Menopause

Menopause is the point in the fertility cycle when menstruation has ceased for 12 consecutive months. This permanent disruption of the menstrual cycle is caused by changes in reproductive hormone activity in the body and indicates that a natural pregnancy is no longer possible.

Anyone with a uterus who reaches menarche, or the onset of menstruation, will eventually experience menstruation if they live long enough. In the majority of cases, menopause occurs between the ages of 40 and 58. When menopause is reached between the ages of 40 and 45, it is considered early menopause. It if is reached before the age of 40, it is considered premature menopause.

However, it can also happen outside of this age range. Menopause can be induced at an earlier age by natural causes associated with ovarian health, as well as through hormonal treatments or surgical interventions.

Perimenopause, menopause, and postmenopause

Perimenopause is the time leading up to menopause. It makes the phase when the body’s hormones begin their change to prepare for the cessation of the menstrual cycle and bring about menopause. This period of time can last from a few months to many years. However, some people will bypass the perimenopause phase altogether, becoming suddenly menopausal rather than taking up to years to reach it. 

During perimenopause, menstrual periods become irregular and the flow of each period will fluctuate. Some will experience heavier flow than is typical for them while others find that it lightens. Periods may be delayed or fully skipped as one approaches their final period. When the perimenopause phase is non-existent or shorter than average, or the onset of menopause is hurried, the symptoms are likely to be more severe. 

Postmenopause is the period of time after menopause, or the twelfth month after the last period, has been reached. 

What happens in the body during menopause

During menopause, hormones associated with reproduction begin to change. Due to lower levels of estrogen, progesterone, testosterone, follicle-stimulating hormone, and luteinizing hormone, the body undergoes notable changes. Most significantly, this is when the loss of active ovarian follicles is observed. 

Ovarian follicles are the thousands of small sacs in the ovaries which contain and release eggs. These reproductive structures facilitate menstruation and other reproductive processes throughout one’s fertile years. When they cease to function, 

Symptoms of Menopause

An individual’s unique experience with menopause can vary greatly. Menopause symptoms may develop a few years prior to their last period and/or continue on for a few years after their last period, though this range can vary. Though it is less common, some people have experienced symptoms for as many as 10 years prior to the onset of menopause and as many as 12 years after menopause has occurred.

Beyond the fluctuations and a reduced frequency in periods, the most common perimenopausal symptoms are hot flashes and night sweats. It is estimated that 3 out of 4 people going through menopause experience hot flashes for 6 to 24 months, however, they can last up to a decade.

Other common symptoms of menopause can include:

- Vaginal dryness

- Pain during sex

- Dryness around mouth, eyes, and skin

- Reduce desire or drive for sex

- Joint stiffness

- Reduced muscle mass

- Difficulties sleeping and insomnia

- Increased frequency of urination

- Urinary tract infections

- Weight gain

- Sore breasts

- Loss of breast volume

- Thinning hair or hair loss

- Increased body hair growth

- Headaches

- Memory problems

- Concentration difficulties

- Anxiety

- Depression

Generally, menopause symptoms can be managed by maintaining a healthy lifestyle or making lifestyle adjustments, and other such natural approaches. However, when symptoms are severe, they can affect one’s quality of life. Some people may benefit from discussing hormone therapy treatments with their medical health provider in order to ease the severity of their symptoms. 

There is no treatment to prevent or reverse menopause. Menopause marks the end of natural fertility and is not a reversible biological process. 

Induced Menopause

In some cases, menopause can be induced earlier than anticipated by outside factors such as injury to the pelvis which affect or destroy the ovaries, damage caused to the ovaries during or by certain hormone or radiation therapies for the treatment of other conditions like cancer, or surgical removal of both the ovaries (i.e. a bilateral oophorectomy). Induced menopause can occur time after the onset of menarche during puberty and before menopause occurs naturally on its own.

Menopause and the Trans Community

As it stands, there is not much data yet on the effects and experiences of menopause in AFAB (“assigned female at birth”) trans and non-binary people. Many transgender people incorporate hormone therapies into their transition process, though not everyone makes this choice.

Without medical intervention, any trans and non-binary person who experiences menstruation will eventually go through menopause. However, if they undergo hormone therapy as a result of their transition to terminate their period, they will not experience menopause because gender-affirming hormones are typically administered for the duration of their lives.

It was once believed that there was some risk associated with continued estrogen treatment and that one day, trans people taking estrogen would need to withdraw from the hormone in order to induce menopause. This practice is no longer deemed necessary. As such, they will not experience the spontaneous reduction in hormone production which results in the onset of menopause.

Risks Associated with Menopause

While menopause is a natural part of the fertility cycle, there are complications and risks associated with the shifted state of the body. The earlier menopause sets in, the higher one’s risk profile can be with regard to osteoporosis, heart disease, changes in sexual function and desire, and changes in cognitive function. 

There are also notable mental health challenges that come with such a significant life and body change. Having the necessary support while navigating this change is as important as managing the physical symptoms.

Having an awareness of these factors can help in managing them, both to prevent greater complications from arising as well as feeling more empowered when discussing any issues with one’s doctor.