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[KarineT]

Hello,

I haven't had a period since February 2020 but I can't establish whether I am 1 year or 2 in postmenopause.  This is because, in the medical field they say that a woman has reached the menopause when she hasn't had a period for 12 consecutive months. I was under the impression that the menopause is that time when a women has her final period and anything after this is postmenopause.  When I did a blood test after 12 months my oestradiol level was 586 pmol. When I did another one at the beginning of this year my oestradiol level was only 29pmol so there was a huge drop from 1 year to the next.  Is the 12-month period only used as a guideline for confirmation that the menopause has occurred or is it the real time when a woman has reached the menopause? Can anyone shed some light about this?

[sheila99]

I wouldn't get too hung up on the semantics. 1 year is an arbitrary timescale and is used by the medical profession to investigate bleeding if it occurs after this time period. Although most women won't bleed again after a year there are some that do have genuine period(s) again. Like you I tend to think of it as the last period but of course you don't know when that is at the time.
You had a big drop in levels - have your symptoms got noticeably worse over the last year?

[KarineT]

Hii Shella 99,

Thanks for your reply.

Strangely enough my symptoms are more or less the same.

It seems that my symptoms are on and off despite the fact that my hormones are no longer fluctuating, if I'm truly postmenopausal that is.

[sheila99]

My understanding is that they can still fluctuate for a time but not enough for ovulation or a bleed. It's good that you haven't got worse (though feeling well would be even better).

[KarineT]

As I wanted to check this further I asked a doctor.  For me, the menopause has occurred when a woman has had her final period and hasn't had a bleed for 12 consecutive months or more. The doctor told me that a woman could not have reached the menopause, despite having no periods for 12 consecutive months, if her oestrogen level is above 110 pmol/l but anything below this is classed as postmenopause, not menopause.  I don't think he understood the term postmenopause.  He said that because I had 568 pmol/l in January 2021, I was still perimenopausal but I had no periods for 12 months.  How could I still have been peri without a period for 12 consecutive months?  Does this seem right to you?  Then he said that I entered the menopause in January this year because my oestrogen level dropped to 29.6 pmol/l. If what he says is correct then I've only been postmenopausal for nearly 3 month and not 2 years as I thought. What do you think? Do you think that what defines postmenopause is the length of time without a period, the oestrogen level or both?  In my own case, my oestrogen level did not coincide with my lack of periods, at least for the first year.

[sheila99]

I think I have brain fog thinking about this  . I suppose using levels makes sense, I wonder if this is the level below which fluctuations stop? The downside is that most women aren't tested so wouldn't know when they reach that level.

[VictoryV]

Hi Karine,
Is the timeframe affecting something else? I’m curious!

[KarineT]

The time frame is not a problem as such for now as my syptoms have always, more or less, been the same since 2018.  It's just that I'm curious about what's happening to my body and also a bit worried that my symptoms might worsen, the further I am in postmenopause.  Some ladies here have mentioned that their symptoms got worse or really started to kick in after 3 years in postmenopause.  I am not worried about the physical symptoms but the emotional/psychological ones. It seems to me tthat the menopause is not a straight forward experience and it has no rhyme or reason. Our body simply does what it wants and it's unique to each woman.  This is ptobably why some women have nothing while others have a horrendous time. It might seem that I"m anticipating things but I'm checking whether or not my symptoms will get worse overtime.

[Kathleen]

Hello KarineT.

Are you  hopeful that after short time in post menopause the body adjusts to low levels and all symptoms will settle? It's tempting to imagine that scenario and indeed one GP told me that three years after my last period my meno problems would be over. Unfortunately that was not the case for me as my anxiety became much worse and I sought HRT for the first time.

I'm sure you don't want to think that your current psychological symptoms will always be with you and I sympathise because they are also my worst symptoms. If it is any comfort one GP told me that the emotional turmoil does settle eventually and my trusty meno book agrees, I  also know women who have moved through this phase and out the other side so it clearly can happen.

Wishing you well and take care.

K.

[KarineT]

Hi Kathleen,

Thanks for your reply.

It seems like a gamble but in my own case, I'll have to see what happens in the future.  The low mood and anxiety are by far,  the worse and I admit I envy those women who don't have it.  Maybe they are not sensitive to hormonal changes and this is probably why the menopsuse doesn't affect them psychologically.  I used to have a bit of anxiety and low mood during my reproductive years so it's not a surprise but one hopes that it will settle one day.  I am still not on HRT and I do hope that it will stay this way.  Does HRT really help with emotional issues when taken on it's own?  I'm not so sure. If anything, the dose would probably need to be equivalent to what it was before the menopause to really make a difference.

