The signs of menopause and perimenopause—the years leading up to the menopause transition—are many, and not every woman experiences them in the same way, intensity, or sequence. What's more, many of the symptoms, such as depression, anxiety, and fatigue, are similar to those presented by other issues and diseases. So how do you know whether you're on the verge of midlife or not? Pause a moment (sorry not sorry), and take this quiz to test your knowledge of all things meno.
False. Both perimenopausal and menopausal women experience the same issues, including vasomotor symptoms (VMS)—aka hot flashes and night sweats—as well as irritability, brain fog, mood swings, insomnia, and vaginal dryness. "The main difference between perimenopausal and menopausal women is that perimenopausal women can still get pregnant," says Stephanie Faubion, MD, an internist specializing in women's health issues in Rochester, Minnesota.
A perimenopausal woman may begin to experience one or more menopausal symptoms as early as her 30s, and a woman is considered menopausal when she has not had a period for 12 consecutive months.
False. "Perimenopausal women can have a regular menstrual cycle and still have symptoms," says Dr. Faubion. "Yes, you're producing less estrogen than before, but you're still producing it and can still conceive a child." This decline in estrogen might cause irregular periods in some women, but in others their cycle remains unchanged.
True. According to the Study of Women's Health Across the Nation (SWAN), nearly 30 percent of women will have hot flashes in their 30s—even while they are still getting regular periods. "Most women flash for about 7 to 10 years," says Dr. Faubion. "According to SWAN, some women may begin flashing 11 years before their last menstrual cycle, and continue to flash for 14 years afterward. This group is known as the 'superflashers,' for obvious reasons."
False. Just as there are superflashers, there are also women who have zero flashes, and who transition into menopause without issue. "When I was writing my first menopause book in 2016, my mother asked why we were writing about menopause at all," says Dr. Faubion. "So I asked her what her experience had been with menopause and she said, 'Well, I may have had a hot flash once at a cocktail party when I had a glass of wine.' And that was it for her."
Where you fall within these two extremes is an individual thing, as are the severity and frequency of your hot flashes.
False. With VMS, the heat comes from within. Your ovaries, your pituitary gland, and the hypothalamus region of your brain work in tandem throughout your life to control your body's thermoregulatory system. As your ovaries produce less and less estrogen, though, this partnership is interrupted, and neurons in the brain known as KNDy neurons become overstimulated, sending a signal to your body that it's hot even when it's not. Your body then tries to cool itself by sweating and sending blood to the skin, causing you to flush. After a few minutes, the episode subsides and you return to a normal temperature—until the next flash.
That being said, being in a hot environment may trigger a hot flash in some women, as may eating spicy food, drinking too much caffeine or alcohol, smoking, stress, or even tight clothing.
False. Night sweats are simply VMS that occur at night. The only difference lies in their impact on the flasher. Having VMS during the day is irritating and bothersome, but when they happen at night, they often interrupt your sleep several times. You may wake up drenched in sweat, and may also have to change your clothes and even your sheets before you can go back to sleep.
True. About 30 percent of women have issues with sleep during perimenopause, and often wake up several times during the night. This can lead to irritability, poor cognition, low energy levels, and a general feeling of malaise. Evidence suggests that lower levels of estrogen are associated with poor sleep, and according to a study published in the Journal of Women's Health, common causes of sleep disruption in perimenopausal and menopausal women are depression, night sweats, and a history of insomnia.
Getting enough sleep is also important for your heart health, especially if you're in the middle of the menopausal transition: Research published in the Journal of the American Heart Association revealed that stress and insomnia are linked to irregular heart rhythms in menopausal women. The study collected data from more than 83,000 questionnaires from women ages 50 to 79 and found that more than 25 percent of them had developed atrial fibrillation, putting them at risk for stroke, blood clots, and heart failure.
True. About two-thirds of women report experiencing memory issues and forgetfulness during the menopause transition. The regions of the brain responsible for memory and learning, such as the hippocampus, as well as those needed for emotional regulation and decision-making, such as the prefrontal cortex, are rich with estrogen receptors. Researchers theorize that the decline in estrogen due to menopause may cause these cognitive issues.
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