What is Menopause? | Petra Coveney

Menopause is a medical term. It is derived from ancient Greek, and means the pause in your menses or monthly cycle. It marks the end of the reproductive stage of your life. This is different to the phrase, ‘the menopause’ which is the umbrella term for the three stages: perimenopause; menopause and post menopause.

Perimenopause

Perimenopause is when you are coming to the end reproductive stage of your life. Your menstrual cycle becomes irregular as your ovaries release fewer eggs and your fertility hormones – oestrogen and progesterone – can fluctuate month by month, week by week. It usually occurs between the ages of 45-50. This is just an average age and some women will start younger, and some older. This stage can last up to 6 years. Women who have premature menopause (POI) have a shorter perimenopause; and women who have had surgery to remove their womb will go directly into menopause as a result. The symptoms you experience are mainly due to the fluctuations in the level of your hormones oestrogen and progesterone. 

Menopause

Menopause is simply the medical term for when you have not had a menstrual period for 12 months. Doctors use it to determine the end of your fertility. This stage sounds straightforward, but a woman may not have a period for 11 months and think she is at the end of her menopause, only for it to return on the 12^th month and have to restart the clock.

On average, it starts between 50-52 – but can be earlier or later – and the menopause transition can last several years. Symptoms are linked to the withdrawal of oestrogen and can include heavier or even continuous menstrual bleeds, which may be painful and exhausting causing fatigue. However, other women will barely notice that their periods have stopped and will seemingly breeze through this stage. The withdrawal of oestrogen can intensify hot flushes and night sweats and cause disturbed sleep, fatigue, brain fog and short-term memory loss and anxiety.

Read more about yoga for stress and anxiety in this complete guide

Post Menopause

Post menopause is simply the stage after your menopause. It is a medical term to indicate the post reproductive stage of your life. On average, women move into post menopause between the ages 53-56, but it can occur earlier or later. This stage also has phases of early post menopause and late post menopause. This is because, unless you are taking Hormone Replacement Therapy, it can take several years for your body to adjust to the new level of hormones, and the different type of oestrogen that is produced after menopause. The symptoms in early post menopause are linked to the withdrawal of oestrogen, which can reduce the strength of your bones (osteopenia), weaken your muscles (sarcopenia), increase risks of cardiovascular disease, breast cancer and weight gain.

Some of the symptoms are linked to family history (genetics), and serious illness, but you can also reduce your risks by looking after your body and mind by reducing stress (which triggers symptoms and depletes bone calcium), by improving your nutrition, taking the right kinds of exercise and choosing to take a positive perspective on your menopausal years. 

You can read more about your hormones in Hormones and the Menopause article.

Symptoms

You have probably heard a lot about the negative symptoms that often accompany the menopause. It is important to remember that every woman’s experience of the menopause is individual, and you may experience many, or very few symptoms. You may not even realise that these are related to the hormonal changes.

The decline in the production of your fertility hormones oestrogen and progesterone in your ovaries actually affects your whole body. Progesterone is needed to support the health of their womb lining. But women need oestrogen to support the daily functioning of their bodies.

When oestrogen withdraws, women may experience vasodilator symptoms such as hot flushes, or shivers, night sweats and insomnia. There are oestrogen receptors in almost every cell, tissue and organ in her body, including her brain. So, a woman may experience cognitive symptoms such as brain fog, mental overload, headaches, short term memory loss, anxiety, panic attacks, and insomnia, loss of joy, low mood and depression. Physical symptoms can include: sore joints and muscles (especially frozen shoulder and lower back pain), hair loss, dry skin, dehydration, itchy skin, vaginal dryness, digestive problems such as allergies, constipation, bloating, inflammation, weight gain, twitching muscles, heart palpitations, lethargy, extreme fatigue, and many more. 

The symptoms you may experience will vary at each stage of the menopause.

Early signs and symptoms

In early perimenopause, your symptoms are mainly related to the fluctuations in progesterone and oestrogen.  Some months you’ll have a regular menstrual cycle, and on other months your ovaries may not release an egg (anovulatory) and there is a drop in oestrogen and progesterone. This causes hormonal peaks and troughs which can be erratic and unpredictable and lead to physical, cognitive and emotional symptoms. Anyone who has experienced Premenstrual Syndrome (PMS) will know that there are a few days of the month when your levels of oestrogen and progesterone levels are higher or lower, which can cause headaches, bloating, tearfulness, fatigue, low mood, irritability etc. In perimenopause, a woman can experience these symptoms on a regular daily basis as her menstrual cycle stops and starts erratically.  In late perimenopause, the withdrawal of oestrogen can trigger vasodilator symptoms such as hot flushes, cold shivers, night sweats. 

A Meno PAUSE

Women at this stage of the menopause need to rest, literally take a meno PAUSE any time of the day when they feel overwhelmed or exhausted by the effects of these dramatic hormonal changes. They can experience a sensory overload and brain fog that feels overwhelming. Simply sitting or lying down in a cool, dark room for 5-15 minutes may be all you need to get back on your feet. In terms of nutrition and lifestyle, now is the time to stabilise your daily routine creating a grounding structure to your day that can anchor you emotionally. Now is the time to say NO to offers to socialise every night, NO to working late again, NO to skipping meals and replacing food with sugar caffeine and alcohol,  in fact cut them out if you can. These substances trigger vasodilator symptoms causing you to feel anxious, hot, headachy. Or even…depressed. 

The menopause is not an illness, or a sickness. It is a significant, major hormonal shift that can be viewed as the reverse of puberty and has a similar effect on your body including your brain function, in some women it causes short term memory loss, brain fog, anxiety, and insomnia. However, the menopause can mask serious underlying health conditions, so you must always consult your doctor.