[sheila99]

Anxiety and insomnia were my worst symptoms in peri, completely gone after 3 months on HRT. Hrt is an individual decision but for me life was hardly worth living. I'm very late peri now and on 4 pumps gel so yes, probably equivalent to what I used to produce myself. Every time I try to reduce the symptoms return so maybe I'll have to stay on this dose or perhaps I'll be able to reduce in the future. Whatever the risks of hrt I'll take it over feeling so awful without it. Those who have no meno symptoms are fortunate (or maybe not as they won't get the benefit of oestrogen to their heart and bones). I guess you only know if you've made the right decision when it's too late.

[Hurdity]

Hi KarineT

Your doctor is wrong. Menopause is defined, as already said, by the time that has elapsed since the last period and not oestrogen levels at all, and as said, this can only be determined in retrospect. Also some women do bleed more than 12 months after last period because ovulation can occur after the 12 months has elapsed especislly in younger women.

In the 2-3 years following the last period oestrogen levels continue to fluctuate but on average decline dramatically until they reach their approx lowest level where they will remain for the rest of your life ( as I understand). There can still be ovarian activity but as sheila99 says, not sufficient for ovulation.

Hurdity x

[KarineT]

Hi Hurdity,

That's what I thought initially.  Menopause to me means that the periods have stopped permanently. In this case, that would make me postmeno by just over 2 years.  I was still 49 when I had my last period.  I still cannot understand why periods can come back after 12 months.  Mine never came back and, usually, this is what happens to most women.  I thought that hormones had some bearing on the menopause, i.e. low levels of hormones, equals no periods but it seems that from what you're saying, there was still some fluctuation going on, giving me a reading of 586 pmol/l in January 2021 and then I had a huge drop in January this year with just 29 pmol/l.  So, one could have reached the menopause but their hormone levels could still be fairly high in the first year and then significantly low the next, as in my case. This is not consistent at all.  I really wish this hormone decline was like men's, where theirs is very gradual and because of this, they are not affected.

The reason I had my natural oestrogen level tested, i've never been on HRT, is because I wanted to know how low it was and see how much longer it was going to affect me.  I'm hopeful that once it's reached a low but stable level, it will no longer cause me any issues. I would like to think that this is what will happen and things won't get worse for me.

[Hurdity]

hi Karine - as said many times spot testing of estradiol is not especially accurate but will give you  rough idea. As I said too the first 2-3 years your levels will still be fluctuating - it's not a case for most women that the ovaries are one minute functioning perfectly and the next day - boom - they stop - hence the peri-menopausae and irregular periods.

The 12 months (maybe already said on this thread) is given as the somewhat arbitrary time since the last natural period, for menopause to be reached - so that any bleeding beyond this date is investigated so that cases of potential endometrial cancer are not missed. It is the medical definition for this reason. It does not mean that everyone has reached menopause by this time. Far from it - there will be a minority of women who may ovulate after 12 months. If you look at graphs if the oestrogen levels (smoothed over without fluctuations) it will show this rapid decline over the 2 years following the last period (on average), but as I said the fluctuations occur because the  follicles are still being stimulated - and produce some oestrogen - just they don't develop sufficiently to produce mature eggs. I wouldn't take too much notice of the 29 pmol/l either - was this a standard blood tests from your doc - because that is extremey low even for post-menopause?!

Really you don't need to worry about what your levels are doing. Now you are two years since last period your estrogen levels will pretty much have dropped to their approx "final" level though according to research I think there may stil be some minor residual cyclical activity over the next couple of years or so? You don't need to get them measured.

A lot of this is explained in this paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/

Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging

This characterises the different stages, including the menopausal transition and what happens re some of the critical hormones

The long term effects of oestrogen deficiency can cause different symptoms independent of the peri-menopasual estradiol fluctuations - which is a different issue entirely, and yuou may or may not be affected negatively in a way that you will notice ( eg continued flishes, vaginal atrophy) or other ways that you may not (eg cardio-vascular and bone health).

Hurdity x

[KarineT]

Hi Hurdity,

Thanks again for your reply.

On one hand I'm lucky so far as I very occasionally get hot flushes and I don't have VA.  On the other hand I get cold flushes, I get a bit too warm during the night from time to time and I have a bit joint problems and muscle pain.  But I also get something that feels like internal shaking, anxiety & low mood, dizziness on a fairly regular basis and that's the worst part of the menopause for me. I do hope that these are only temporary symptoms and will eventually go away.