At what age does it start?

For many women, especially in their 40s and 50s, this word is scary: menopause. But what is perimenopause, how do you know you’re in menopause and at what age is it possible? We delve into this topic with expert Lisbeth Jessel.

subway I also recently explored the pill in a five-part series, from history to alternatives to male contraception.

Menopause, Menopause, Menopause: What is it?

Lisbeth Jessel is a science journalist focusing on psychology and brain science. She created the podcast in 2021. Menstruation, About menstruation. She is also the author of the book Damn menopause. She stresses that there are quite a few terms used and that this can be confusing. Jessel explains perimenopause, menopause, and menopause this way: “Menopause is a specific moment, the day of your last period. Of course, you don’t know it’s your last period, which is why menopause is diagnosed a year after your last period. Perimenopause is the period of menopause, when you first notice the effects of hormonal changes. This happens before menopause, on average around age 45.”

When perimenopause or menopause begins, the production of estrogen and progesterone, which are normally female hormones, decreases. “This doesn’t happen overnight, but gradually. It can take about ten years before everything stabilizes again. Perimenopause begins about five to six years before menopause and ends on the day of menopause.

Perimenopause and menopause are two terms that can be used somewhat interchangeably, but there is still a big difference. Jessel himself prefers the term “transition”: “There is no strict definition. Perimenopause ends when menopause occurs. This means that from that moment on you no longer have any complaints, but this is not the case for many women. Some still have menopausal-related complaints five years after menopause.

“It’s a bit like puberty.”

According to Jessel, women can think of menopause when something changes in their bodies. “They often notice the first signs of menopause around the age of 45. At this age, for example, women notice that their menstrual cycle is shorter, longer, with shorter intervals, more intense or less intense. Sometimes it even happens that women have a menstrual cycle that lasts twelve days and then returns after two weeks, whereas this was not the case before.”

It’s not that your hormones are dropping very steadily as you go through menopause, but you can actually go through peaks and valleys. “It’s kind of like puberty,” says Jessel. Even then, your hormone levels are very variable and it takes a while for everything to settle down.

Another thing you may notice at the onset of menopause is a flare-up or worsening of premenstrual syndrome (PMS). “Right before your period, you may have more headaches, stomach or back pain, breast tenderness, or a depressed mood. If you’ve never had PMS before, it can come on suddenly, and if you already have it, it can get worse.”

In addition to these menstrual-related things, menopause is also associated with vague complaints. These are things like poor sleep, fatigue, increased headaches or muscle aches, which can be caused by menopause, but there is no clear link to them.

At what age do you enter menopause and how long does it last?

According to Gigsel, most women are around 51 when they experience menopause. Their last period was a year ago, around age 50. “Hot flashes are a common postmenopausal complaint, and they start to occur in the last two years or so before menopause.”

The transition takes an average of five to ten years. Gisel: “However, not everyone is bothered by it, some women don’t notice it very much. Surveys show that on average two out of ten women have no problems with menopause, another two out of ten have a lot of problems and the other six have some complaints, but these complaints don’t prevent them from going about their daily lives.”

early menopause

Then there’s the early transition. If you’re experiencing early menopause, which is when you start menopause in your 30s or earlier, menopause occurs before age 40. “It’s not always clear why, but it could be medical,” explains Gisel. “For example, if you had your ovaries removed or because of cancer treatment. If it’s medical, it can be a very sudden transition, and you have to deal with it from day to day.”

Tips for women in menopause

Gijsel is a strong advocate of seeking help if you are experiencing a lot of menopausal problems. “We definitely shouldn’t give women the message that they should wait until menopause,” she says. “Menopause can cause serious complaints, and there are many things you can do to alleviate them. The most obvious is hormone therapy. This is particularly effective against hot flashes. In eight out of ten women, hormone therapy works within two to three weeks.

Jessel emphasizes that there are contraindications, and people should not use hormone therapy. This is, for example, if you are at risk for cardiovascular disease. Also remember that hormone therapy carries a slight increase in the risk of breast cancer.

But in addition to hormone therapy, there are also things you can try on your own to reduce symptoms. “Stress has been shown to exacerbate all menopausal symptoms, so anything that reduces stress is good,” says Gisel. “But exercise and yoga have also been shown to be effective against hot flashes.” Diet is also a factor, as coffee, alcohol, sugary or spicy foods can trigger or worsen hot flashes.

One way to check in with yourself is to keep a diary. What happened before you started experiencing severe symptoms, like hot flashes? What did you eat, what happened in your social life or at work? “It’s also important to get good sleep. If you sleep poorly, the mood swings and irritability get worse,” Gissell advises.

“The belief that women should not act”

If you’re experiencing menopause, Jessel recommends definitely seeing your GP. “They can then refer you to a menopause counselor or gynecologist and then you can look at your nutrition, stress and any supplements you’re taking.”

There is often an image that women have to wait until menopause. According to Gijsel, this is changing in Flanders, where she comes from. “In Belgium, 20 percent of menopausal women use hormone therapy. In the Netherlands it is much lower. But I often compare this treatment to anesthesia during childbirth: not everyone has to take it, but if you are in a lot of pain, it is nice to have it. If it is there and it is not too dangerous for you and you suffer a lot from your complaints, why not do it? It is a dogma that women should not act and that it is part of them, but this image has to change.”

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