What's in a name?

Question

I'm all confused. Am I in menopause or not? If I am, how come I have regular periods? If I'm not, how come I get night sweats? I have a friend that's menstruating and flushing like me who went to her doctor, had some blood test and was told she was "not in menopause." Can you help me make sense of these confusing words?

Answer

I'll do my best to clear up your confusion. You are quite right that what we call women's midlife experiences is very mixed up. And so is how we understand, and how we treat women's midlife health problems. I think that accurate naming is the first step toward better understanding and more appropriate, safe and effective treatment.

Who has the right to name things? That's an important question. We generally let powerful people create names. I'm sure you know of buildings that carry a person's name. All you have to do is donate so many millions of dollars and you get a tower named after you. bell hooks, a black feminist, activist and professor of English and women's studies calls naming "a privileged act" (Ms. Magazine, July 1992; vol 3, pages 80-82).

What you already know is that the name, "menopause," doesn't seem to apply to you. So let's start by discussing what the word menopause means.

Menopause

This word is used at least three different ways, and some scientific and most women's magazine articles confusingly mix all three meanings.

Let's look at each of these three definitions, starting with who is naming:

1. Gynecologists using the word, "menopause" mean the actual, (I mean literally) last menstrual bleeding. That is a bit odd because it takes a further year without flow before there is a high likelihood-over 80% if you are 40-49 years old; over 95% if you are 50 or older-that the particular period was really the last you will ever have.
2. Ordinary women consider "menopause" to be anything changing from mid-life onward, especially when they have had their first night sweat.
3. Epidemiology or population health experts and CeMCOR consider "menopause" the normal phase of every woman's life that begins one year after the final menstrual period. Menopause lasts for the rest of our lives.

Note that the official gynecology says that the day after your flow stops in what may/may not be your last period, you are "postmenopausal." I think that postmenopausal is not only saying the same thing twice, but only occurs when we are dead!

bell hooks, in talking more about the "privileged act of naming", went on to say that the process of naming ". . .may obscure what is really taking place" (Ms. Magazine, July 1992; vol 3, pages 80-82). I feel that is what gynecologists are doing by calling "menopause" a particular menstrual period-it sounds quite legitimate. However, even if that is the last flow you ever have, at least one year is needed before estrogen settles down into more stable low levels. Thus the gynecological definition of the word menopause justifies their prescribing estrogen treatment. Because they believe that menopausal women are "estrogen deficient" rather than experiencing a new phase of life that is characterized by low estrogen and progesterone levels, the gynecology definition of the word menopause obscures wrongness of the early prescription for estrogen.

In your question, you were using the word "menopausal" in the second way. But you are not really menopausal if you are having regular flow. And you are not premenopausal if you are having night sweats. Is there a word that fits with your experience?

Perimenopause

Yes, that word is Perimenopause. Perimenopause, like menopause, can mean many things, but for CeMCOR it has a very specific meaning.

"Perimenopause is the normal life phase that begins in regularly menstruating women with definite (to a woman) changes from her usual experiences (such as start of migraines, shorter cycles, heavier flow, start of night sweats, start of waking in the middle of the night, unexplained weight gain and/or increased premenstrual symptoms)." Perimenopause has several phases but ends when one year has passed since any spotting or the last menstrual period. (You will notice that from the end of perimenopause you graduate into the last phase of our reproductive lives, menopause.)

Menopausal Symptoms

The final term we need to talk about is "Menopausal Symptoms." Many articles imply that every doctor knows what that phrase means-like a "cold" means a stuffy head, runny nose and perhaps a sore throat. But, does "menopausal symptoms" include irregular bleeding, sore breasts or mood swings that happen in perimenopause, but not in menopause? Does it mean hot flushes that may occur in both perimenopause and menopause? Unfortunately it's not clear. Therefore we must be specific. I believe we need to say "Perimenopausal Night Sweats" or "Menopausal Night Sweats" if that is what we mean.

Why do we need to be specific rather than say "menopausal symptoms?" We need to be specific because the therapies are (or should be) different for perimenopausal and menopausal hot flushes. We know that menopausal hot flushes are well treated by estrogen alone (primarily used in women who have had a hysterectomy) or by estrogen with progesterone or medroxyprogesterone. (In fact, for a menopausal woman with or without a uterus, estrogen with progesterone/progestin works better for flushes than estrogen alone.)

However, there is no good evidence that estrogen or estrogen with a small amount of progestin is effective for hot flushes in perimenopause. Likewise, there is no good evidence that oral contraceptives are more effective than placebo (a sugar pill) for perimenopausal hot flushes (and The Pill has very high dose estrogen with normal dose progestin).

I think that the term, "menopausal symptoms," should be totally abandoned. If we are talking about hot flushes, or heavy flow, or painful sex, or trouble sleeping, we should say just that. To some, a left little toe itch might be a menopausal symptom!

We've discussed a lot of terms here. I hope that you are now clear that you are in Phase A or B of perimenopause. If you have further questions about the meaning of words, take a look at the CeMCOR glossary, or just put the word you want to look up into the search line of the CeMCOR website.

Hope this is helpful for you,

All the best,

Jerilynn