Stages and Symptoms of Menopause

A normal part of the process of aging, menopause is a transition period wherein reproductive hormone production slows and the ovaries cease producing eggs. This ends menstruation, as well as a woman’s fertility and ability to conceive. There is no definite age at which menopause starts, but it is typically between 40 and 55. In certain cases, as when ovaries have been surgically removal or premature ovarian failure occurs, it may begin earlier.

There are three stages of menopause: perimenopause, menopause, and postmenopause. The perimenopause phase involves an atrophy of the ovaries, which triggers a decline in the hormonal activity. Estrogen and progesterone levels drop and fail to stimulate the menstrual cycle. At the same time, the quantity of eggs produced by the ovaries naturally declines, with the result a gradual drop in fertility. The complete transition, from perimenopause to menopause, typically lasts at least seven years.

The changes associated with perimenopause are noticed by some women as early as their mid-30s. Menstrual cycles often become more irregular, shortening or lengthening. In addition, some menstrual cycles may not result in ovulation, the release of an egg by the ovaries. Menopause-like symptoms, including sleep disruptions, vaginal dryness, and hot flashes, may start to accumulate.

Perimenopause usually lasts three to five years, and the later stages involve 60 days or more without a period. Getting pregnant is still a possibility, so it is important to practice some form of birth control if the aim is not to conceive.

The official start of menopause is when a menstrual period has not occurred in the last 12 months. Some experience relatively few menopausal symptoms and may experience a sense of relief that the painful aspects of periods are past and there are no concerns about getting pregnant. Other women experience hormonally linked symptoms such as irritability, moodiness, and depression, as well as painful intercourse.

Among the most emblematic symptoms of menopause are hot flashes, which involve surges of heat on the skin and drenching sweat. The heart rate elevates, and the neck and face often turn red. Such flashes arise as quickly as they pass, usually lasting between 30 seconds and five minutes. They may also occur during sleep, with night sweats characterized by a sudden jolt of heat and a sensation of sweat overwhelming one’s body.

Particularly when hot flashes happen at night and disrupt sleep, they may result in irritability, fatigue, and a tendency to forget things. Around 10 to 15 percent of women going through menopause experience hot flashes of such severity that they disrupt their normal patterns of life. A major cause is believed to be disruptions in the thermoregulatory center, which is hormonally influenced and modulates the production and loss of heat in the body. For many women, controlling hot flashes involves avoiding triggers such as red wine or coffee, as well as specific drugs for cholesterol and high blood pressure. Potential therapies include acupuncture, as well as menopausal hormone therapy and other nonhormonal medications.

Other changes associated with menopause include loss of bone, which can increase the chances of osteoporosis. A lowering of estrogen levels can also cause a spike in “bad” low-density lipoprotein (LDL) cholesterol, which elevates cardiac disease risks. This is compounded by the fact that “good” high-density lipoprotein (HDL) cholesterol levels naturally decrease as many women age.

The postmenopausal stage is one in which menstruation and ovulation are no longer possible, due to low progesterone and estrogen levels. Symptoms associated with perimenopause and menopause may continue for an extended period following the last menstrual cycle, but they ultimately dissipate, and regular exercise and a healthy diet can help ease the transition.

A Study of Health Inequity Among Black Women in the United States

The 2021 study “Health Equity Among Black Women in the United States” (Journal of Women’s Health) focuses on persistent health disparities that marginalize black women. Despite overall progress in medical care over the past century, black women continue to have excess mortality in comparison with other US women, which results in higher maternal mortality and shorter life expectancy.

With health outcomes tied to social conditions and structural inequities within the health care system, black women disproportionately bear the weight of chronic conditions such as heart disease, anemia, and obesity. Behind this is systematic oppression, which impacts black women’s access to education, employment, and the ability to secure safe and affordable housing for their families. Beyond racism, black women also face sexism and a level of discrimination that neither white women nor black men do.

The authors place the blame for this health inequality on the historical construct of slavery and how white slaveholders viewed black women as a means of economic gain and as property that could be abused, with little regard for reproductive health. Lacking self-agency when it came to pregnancy and procreation, many black women had minimal access to medical care. This “accumulation of disadvantages across generations” has led to a public health emergency, in which non-Hispanic black women have mortality rates three or four times higher than non-Hispanic white women.

Among the metrics in play for a group that makes up 13.6 percent of all American women is that they have a life expectancy at birth that is a full three years less than non-Hispanic white women. In addition, infant mortality rates are higher by a factor of two. The weathering hypothesis explains much of this in terms of “differential exposures to stressful environments,” with socioeconomic disadvantages accumulated over a lifetime associated with widening health disparities as black women grow older.

One outward manifestation of this disparity is obesity, which is 34 to 50 percent higher among black women than among other US ethnic groups. Another is cardiovascular disease (CVD) incidence, which declined for a half-century for black women before stalling out in 2011. A key research question involves understanding the connection between the socioeconomic roots of CVD and genetic studies that offer pathways to the potential use of precision medicines. One major differentiator appears to be sleep disparities, with black women more likely to experience insomnia, obstructive sleep apnea, and prolonged or short sleep durations.

When it comes to maternal morbidity and mortality, one major factor impacting black women is hospital quality and access to appropriate health services. Studies reveal that black women tend to give birth in lower-quality hospital settings, with elevated severe maternal morbidity rates. Statistical models suggest that if just these two factors were changed, maternal morbidity rates among black women would decrease 47.7 percent, from 4.2 percent to under three percent. In addition, homicide is an understudied yet leading cause of mortality among black women during pregnancy.

Much of the health disparities black women face also have roots in mental health and the psychological stressors they must confront on a daily in a society where discrimination is all too common. Physiological dysregulation (known as allostatic load)) places cumulative chronic stress on the body and significantly predicts poor birth outcomes. As the authors describe it, “without equity in social and economic conditions, health equity is unlikely to be achieved,” and the cost will continue to be borne in the lives of black women.

ACLU’s Focus on Racial Injustice Issues

Shawanda Renee Obey, MD leverages nearly two decades of experience in obstetrical services to inform her role as a supervising physician at Northeast Valley Health Corporation. Outside of her clinical work, Shawanda Renee Obey, MD supports efforts for equal rights through membership with the National Association for the Advancement of Colored People and the American Civil Liberties Union (ACLU).

The ACLU, a leading defender of individual rights and liberties, has protected people from governmental abuses for close to a century. The organization safeguards the rights of all through a network of over four million members and activists who address issues, ranging from capital punishment and criminal justice reform to LGBT rights and racial justice.

The ACLU’s Racial Justice Program strives to address embedded systemic racism and ensure equal rights for people who have historically been mistreated based on their race. Currently, the organization’s work in this area focuses on five core areas:

1. Race and Criminal Justice – address bias in the criminal justice system and reform policies that target people based on their race.

2. Race and Economic Justice – address economic systems of inequality, such as barriers to homeownership and credit based on race.

3. Race and Education Inequality – ensure equal access to high-quality education and reform policies that criminalize students for minor misconduct.

4. Affirmative Action – support programs that remedy system discrimination and ensure racial diversity.

5. American Indian Rights – defend the rights of American Indians and tribes.

Cervical Cancer Prevention and Screening