I can distinctly remember the first client I coached who went through menopause. I had already been coaching her for 4-5 years when things began to shift for her. Being a fairly novice coach, I can remember doing an exhaustive amount of reading, research and self study about menopause; what menopause was, the changes that occurred, the challenges it presented, and most importantly, what I could do to help guide my client through that transitional period in her life.
Fast forward to today and I both coach and have coached dozens of women who have either gone through, or are going through menopause.
Women go through pretty remarkable physical changes throughout their lives. What God designed a woman's body to do is truly extraordinary.
Yet I have discovered many women don't even really understand what exactly menopause is, how it changes their bodies, or what to expect throughout the process.
In this blog I want to focus on explaining the changes that can happen to your body before, during, and after menopause as well as the challenges this period of life can present.
THE STAGES OF MENOPAUSE
As you probably know, menopause is the term used to generally refer to the natural decline in reproductive hormones that occurs as women enter their 40s-50s. The average age of a woman going through menopause in the U.S is 51.
There are various stages of menopause, and the entire process typically takes a few years.
The three stages of menopause are perimenopause, menopause, and postmenopause.
I’m going to briefly touch on premenopause as well.
Premenopause - Premenopause and perimenopause are sometimes used interchangeably, but technically they have different meanings.
Premenopause is when you have no symptoms of either perimenopause or menopause.
You are considered to be in your reproductive years and still get your cycle regularly.
I like to encourage my clients to start regularly checking their hormones around the age of 35 for two main reasons:
1- to make sure hormones are adequate
2- to begin to get a baseline of individual hormones levels prior to entering perimenopause.
Perimenopause - Perimenopause means “around or near menopause" and this stage occurs well before you officially hit menopause.
The Cleveland Clinic states that hormonal changes can be seen as early as 8 to 10 years before officially hitting menopause. This means symptoms can unfold during your 30s or 40s.
During this stage, you will begin to experience symptoms of hormonal changes.
The average length of the perimenopause stage is about four years. For some, it may only last a few months, and others, it may go beyond the four year average. During this time, it is still possible to become pregnant.
Menopause - Menopause officially occurs when you have not had a menstrual period for 12 consecutive months.
Estrogen gradually declines from perimenopause into menopause. Eventually the ovaries produce so little estrogen that eggs are no longer released. This also causes your period to stop.
Postmenopause - If it has been over a year since your last menstrual cycle, you are then considered to be in the postmenopause stage.
THE ROLE OF HORMONES
Hormones are obviously the key players in menopause.
Hormones are chemical messengers that are secreted in the blood or other extracellular fluids.
They send messages to specific parts of the body, or “target sites” to tell these parts what to do.
Five hormones central to menopause are:
1- FSH (follicle-stimulating hormone)
2- LH (luteinizing hormone)
3- GnRH (gonadotrophin-releasing hormone)
4- Progesterone
5- Estrogen.
Follicle-stimulating hormone (FSH)- FSH is released by the pituitary. It stimulates the growth of ovarian follicles in the ovary prior to the release of an egg at ovulation.
FSH levels vary throughout the menstrual cycle but are the highest just before the ovaries release an egg.
Luteinizing hormone (LH) - LH is also released by the pituitary. It helps to control the menstrual cycle as well as helps to release an egg from the ovary.
Both FSH and LH also stimulate estrogen production, specifically oestradiol.
Gonadotrophin-releasing hormone (GnRH) - This hormone is produced and secreted in the hypothalamus of the brain. It is released into the bloodstream where it is transported from the brain to the pituitary gland. There, it stimulates the production of the two hormones I just mentioned, FSH and LH.
Progesterone - Progesterone prepares the endometrium, which is the inner lining of the uterus, for a potential pregnancy. Its job is to signal the lining to thicken to provide a stable home for a fertilized egg.
Progesterone also stops uterus contractions that would cause the body to reject an egg. If a pregnancy occurs, progesterone levels remain high, preventing ovulation. If a pregnancy does not occur, progesterone levels lower, allowing menstrual cycles to continue.
Although the corpus luteum in the ovaries is the major site of progesterone production, progesterone is also produced by the ovaries themselves, and the adrenal glands.
Estrogen - Estrogen plays a big role in puberty and beyond. The main source of estrogen comes from the ovaries, but adrenal glands and fat tissues also make small amounts of this hormone which is often why estrogen levels decline in athletes, women under chronic mental, emotional or physical stress, or women with very low levels of bodyfat.
Estrogen is responsible for:
Growth of breasts in puberty
Growth of pubic and underarm hair
The onset and regulation of the menstrual cycle
Cholesterol control
Protection of bone health
Health of brain, heart, skin, and other tissues (2)
CHANGES THAT OCCUR THROUGH STAGES OF MENOPAUSE
1. There is an exhaustion of follicles - Ovarian follicles contain egg cells, which are released during ovulation. Over the period of production, ovarian follicles decrease steadily.
