This year, over two million U.S. women will reach menopause, marking 12 consecutive months without a period. Menopause signifies the permanent end of fertility, due to the natural depletion of ovarian oocytes (egg cells) from aging and the drastic reduction in production of reproductive hormones, particularly estrogen. By around age 51, for all procreative purposes, a woman’s ovaries have retired.
To appreciate the significance of this biological change, consider the role the ovaries play over the course of a female’s lifetime. At birth, the ovaries already house all the cellular material that will mature into female gametes. During puberty, the ovaries decide the conditions for childbearing are right and they trigger development of the mammary glands and uterus.
Throughout the decades of fertility that follow, the ovaries stimulate the monthly ovum release, create changes in the uterine lining, and bring about a menstrual cycle. From approximately 100 days in utero until death, the ovaries impact the entire body in delicate and unpredictable ways. They are, without a doubt, the most important organs in the female reproductive system.
Sometime in her late 30s or early 40s, after decades of diligent monthly offerings to propagate the species, a woman’s ovaries will start to slow the production of estrogen. This conversion period, known as perimenopause, can last up to ten years as the ovaries continue to wind down, and the body must adjust to the absence of this hormone. Menopause is the conclusion of this gradual change, when elevated follicle stimulating hormone (FSH) and low estrogen (estradiol) have caused menses to cease completely.
Women will spend over a third of their lives in this stage of life, and yet, its physicality remains a mysterious and shameful feature of aging. Menopause is stigmatized as a miserable and crazy time we must endure in silence, but it needn’t be. Being equipped with knowledge about what to expect during this transition can make a world of difference.
The simplest way to understand what lies ahead is to think of estrogen as a drug – a drug that affects your brain, your cardiovascular and endocrine (glands) systems, bone and tissue building, and literally every other organ in your body. Your body is dependent upon this drug, and when it ceases to be available your systems go through withdrawal, or perimenopause. The associated symptoms, severity, and duration vary wildly from person to person, and just like any other addictive process, they are followed by a maintenance period. This maintenance period where your body adjusts to the permanent absence of estrogen is menopause.
Here are the most common symptoms of perimenopause and menopause you can expect:
1 | Body temperature surges
Hot flashes are a vasomotor response to your brain misreading hormone cues from its thermoregulatory center. Basically, your brain thinks you’re overheating and tries to cool you off. The result is a rapid dilation of blood vessels, profuse sweating, and heart palpitations. Episodes typically last several minutes and are most frequent in the early stages of estrogen withdrawal.
2 | Sleep disruption
Most perimenopausal and menopausal women complain of insomnia, characterized by difficulties both falling and staying asleep. Originally, hot flashes were to blame, but research shows that menopausal women are actually experiencing a flight-or-fight reaction due to the brain withdrawing from reproductive hormones. Regardless of the cause, inadequate sleep can make you miserable and triggers other problems like moodiness, irritability, cognitive decline, lethargy, and even weight gain.
3 | Changes in skin
Your skin is constantly battling the effects of sun exposure, environmental factors, and intrinsic aging. Unfortunately, menopause weakens its ability to repair itself, and the effects of these conditions are accelerated. Estrogen is essential to our skin cells’ production of collagen and elastin, which help retain moisture and shape. Without it, skin becomes thin, dry, and saggy in appearance. Low estrogen also contributes to a loss of muscle tone, decreased sensitivity, and slower healing time.
4 | Hair loss or change in texture
Hair thinning, coarsening, and graying are natural parts of the aging process and are also accelerated by menopause. Diminishing estrogen disrupts the hair follicle function and production, so fewer new hairs grow; melanin, which gives hair its color, is sparse; and sebaceous gland (natural body oil) activity slows as well, so new hair is dry and brittle. While estrogen decreases, androgen hormones (e.g. testosterone) remain, causing hair to grow in new places, like the chin, upper lip, and sideburns.
5 | Weight shifts
While many women complain of gaining weight during menopause, it is unclear whether this is a direct result of dwindling estrogen supplies. What is clear is the body’s weight shifts from the effect of estrogen withdrawal on the metabolic hormones like insulin, cortisol, and thyroxine. Body fat tends to accumulate around the abdomen and decrease on the extremities.
None of this is any fun, but it is the price we pay for an increasingly long lifespan. While there is no cure for aging ovaries, there are excellent hormone replacement therapies available, which ease the unpleasant symptoms of estrogen withdrawal. Eating right and exercising do wonders for any physical challenge, and most importantly, talking about menopause and sharing experiences will foster a healthy mindset.