What exactly are we talking about anyway?

Before we talk, we need to talk about how we talk.

Menopause is challenging enough. The language used to describe it shouldn’t make it harder. As it stands, the language, terminology and usage related to menopause is quite muddled. Which is fine for the limes and mint in a Mojito but not so much for a woman trying to get a grasp of what the hell is going on, what is going to happen and what it all means.

As I started to experience perimenopausal symptoms, I poured myself into research and what I found was an outright mess. The language is all over the place and often used in ways that are inaccurate and misleading. This is a graph of the usage of the word menopause since 1800 (Thank you, Google). As you can see, it’s pretty new. So it makes sense that we are not yet that sophisticated in how we use it. Perimenopause even newer and only starts to show up as the first Boomer women start to reach their mid 40s in the mid-1980s.

So, basically, we’ve gotta clean this up. In order to clearly communicate, we need a clear vernacular around the experience of menopause. We need to use the same words in the same way.

I know this is a big ask. And I am no expert. I just tired of having to explain this to every woman I meet. Well, most of them, anyway.

Let’s break it down.

Menopause is derived from two roots from Greek, men or meno for month and pausis meaning to pause or cease (Menstruation uses the same root men). In perimenopause, the peri prefix which means about or around — think peri-meter.

Menopause is technically a point in time. That point in time is when a woman has experienced 12 consecutive months without a menstrual cycle. This is reflected in phrases “hit menopause, reach menopause, through menopause”. For a young girl, puberty is marked by the first menstrual cycle. Menopause is marked by its cessation.

Let’s put it together. The four terms for this multi-year journey: Pre-, peri-, early post-, late post-.

Let’s start with pre. While anything before you hit menopause could technically be considered “pre”, as far as I can deduce, it generally refers to the time in your 40s leading up to menopause (the average age is 51 in the US and UK). More specifically, before menopause, there is perimenopause. The prefix “peri” means “around” so perimenopause technically means the time around menopause. However, its common usage refers to the time before menopause when symptoms arise due to hormonal change. It’s used in phrases such as “in perimenopause”, “experiencing perimenopause” or “I am perimenopause”. (Linguists, I beg leniency). If you’re still having periods without noticeable changes and you’re in your 40s, you’d be pre-menopause. If your periods are changing and you’re starting to experience symptoms, you are technically still in pre-menopause but you are now also in perimenopause. (We’ll get in to symptoms another time.)

Next let’s talk about post. Post is any time after you’ve marked those 12 consecutive months. The time after can be separated into two phases: early post-menopause and late post-menopause. Early post-menopause is when your body is working towards its new normal, ovaries have ceased ovulation and estrogen levels are falling. Late post-menopause is when your body has found a new normal with essentially no estrogen production and generally (generally!) symptoms go away.

Pre and peri- get confused. Early post- and later post- get lump conceptually into one thing. All this is problematic.

Hormonally they are distinct and require language so we can recognize that. Perimenopause is marked by wildly fluctuating estrogen and a drop in progesterone (on average, perimenopausal women have higher estrogen levels than teen girls during puberty). In early post-menopause, estrogen is falling. In later post-menopause, estrogen levels have stabilized to a very low level.

Add to this another problem. It is also used to refer to the “entire” process (perimenopause to late post-menopause). It is a very lazy way to describe a very complex process. Not helpful. Especially when women are trying to understand what is going on and trying to communicate it to others when seeking support.

The distinction between peri, early post- and later post- is a matter of not linguistic gymnastics. It is a critical categorization that will help foster self-awareness and guide treatment of symptoms. The more sophisticated we get, the better we all are.

So, can we agree on how we are talking about it so we can finally talk about it?

Oh, one more thing. Does anyone have any good phrases to use instead of menopause transition or menopause journey? They just seem so played out. So, not only do we need clearer words, we also need better words.