In the perimenopause stage, follicles are present and eggs are released, allowing pregnancy to still be a possibility, although it’s often more difficult.
While you still have some follicles at the menopausal stages, they are significantly fewer.
2. Ovaries stop releasing eggs - This is the hallmark sign of menopause.
Perimenopause is marked by a drop in estrogen, the main female hormone produced by the ovaries. Estrogen levels can also go up and down more sporadically than they do in a typical 28-day cycle. This can cause irregular periods and other symptoms. As you get closer to menopause, periods and ovulation will likely become more irregular.
Menopause officially kicks in when the ovaries produce so little estrogen that eggs are no longer released. This causes the cessation of menstruation.
3. Ovaries stop making estrogen and progesterone - Estrogen and progesterone are essential for control of the menstrual cycle and reproduction. With menopause, the ovaries cease to produce these hormones.
Estrogen then comes solely from adrenal production and fat cells.
The decrease in estrogen is largely what contributes to a decrease in the metabolic rate in which you use starches and carbs. This can contribute to the weight gain some women experience in menopause.
4. LH and FSH levels increase - Because the ovaries stop producing estrogen, there is no longer enough estrogen to turn off FSH, which allows these levels to increase. The same is true of LH.
POSSIBLE CHANGES & CHALLENGES OF MENOPAUSE
When it comes to menopause, most women think about the symptoms more than anything else. Understandably, these major changes happening within your body are going to produce challenging **symptoms.
** I should mention that every woman’s journey through menopause is unique. There is no “one way” to go through menopause, no set of symptoms I can conclusively say you will or will not experience. It’s important to accept that your experience of menopause- physically, mentally, and emotionally- will be unique to you!
Urologic Challenges
Estrogen can strengthen the urinary tract tissue through strengthening the bladder’s surface layer.
Because estrogen declines in menopause, the urethra and bladder lining will thin. This thinning allows for folds that can become pockets for infections to thrive, allowing more UTIs to occur in the perimenopausal, menopausal, and postmenopausal stages.
A urinary tract infection (UTI) is an infection from microbes. These are organisms that are too small to be seen without a microscope.
Most UTIs are caused by bacteria, but some are caused by fungi and in rare cases by viruses.
The most common and obvious symptom of a UTI is dysuria, or pain/discomfort during urination. However, I have also seen many menopausal or postmenopausal women who have no UTI symptoms, though through a lab urinalysis, we find UTI’s.
These continual - often undiagnosed- UTIs slowly wear down the immune system opening these women up to inflammation and more infections.
Vaginal Changes
Beginning at perimenopause, a decrease in estrogen may cause the vulva tissues and vaginal lining to become thinner, dryer, and less elastic.
This is known as vulvovaginal atrophy.
Women experience lower amounts of vaginal secretions and decreased lubrication. This can cause dryness, itchiness, burning, irritation, and/or vaginal pain. Intercourse can become uncomfortable or painful.
Some women may experience this early in perimenopause, while others won’t experience it until several years after reduced estrogen levels or potentially not at all.
These symptoms can also relate to a vaginal bacterial or yeast infection (also an increased risk during menopause) or a UTI.
Neurologic Challenges
A decrease in estrogen levels may also lead to challenges in the brain. These challenges seem to be less discussed, but I’ve worked with several women who’ve dealt with headaches or migraines, mood changes, memory loss, depression, and anxiety (4, 5) as a result of menopause.
Cells throughout the brain have estrogen receptors, and reduced estrogen levels lead to reduced signaling to these brain cells.
This can leave the brain more susceptible to disease and dysfunction. Mounting research is even beginning to show a connection between menopause and Alzheimer’s.
Hot Flashes/Night Sweats
These two are probably the hallmark symptoms of menopause.
A hot flash is a sudden feeling of warm, which is usually experienced around the face, neck, and chest. You may also experience a rapid heartbeat, flushed appearance (possibly including red, blotchy skin), anxiety, and/or perspiration during a hot flash. They usually last around 5 minutes. As the hot flash passes, a chilled feeling may follow.
Night sweats are simply hot flashes that occur at night or in your sleep.
While it’s unknown exactly why hot flashes occur, it’s suspected that decreased estrogen levels cause your hypothalamus (your body’s thermostat) to become more sensitive to minor changes in body temperature.
If the hypothalamus thinks your body is too warm, it starts a hot flash to attempt to cool you down.
Joint Pain
Lowered estrogen levels in menopausal and postmenopausal women are also associated with an increase in joint pain.
You may notice that previous joint injuries may once again begin to ache or you may feel pain in joints overall.
Some of this is likely attributed to general aging, however the drop in estrogen levels does play a role as well. Because there are estrogen receptors all over the body, including the joints, declining hormone levels can impact the joints.
