Alice Callahan c.2022 The New York Times Company/Photo: Eliza Sinadinou

The word “pause” in the word “menopause” implies, perhaps, that this phase is short or temporary – taking a little more time than annoying temporary discomfort. But in fact, the symptoms associated with menopause can persist for ten years or more, and there is at least one symptom that may never go away.

Menopause technically begins after a woman’s last menstrual period, according to Dr. Stephanie Fobion, director of the Mayo Women’s Health Clinic. But because our last period doesn’t automatically alert us, and cycles can be irregular around that time, health professionals often don’t diagnose menopause until after a year without a period, Dr. Fobion explains. “After that, you’re postmenopausal for the rest of your life, which in some cases is a third of a woman’s life.”

In the US, the median age of the last period is 52, according to the US Department of Health and Human Services. But any age past 45 is considered normal, and about 95 percent of women reach that age by age 55, says Dr. Fobion, who is also director of the North American Menopause Society.

However, her symptoms menopause they may begin years before a woman’s last menstrual period and continue for several years after. According to Dr. Fobion, the intensity and duration of symptoms can vary greatly from case to case. Some women experience only minor discomfort, while for others, the symptoms have a particularly negative impact on their work and life.

SIGNS

The first sign that you’re in the menopausal transition is usually changes in your cycle: your periods may be more or less frequent, your bleeding may be lighter or heavier, says Siobhan Harlow, director of the Center for the Study of Middle Ages at New York University. Michigan School of Public Health. These changes can be unpredictable and frightening, Harlow says, and in women who typically have heavy periods, they can also cause heavy bleeding that requires medical attention.

At the same time, says Dr. Fobion, fluctuations in estrogen levels can lead to hot flashes, night sweats, migraines, insomnia and irritability. There may then be several normal cycles and the symptoms will disappear but return. A number of other symptoms may also occur during the transition to menopause, including depression, anxiety, confusion, skin and hair changes, joint pain, and vaginal dryness.

When 60 days have passed without a period, you are in a stage known as late perimenopause. According to Dr. Nanette Santoro, professor of gynecology at the University of Colorado School of Medicine, most women have their last period within two years. At this stage, “the symptoms tend to increase, so if they were bothersome at the first transitional stage, they are intensified here.”

One of the most well-known symptoms of menopause is hot flashes, which about 80% of women experience, often accompanied by night sweats. In women who had hot flashes earlier in the menopausal transition, up to 60 days without a period, they lasted longer, on average, 11.8 years. “If it starts early, it can be a long and painful menopause,” says Santoro. “Given that, you might want to ask for help sooner.”

SPECIAL FEATURES

Of the various ethnic or racial groups in a 2015 study, women of Japanese and Chinese descent had the shortest duration of hot flashes or symptoms of “hot flashes” (mean 4.8 and 5.4 years), while black women had the longest (average). 10.1 years). In a study published in February, Harlow and her colleagues analyzed data showing that black women go through menopause earlier and are more likely to experience depression and sleep disturbances than white women. The authors suggested that these differences may be due, at least in part, to greater economic hardship and stress, experiences of discrimination, and decreased physical activity. All of the above, the authors of the study note, “is rooted in systemic racism.”

Most menopausal symptoms eventually disappear after an average of seven to nine years, according to Dr. Fobion, but in one-third of women, symptoms persist for ten years or more. He adds that a health worker with experience in menopause can help you consider options that can relieve symptoms, such as hormone therapy.

One symptom that usually doesn’t go away is vaginal dryness, which can be accompanied by pain during intercourse, increased urge to urinate, and more frequent urinary tract infections, Dr. Fobion says. These symptoms worsen over time, so early treatment is required, which may include lubricants, moisturizers, or estrogen treatment.

Once you reach menopause, Santoro says, you are technically there for the rest of your life. But you know that the menopausal changes ended when other menopausal symptoms improved. “They just walk away – and some women get a feeling of arousal.” Hormonal changes settle down, and by the time women are 65 or 70 years old, they have to deal with age-related changes more than reproductive hormone changes.

There are also quite a few positive things about going through menopause. Painful conditions like endometriosis and fibroids often go away and a woman doesn’t have to worry about menstruation or the risk of pregnancy, adds Dr. Fobion, stressing, however, that STDs remain a risk and a reason to keep condoms in our lives. In that sense, menopause is indeed a transitional period of middle age, and while it may be a longer and more murky period than we might expect, we can at least hope for the relief that comes at the end of the journey.