After not having a period for a while, I’ve had spot bleeding. Am I still in menopause?
I was recently speaking to a 43-year-old woman who was coming to grips with the fact that she is in peri-menopause. A highly educated wellness coach herself, she said to me, “I guess it’s time that I crawl out from under the covers and confront the fact that I’m in peri-menopause.” As if peri-menopause is some kind of bogey man! I totally understand what she means, as I was also 43 when I discovered that peri-menopause starts at age 40, and felt the same way. The term menopause is even more frightening for women, and it’s important that we understand what it means.
For most women, there’s an emotional association of menopause with loss of fertility. And, indeed, that is what the definition of menopause is: the lack of a period for 12 months due to shutting down of the ovaries and corresponding infertility. It’s one of the dreaded “I” words: infertility, insomnia, irritability, itching, incontinence, infections of the urinary tract and instant hot flashes. Okay, that last one was a stretch. But the reality is that most women will have menopausal symptoms without being “fully” in menopause. Also, after women have made the full transition into menopause, we may still have symptoms that can last for a long time, such as hot flashes.
Other symptoms are night sweats, memory loss, anxiety, depression, vaginal dryness and joint pain. Some symptoms, such as vaginal dryness and joint pain, will deteriorate and worsen over time. They all relate to loss of hormones as our ovaries decline in function and produce less of key hormones such as estrogen (the female hormone), progesterone (the nurturing hormone) and testosterone (the libido hormone).
The typical age of full onset of menopause is about 50 years old, and peri-menopause refers to the 10-year period after age 40 in which ovarian function starts to fall. During this peri-menopausal period, our hormones can fluctuate drastically because our ovaries are trying to push out eggs and sometimes overcompensate, leading to increases in estrogen and symptoms such as facial acne, breast tenderness, and heavy bleeding.
After about age 50, our periods stop altogether. Going without a period for 12 months is an indication of full menopause and therefore an inability to conceive. The reality is that our fertility starts to decrease dramatically in peri-menopause, at about age 40. In early menopause, women can still have spot bleeding or irregular periods, e.g. a period every 2, 3 or 6 months. The irregularity is from decreasing progesterone – the hormone that regulates ripening and “pushing out” of our eggs, and is also our nurturing and loving hormone. After full menopause, women can still have spot bleeding; however, this needs to be evaluated by a physician as it may be an indication that there is dry tissue that is inflamed or bleeding. It may also be a sign of endometrial cancer.
It didn’t occur to me that menopause is for the rest of my life, i.e. once you enter into menopause you stay in it. I thought it was like a revolving door. Something that I have heard often is “I am no longer in menopause”, after a woman has spot bleeding or a period after 6 or 8 months, or her doctor has told her that her “clock has re-started.” These are false statements. There isn’t a “re-start” button that we can push to end menopause.
I also hear from women who say they never had an opportunity to say “Goodbye” to their period or come to grips with their loss of fertility. I have been reading the works of post-menopausal women who equate their childlessness to a “death that you will survive”. This is a topic that is consuming me quite a bit as I believe that dealing with grieving – whether the loss of your period, your ability to have children, or your fertility – is a taboo about menopause that is not well addressed at all by our society.
Despite being 46 and likely never able to have another child, I do still think about it from time to time. Hope does spring eternal. I have given up though, for so many reasons: my lovely teens, my own peri-menopausal health, and coming to grips with the low possibility of success balanced with the stress that trying for a child would create. So now that I have given up on having another child, where do I channel my energies these days? Into my teenage children and Damiva, where, with my loving partner, we started making products for me and my menopause. Little did we know that this would create a movement and that so many wonderful people would want to help us make a difference in women’s lives.
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