Estrogen also reduces inflammation, so when estrogen levels drop during menopause, inflammation can increase, the risk of osteoporosis and osteoarthritis can go up and the result can be painful or aching joints.
Weight Gain
The hormonal changes that go along with menopause may also cause weight gain.
As I discussed earlier, the ovaries stop producing estrogen, leaving the burden of
producing this hormone to the adrenals and fat cells, which influences the way women process starches and carbs.
This hormone shift has a great influence on where women tend to gain weight.
Prior to menopause, most women with balanced hormones will tend to gain weight around their thighs and glutes in the form of subcutaneous fat. Subcutaneous fat is the white fat just under the skin.
But as hormone levels decrease during menopause, many women notice they tend to gain weight in their midsection. This is what’s known as visceral fat. Visceral fat is stubborn fat that’s difficult to lose. It’s known as belly fat because it coagulates around the midsection and your vital organs. This fat can raise bad cholesterol levels, cause insulin resistance (which leads to more fat) and increased cortisol production (which ALSO leads to more fat). It’s a vicious cycle.
Another contributory factor to menopausal weight gain is a decline in thyroid function. Hypothyroidism (even subclinical) may share symptoms with menopause, such as fatigue, anxiety/depression, mood swings, and sleep disturbances.
For more on how to properly test for thyroid conditions, read my blog here.
Blood sugar dysregulation issues can also occur with menopause. The shift in estrogen and progesterone levels changes how cells respond to insulin.
Insulin helps to keep blood sugar levels under control, so these menopausal hormonal shifts can trigger fluctuations in blood sugar levels, especially in women who have diabetes. If blood sugar levels are too high, this can lead to weight gain (8).
Lastly, another factor contributing to weight gain in menopause can be the increased appetite and calorie intake that occurs in response to hormonal changes.
In one study, levels of the “hunger hormone,” ghrelin, were found to be significantly higher among perimenopausal women, compared to preand postmenopausal women
The low estrogen levels in the late stages of menopause may also impair the function of leptin and neuropeptide Y, hormones that control fullness and appetite.
In other words some women in the late stages of perimenopause /menopause may be driven to eat more calories.
Menopausal Incontinence/Bed wetting
Some women experience incontinence, bed wetting, or leaking urine during intercourse.
Stress urinary incontinence is the most common type of urinary incontinence in menopause. Stress incontinence is when you leak small amounts of urine when you cough, sneeze, laugh, exercise or jump. The reason it happens is due to weakening of the urethra, which happens due to the decrease in oestrogen. The urethra is the muscular valve that holds urine tight at rest and relaxes to let urine flow when you need to go.
Urgency urinary incontinence (“the overactive bladder”) is when you have a sudden need to empty your bladder (urgency) and can even lose urine before you get to the bathroom.
Overflow incontinence involves two seemingly opposite problems. On the one hand, the bladder does not empty sufficiently (either due to a weak bladder muscle or a non-relaxing urethra) while on the other hand you experience leakage because the bladder becomes so full that urine is forced to leak out. Urinary tract infections are a common factor in overflow incontinence.
Nocturnal enuresis or bedwetting is the involuntary release of urine during sleep. Bedwetting can be a symptom of some of the bladder control problems I mentioned like incontinence or overactive bladder.
Digestive Changes
Sex hormones themselves can influence the digestive system.
This is why changes in bowel habits are often experienced with menstruation and menopause.
Imbalances of estrogen and progesterone can influence the movement of food through the intestines. They can either speed up the process (causing diarrhea, nausea and abdominal pain) or they can slow things down (causing bloating or constipation).
Altered estrogen levels can also cause hyper-responsiveness to stress and a stress response can often cause changes in bowel habits as well.
When estrogen declines around menopause it can cause you to feel more anxious.
One reason is because estrogen helps regulate cortisol — the “fight or flight” hormone triggered by stress.
When estrogen drops your ability to regulate cortisol declines.
Not only does this cause your reaction to stress become more extreme, but the ramped-up cortisol has the add-on effect of slowing down the digestion of food. That can lead to gas, constipation, and bloating.
A heightened stress response may also promote an immune response and could contribute to intestinal permeability. The GI tract is lined with a single layer of tightly packed epithelial cells designed to keep pathogens and other unwanted species out of the bloodstream. If the barriers between cells become permeable (passable) then undigested protein molecules and bacterial toxins can pass through and trigger immune reactions and inflammation.
THE BOTTOM LINE:
While menopause can feel overwhelming, it’s a normal and natural phase of life that all women go through. It may feel scary, but God designed our bodies to be able to manage and overcome this period in our lives.
It can be really helpful to enlist the help of a professional if you’re struggling or experiencing symptoms that interfere with your quality of life. A coach can educate you on how you can best support your body to help ease your symptoms. They can also provide mental and emotional support to help make for an easier transition.