-menopause, perimenopause, or postmenopause?

Did you even know there was a difference?

Don’t worry, many women are confused by the terminology and how to tell when or if  they have transitioned from one stage to another. Firstly, menopause isn’t a night and day event, this second life stage is a transition, and as with all transitions in life there are bumps and glitches along the way.

When we hit approx 40 years of age things start to shift, mainly because the follicle production (termed Folliculogenesis) in the ovaries and the process of ovulation is becoming harder work to perform. Folliculogenesis is the process in which a recruited baby (primordia)l follicle grows and develops into a specialized “chosen one” graafian follicle with the potential to either ovulate its egg into the fallopian tube to be fertilized or to die by natural atresia. The process is long, requiring almost 1 year for a primordial follicle to grow and develop to the ovulatory stage, and thereby as we move through each decade this priming and development of baby follicles slows and eventually ceases. Only a few follicles in the ovary survive to complete the  differentiation process, with 99.9% dying by a programmed cell death mechanism. 

As a result of the slowing down process the 4 master hormones:  LH, FSH, Oestrogen and Progesterone that direct the menstrual cycle - and the maturation of the follicles and ovulation become more chaotic and erratic in nature -  this is menopause transition. 

Medically speaking menopause transition is divided into two phases: early and late (how catchy!) and is derived from the STRAW classification.  The STRAW (Stages of Reproductive Aging Workshop) classification proposed by the American Society for Reproductive Medicine depicts the natural transition in a female's life from the reproductive years to the time of menopause.

The STRAW+10 staging system is applicable to all women regardless of age, demographic, body mass index, or lifestyle characteristics. The STRAW criteria is widely considered the gold standard for characterising reproductive ageing through menopause.

Ok, enough of that, what does that mean to you, the woman reading this….?

  • The early stage transition (shown on the graph as -2) is marked by increased variability in menstrual cycle length, defined as a persistent difference of cycle length by 7 days. We also see on the graph that oestrogen is HIGH (not indeed low as women are told and led to believe)  in the early “menopausal transition”.
  • The late Stage transition (-1) is marked by the occurrence of amenorrhea (skipped periods) - meaning 60 days between menstrual cycles. Estrogen levels are still erratic but beginning to decline and this stage can last 1-3 years. 

Symptoms such as hot flashes and insomnia “generally” but not always, start in the late phase along with other typical signs like fatigue, the dreaded change in metabolism and weight gain, vaginal dryness, lack of interest in sex, and moodiness. Your menstrual  flow will change as well. 

Now, let me go back to my original point, “with all transitions in life there are bumps and glitches along the way”.

Women's hormones are beautifully complex, yet highly sensitive and responsive to all aspects of our environment: from our nutrition, sleep patterns, blood sugar management, weight, inflammatory burden and status of other hormones like insulin & thyroid. During this transition process the brain and body is having to recalibrate. The operation system by which it ran so smoothly previously is changing its rhythm and there are some key “players" missing.  Hormones are often likened to an orchestra, with the brain (hypothalamus) and pituitary acting like the conductor of that orchestra. At the menopause transition, the orchestra is not only having to learn an entirely new piece of music, but the players are different too (it's like having a new bunch of primary school children in the orchestra learning the recorder (ohhh how I struggled with that phase!). So, the sound is neither sweet or fluid and the tempo is erratic- sound familiar!

And THIS is why, all those other hormones and external contributory factors are vital to address and keep in tip top condition.

Is there a test to see what stage you are in?

Well……….I have recently had a fascinating meeting with an innovative, and I believe game changer of a company FORTH that specialise in women's health from an assessment perspective. 

They have created The Female Hormone Mapping test, which is without doubt the next generation in female hormone blood testing. The test (two home blood spot samples) helps women's gain a deeper insight into their fluctuations (based on all that I've written above) and can along with symptoms (that are collected from an app that is then fed through AI technology) provide confirmation of stages of menopause transition.

With this information “care” really can be targeted, be that suitability to HRT and other lifestyle and dietary interventions. Take a look here for details, they are running a special offer until the end of June for just £99 (I have absolutely no financial interest or gain in this test, I simply believe from speaking with their CEO - Sarah Bolt and her team this really is going to help so many women). 

I hope having this information explained a little more, has helped you understand your body a little better, and having this knowledge empowers you to seek out where to focus your attention. It might be giving up that daily glass of wine at 7pm to help you sleep better and re-stabilise your blood sugar or getting out of bed half an hour earlier and sitting in the garden to reset your circadian clock - honestly, every little intervention stacks up to make a significant impact during this transition stage.  From small acorns and all that……...

In health, Tanya x