When I first started digging around in this big and messy world, I realized how confusing it was. It reminded me of when I first started teaching yoga philosophy (many years ago) to yoga teachers-in-training. The challenge was that yoga was simultaneously a philosophy, a state of mind, a form of physical exercise, numerous spiritual practices and now, also, a style of pants (don't get me started). And in order to teach yoga philosophy, the term needed to be better understood. And, it is apparent that menopause needs similar attention.
Menopause. This is one powerful word. Think of all the myriad places the reading or utterance of this word pulls your thoughts and your emotions. This single word gets thrown around many different ways that, frankly, it’s just not very helpful. So, let’s see what we got.
Menopause as a point in time | The average age of menopause is 51
Menopause is technically just a point in time. Menopause marks the end of ovulation and menstruation physiologically indicated by 12 consecutive months without a period. The reality is that once you've skipped more than six months you can consider that you're pretty much there.
Menopause as a gross over-simplification of a complex and lengthy process |All women experience menopause
This multi-year transition. It's not simple, it's not easy and it's not quick. It is made up of different phases, each with a pretty distinct hormonal profile. Perimenopause, early post-menopause, later post-menopause. Hormone changes (and symptoms) can start in a woman’s 40s and continue into her 60s. Symptoms change in type, severity, frequency over time and, yes, you've heard it before but I'll say it again, all women experience it differently.
Menopause as a stage of life | She is in menopause or She is menopausal.
Menopause marks the end of a women’s reproductive years and, based on common usage defines the physical/health/female status rest of her life. I’d argue for the terms to be pre-menopause, perimenopause, early-post menopause and later post-menopause to describe the hormonal states. And say that I am approaching menopause, I’ve hit/reached menopause and I’m past menopause. Think about how we use the word puberty. Once we are through it, we don’t ever even refer to it, right?
Menopause as a deficiency in a single hormone | Women in menopause have no estrogen which is at the root of all the symptoms
Estrogen levels don’t immediately drop to zero once the menopause transition starts. Woman’s body gradually arrives at this new normal over many years. Symptoms are not due solely to a lack of estrogen. In fact, estrogen can fluctuate wildly before it gradually declines. (Average estrogen levels in perimenopause are higher than for girls going through puberty).
Menopause as an enigmatic disease state | You are suffering from menopause with [fill in the number of] symptoms
Because most understanding about menopause has been derived from conventional clinical experience, it is not surprising this perspective persists. It is at the root of the idea that menopause is a hard-to-diagnose-so-we-can't-rally-help you medical condition with tremendous suffering with numerous severe symptoms and, ya’ know, every woman is different so we are gonna use that as an excuse for little or no actual treatment (many women I know have gone into her gynecologist with symptoms and left, literally, with nothing except frustration).
Menopause as myth
This topic deserves a separate piece which I will write soon. Suffice it to say, that it is an extension of the "enigmatic disease state" and a fundamental lack of understanding (individually and collectively) that perpetuates, imho, wrong action or inaction.
When you next hear/read/use the word menopause, take a moment to make sure you understand how it’s being used. That simple reflection will reveal A LOT.