Menopause-related terms are imprecise, which makes it difficult to create an accurate, shared understanding.
The issue with the word “symptoms”
A person on the path to menopause begins to have more headaches, new anxious feelings and feels like they can’t cope as well as they used to. They struggle to sleep through the night for several nights leading up to their period. They certainly feel like they have “symptoms” but in reality, the things they are experiencing are the “result of,” “the impact of,” or “a manifestation of” changing hormonal patterns. “Symptoms” suggest one is ill. This is not an illness. These changes are normal and meant to happen as the reproductive system finishes up.
At this point, we at Women Living Better, are still using “symptoms” on the site but we aim to come up with a better term. We discuss and debate this topic with experts regularly so stay tuned for an update. In the meantime, here are the words we’ve decided to use — for now —and why.
Stages of Reproductive Aging
Terms used to describe various stages of reproductive aging
THE REPRODUCTIVE YEARS
The years when our periods are coming on a regular basis (along with ovulation) and thus we are most capable of conceiving — between approximately 20 and 35 years old. Peak fertility is around age 26. Often used interchangeably with premenopause see below.
PREMENOPAUSE
This is another term used to describe the reproductive years when periods (and ovulation) are happening approximately monthly. Studies put peak fertility at around 26. It is also sometimes used more broadly to describe any time before menopause or perimenopause. Because we’ve seen premenopause used to describe so many different phases, we think it’s confusing, and we don’t use it on our site.
PERIMENOPAUSE
Perimenopause is a word with at least three definitions.
- In general, it’s used to describe the period of fluctuating hormones leading up to menopause.
- The majority of healthcare providers would say a person is “in perimenopause” when cycles are of irregular length or a period has been skipped.
- The research community defines the entry to the “menopause transition” aka perimenopause as beginning when consecutive cycles vary by 7 days. This would mean a cycle of 33 days followed by one of 26 days or fewer. We know from our research and other research that many people experience changes and symptoms associated with hormonal fluctuations before this point — when their periods are still coming every month. We are working to raise awareness that changes/symptoms happen before dramatic changes in cycles.
MENOPAUSE
You are said to have reached menopause when you have had your final menstrual period. The catch is that you cannot know it was the final period until 12 months have passed without another one. So there are actually twelve months when you’ve had your final menstrual period but don’t know it yet. The average age of menopause in the U.S. is 51.2 years, but the onset varies significantly. The most common range is between ages 48 and 55, though having a last period anywhere between 40 and 60 is still considered within the normal range.
Menopause is also used as the broadest way to refer to any repercussions of changing hormonal patterns as you move from the reproductive years to the non-reproductive years.
POSTMENOPAUSE
Postmenopause is a term used to describe the years after reaching menopause. For some, this is an unnecessary term, since once you reach menopause, people say you are “in menopause” or “menopausal” for the remainder of your life. However, it is the most common way to describe the years after menopause and so we use this word.
MENOPAUSE TRANSITION
The menopause transition is the term we will use to describe the often long period of time when hormones are fluctuating on the path to menopause.
We break this into two phases
- one part when periods are coming monthly, but cycle length (the time between day 1 of menses/flow of one cycle and day 1 of menses/flow of the next cycle) is shortening
- a second part when cycle lengths are irregular and periods are skipped.
Menstrual Cycle Terminology
Terms used to describe various parts of the menstrual cycle
A “CYCLE” – MENSTRUAL CYCLE LENGTH
The length of a menstrual cycle is the number of days between the first day of menses (or bleeding) of one cycle and the first day of menses for the following cycle. As an example, if you get your period on June 2 and then again on June 30, your “cycle length” would be 28 days.
MENSES
Also referred to as flow, menses are the days when menstrual blood flows out of the uterus through the vagina.
FOLLICULAR PHASE
This is the first half of the menstrual cycle. It includes menses and lasts until ovulation at mid-cycle. During this time a group of follicles (eggs) is being stimulated to develop. One of these follicles becomes “dominant” and is released at ovulation. The rest die off.
LUTEAL PHASE
At ovulation, the dominant follicle bursts from the ovary. The location of where the ovary opens or bursts to release the follicle becomes the corpus luteum. The corpus luteum becomes a temporary gland and releases progesterone and estrogen during the second half of the cycle. This is the only source of progesterone production which is why when you don’t ovulate no progesterone is produced.
Menopausal Hormone Therapy
Terms used to describe menopausal hormone therapy
BIOIDENTICAL HORMONE PRODUCTS
Bioidentical products have the same molecular structure as those hormones produced by our own bodies. These products are still synthesized (or manufactured) in a lab. While it seems intuitively logical that a chemical that is molecularly identical to those already in our bodies might have fewer side effects — than one that is manufactured to work similarly but has a different molecular structure — this has not been proven. Here you can see the difference in structure between progesterone (the one made by our body) and a synthetic one (a progestin), similar but not the same.
SYNTHETIC HORMONAL PRODUCTS
Products that are created by chemists in a lab to work like the hormones in our bodies. These products are often optimized for potency (strength) and have similar, but not the same chemical structure as those produced by our body. For example, synthetic estrogen (ethinylestradiol, or EE) is four to 10 times more potent than 17β-estradiol (the bioidentical one).
NATURAL HORMONE PRODUCTS
Some people claim that bioidentical hormones are “natural,” but this is a loaded (marketing) term that has no agreed-upon scientific definition. While they may be derived from a plant or other source that occurs in nature, even bioidentical hormones are manufactured in a laboratory to create a final product.
HORMONE THERAPY ACRONYMS
HT: hormone therapy
HRT: hormone replacement therapy
BHT: bioidentical hormone therapy
BHRT: bioidentical hormone replacement therapy
OHT: ovarian hormone therapy
MHT: menopausal hormonal therapy
ET: estrogen therapy
CHT: combined hormone therapy
CHC: combined hormonal contraception
OCP: oral contraceptive
Other menopause related terms
VAGINAL ATROPHY
Also known as atrophic vaginitis, it is the thinning, drying, and inflammation of the vaginal walls due to less estrogen.
DYSPAREUNIA
Painful intercourse.
VULVAR AND VAGINAL ATROPHY
A common and underreported condition associated with decreased estrogenization of the vaginal tissue. Symptoms include dryness, irritation, soreness, and dyspareunia, along with urinary frequency, urgency, and urge incontinence. This term has recently been renamed the Genitourinary Syndrome of Menopause.
GENITOURINARY SYNDROME OF MENOPAUSE (GSM)
Genitourinary syndrome of menopause (GSM) is a constellation of physical changes and symptoms including vulvovaginal dryness, burning, or irritation; dyspareunia; and urinary symptoms of urgency, dysuria, or recurrent urinary tract infection (UTI) associated with estrogen deficiency.