Menopause & perimenopause
Post-menopause — what happens after the change
by Dixie Mills, MD
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Who is the post-menopausal woman? Exactly what is menopause, and what does “post-menopause” mean? Literally, the term means after the menopause, or the stopping of periods. To be more precise, most providers consider a woman to be post-menopausal when she hasn’t had a vaginal bleed for one year.
But for many women, it’s difficult to calculate when exactly their last period was because you don’t know it was the last one until 12 months later. We often see women who hope that a particular month’s bleeding is the last, only to have another period several months later and have to start counting all over again. So it’s understandable how we could conflate what is actually premenopause with menopause. (For more information on “what is menopause,” see our article on ending confusion about menopause.)
Aside from transitioning into menopause naturally as described above, some women have their ovaries removed surgically, and are considered post-menopause after the operation because there is no longer any chance they will have another period. On the other hand, women who stop having periods during chemotherapy might resume them after treatment is over. Even if the treatment causes their periods to stop for a whole year, most doctors do not consider these women to be post-menopausal without checking their FSH levels. Also, women who are taking any type of hormone replacement therapy (HRT), even if they’ve not had a period in 12 months, may not be technically post-menopausal because once they stop therapy they usually have some of the symptoms of menopause again.
So are all post-menopausal women the same? The answer, of course, is a resounding NO.
The range of menopause symptoms, related diseases, and quality of health for post-menopausal women is gigantic. Some women get very few hot flashes; others have night sweats into their 70’s. We don’t even know what the average age is when women stop having hot flashes because the number is affected by too many variables to be accurate. Many women are reassured by talking to their doctors about this important time. You may want to get the conversation started as early as possible, even while you are transitioning through menopause.
Post menopausal and what it means to women
Are you post-menopause until you die? Theoretically, yes, but the same could be said for post-puberty and post-partum. The difference is that these other life stages seem to have natural endings when a new one begins. But what is the new stage after menopause?
We are considering offering a contest to pick a new heading for the time in a woman’s life that we now call post-menopause. The present terms just are not satisfactory! For the possible 40 or even 50 years of life after menopause to be labeled as simply post-menopausal seems terribly anticlimactic.
The years between 20 and 50 are often referred to as “the childbearing years.” This term is not perfect either, but at least it carries none of the negative connotations of menopause, because we are creating. But what are we doing if we are “post-menopausal?”
With all the baby-boomer women reaching the age of menopause, we are sure to create a new expression. What will it be? The term “midlife” obviously won’t last, and no one wants to be called elderly — even “young elderly” isn’t going to sit well with my friends. I imagine my friends as hip 80-year-olds, driving around in Smart Cars and keeping connected with the latest Blackberry-like devices.
A new beginning with menopause
We contend that menopause brings many benefits along with its changes. But unfortunately we see and hear the negative side effects of menopause emphasized while the joys of post-menopause are neglected.
Our grandmothers and even most of our mothers did not talk about their bodies, let alone their periods. I have read several famous women’s autobiographies to find out if they shared their experiences of menopause or post-menopause. Jane Addams took to her bed in the 40’s with undiagnosed fatigue and headaches. Was it menopause, or just rheumatism as thought at the time? Eleanor Roosevelt never once mentioned a hot flash in her diaries or columns. This did not stem my curiosity about what menopause meant for women of yesteryear. Margaret Mead did write about post-menopausal zest, but then, anthropology is a holistic science, and perhaps this gave her greater license! (For more cross-cultural insight, see our article on menopause across cultures.)
Discover the joys of post-menopause
There are many things to love about being post-menopausal. There is a light at the end of the tunnel of heavy bleeding and hot flashes. No more Kotex pads or Tampax! No more worry about pregnancy. Most women find their voice and have no qualms about raising it. This does not happen overnight of course, and for many women it takes time to stop feeling bad about speaking up — but they realize they have nothing to lose and much to gain!
Many women find another avocation of sorts for their second act. With children out of the house, they can spend time on themselves, go back to school and take a class in the area they have always dreamt about. Many pick up a paint brush for the first time or try a musical instrument. I have a patient who was formerly an accountant for a large university, and she decided to resign and open a knitting café that sells organic coffee and green tea! Of course, this wasn’t a snap decision and took months if not years of meditation and consultation with family and friends. But the possibilities are endless. Another patient, once her youngest was in college, enrolled in theology school to satisfy her spiritual quest. Yet another patient for her 60th birthday packed up her husband and her house and began a year-long trek through Europe to explore her ancestral heritage and leave a legacy for her children.
Post-menopausal women are not going to be invisible anymore. There are too many of us to just slip away into anonymity. As a collective we are rediscovering ourselves. fSome, maybe including yourself, are going through a lot of angst and discomfort, and we don’t want to trivialize that. But there are answers, and once you begin to feel better you can re-live your passions and really explore with zest! There is no need to grin and bear it — instead, go ahead, scream and dig into it. Let’s make these years truly golden ones. Send your ideas and let us know what you love about being in post-menopause.
(PS: For one, I see a lot less breast pain once periods stop!)
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Last Modified Date: 06/02/2011
Principal Author: Dixie Mills, MD