‘You are unique’

Your experience of the menopause will not be the same as another woman’s experience. Doctors are advised to offer women individualised treatment.

Your experience of the menopause is individual and depends on many factors, including: 

• genetic history, 
• lifestyle, 
• socio-economic status and the 
• culture in which she lives. 

Genetics

A woman with a family history of osteoporosis, low body weight, and early menopause will be advised to take Hormone Replacement Therapy to retain oestrogen to protect her bones and heart. Ethnicity can also have an impact, although the research on this is limited.

Lifestyle

What a woman brings into the menopause will be amplified. If a woman enters perimenopause feeling that her life is well balanced, she has time to work, socialise and relax, she eats a balanced diet of nutritious foods that support bone and muscle strength, the endocrine system (hormones) and gut health, exercises enough and goes to sleep at a regular time, then she is more likely to be able to manage her menopause symptoms. However, a woman who is frequently stressed, overloading her work-life balance, facing financial instability, and as a result of stress she is consuming coffee, unrefined carbs, sugars and alcohol, which are vasodilator stimulants, then she is more likely to struggle with menopause symptoms, such as hot flushes, menopause rage and irritability, anxiety, low mood and insomnia, fatigue.

Socio-economic status

Low income, financial worries and limited access to information can leave a woman in the dark about how to help herself, and unable to afford many of the expensive natural remedies and complementary therapies. 

Culture

Working long hours, later in life, and being expected to juggle this with family responsibilities is stressful, which makes menopause symptoms worse. Being constantly connected to digital devices 24/7, missing meals and comparing yourself to others (FOMO) will activate the stress response and can cause chronic fatigue over time. 

Honour the transition

Pushing through and forcing your way through perimenopause is not going to help you. It’s not a short-term work deadline that you have to meet. It’s a transition that lasts a long time and changes as your body adapts. Pushing through tiredness will not help you at this stage of life. Your symptoms are signifiers that tell you to change your way of living, for the better, so that you can move into this next stage of your life feeling happier, healthier than ever before. 

Resting and reducing stress, taking care of your health and nutrition are vital. View this as your time to take a meno-PAUSE, time out of your daily life to focus on your health and wellbeing. If you’ve ever needed an excuse or permission to practice self-care – this is NOW. Wrap yourself in kindness and self-compassion. My mantra is to ‘Nurture and Nourish’ yourself with whatever feels supportive for you. 

The emotional and psychological symptoms of the menopause can be as significant as the physical manifestations. Your hormones can affect your mental health and wellbeing, but so can your view of the menopause. 

Eastern vs Western perspective 

In the eastern systems of healthcare the menopause is viewed as a natural process. It is an opportunity for women to change the pace of their lives. It is a time to slow down, do less work, and let others look after you to conserve your lifeforce (Agni or Qi).  In Indian Ayurveda and Traditional Chinese Medicine (TCM), women are more likely to view menopause as a well-earned break after years of caring for, and tending to the needs of, others.  If you allow yourself this quiet, introspective, restful time, you can re-emerge feeling restored, re-energised and ready for the later stage of your post reproductive life. 

In TCM this is called Second Spring. A beautiful time of renewal and rebalance when a woman’s body finally becomes her own and she is not tied to the menstrual cycle. 

In Indian Ayurveda this is Vata – the age of the wise woman. Of course, the culture in which we live and attitudes towards older women will affect our perspective on the menopause. In eastern cultures there is still a level of respect for older women who have a role to play in extended families and their communities. These eastern systems offer advice on nutrition and natural remedies to manage your symptoms.

Read more in Yoga for Stress and Anxiety: A Complete Guide

Embracing age

In westernised cultures,  attitudes to the women aging are often negative and the menopause has been given a bad press. It is important to recognise this, and the effect that negative images of older women may have on your feelings about the menopause. Women I work with tell me they associate the menopause with all of the awful symptoms. Women in perimenopause associate aging with: “becoming invisible”; “old and grey”; “passed it”; “unvalued”; “not sexually attractive”; ‘ugly”; “witches and hags.” These are the images they’ve seen around them since childhood, in storybooks, TV, films and news headlines. A survey by Newson Health revealed that most women feel too embarrassed to tell their managers at work. They’re are fearful of ridicule from colleagues or even lose their job. 

Menopause Yoga offers you a different perspective  

The menopause is so much more than just a pathologized list of symptoms, the end of fertility and getting older. I hope you will start to view the menopause as an awakening to yourself and your inner wisdom. Listen to the intuitive voice within you that is always present, but which we override and ignore because we are listening to external alarms telling us when to wake, eat, work, sleep and repeat. 

An Awakening

The menopause is a natural, hormonal alarm bell that usually rings in our mid-life. It tells us to take a … pause… in our hectic schedule to really look at our lives, and our lifestyles, and ask: 

• Is this lifestyle supporting me? Am I feeling healthy and happy? 
• Where am I in all of this?
• Is there anything holding me back, or self-limiting me? 
• Can I give myself permission to be the fullest version of myself?
• Can I let go of past pain, memories, relationships that have cast a shadow over my life – my light.
• I have almost half of my life still ahead of me; how do I want to live the next 30-40 years?
• Are there any dreams and adventures that I have not yet experienced? 
• What am I waiting for? If not now – when?

If these questions are resonating with you, then please continue reading because I have something to share with you. The menopause is more than a change in the levels of your hormones. It can be an AWAKENING. A reconnection to your SELF and an opportunity for self-growth. Life doesn’t need to stop after post-menopause. It can be exciting, sensual, empowering, and an opportunity to have your voice heard!  

So, what is the menopause? It is a bio-psycho-social-spiritual journey. Where you take that journey is up to you. This MFML course is a wonderful start.

Read more about Yoga for Menopause in our COMPLETE guide. Also read the best Yoga poses for Menopause here.