Menarche to Menopause

Original Editor - Carin Hunter based on the course by Sue Piché
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson, Wanda van Niekerk and Ewa Jaraczewska

Introduction[edit | edit source]

This course is directed towards ‘normal’ female aging, women born with ovaries.

Those trans & non-binary persons must be looked at independently since studies are lacking in order to provide adequate general information.

By understanding the ‘norm’ we can better deal with irregularities

Consider this, in her lifespan a Female will spend:

  • only 12% of her life from birth & infancy to menarche
  • 40% of her life after menarche and through her reproductive years (this may include pregnancy)
  • 40% of her life from menopause through her post menopausal years
  • 1%-2% /pregnancy, (conception, birth, to the end of the postpartum period of 12 months or 21 months in complicated cases)

Complex NORMAL developmental processes

Menarche                   Menopause

  • Occurs at the beginning of the reproductive stage
  • Marked by the first menstrual period
    • Occurs at the end of the reproductive stage
    • Marked by the final menstrual period

Exact timing of this period can not be forecast

Fertility can not be guaranteed or ruled out Birth Control is an important discussion.

Menstruation

…a menstrual period defined as

“the monthly shedding of the functional layer (the endometrial lining) of the uterus.”

  • Approximately every 28 days

   (hence it ‘cycles’, it is ‘periodic’)

  • Occurs when fertilization of egg (ovum) DOES NOT happen.
  • There are thousands of euphemisms for a menstrual period throughout the world. (more than 5,000 to be more exact)

                         Puberty                     Sexual                      Climacteric             Post-Climacteric

Infancy          Adolescence             Maturation         Menopause Transition    Post-menopause

                                                      Reproductive

Menarche – mēn (month) + arkhē (beginning)

It is when the first ‘period’ starts. It occurs during the late stages of puberty and signals the probability of ovulation and the beginning of a woman’s reproductive years.

Menopause – mēn (month) +  pausis (to cease)

It is when the final menstrual ‘period’ (FMP) occurs. This occurs at the end of the reproductive years BUT can only be pinpointed in retrospect, when 12 months have passed without a period.

Diagnosis of Disease

“Functional” Diagnosis

  • Age of female
    • Younger (8-16 yrs) or Older (45-54 yrs)
  • Character of Menses:
    • How often does it occur?
    • How long does it occur?
    • How heavy is the flow?
  • Physical & Mental changes:
    • Breast budding and growth spurt in younger females
    • Low energy/fatigue, moodiness, short temperedness, difficulty concentrating, acne, bloating, fluid retention…
    • Etc., etc., etc….

*Note: not all women progress from one stage to the next, most women do, but some move back and forth between stages or skip a stage…this doesn’t mean that they aren’t healthy.

Transitions

not disease that need to be diagnosed

Puberty is the lead up to menarche.

  • a transitional stage that alerts providers & clients to the upcoming event. There are a number of hormones and organs that begin this process.
  • regular monitoring should be done
  • Conversation should be initiated by provider by approximately age 6 of client


HPG Axis

  • Controls & synchronizes
    • Adrenal gland maturation is an independent but interrelated process

Health visit monitoring:

  • Visual exam External Primary sex characteristics
  • Height/Weight
  • Identification of appearance of Secondary Sex characteristics
  • Prepubertal genital exam https://obgynkey.com/prepubertal-genital-examination/ Doctor visit https://www.shutterstock.com/search/doctor%2Bmeasuring%2Bheight%2Bchild?gender=female&mreleased=true

Sexual Maturity Rating (SMR) - Tanner’s Stages

https://quizlet.com/514600861/tanner-stages-flash-cards/

Menstruation


Cycles are erratic at beginning

  • Follicles are present in a high % of girls but ovulation may not occur until after a half dozen menstrual cycles
  • Monthly cycles may not regulate for years

Menopause

Perimenopause to Postmenopause

  • Triggered by ovaries
    • viable follicles number less than 1,000
    • S&S begin to disrupt life
  • Normally begins between 45-58 yrs
  • End occurs after FMP – determined in retrospect, when post menopause starts

Signs & Symptoms (S&S)

Puberty to Menarche

  • secondary sex characteristics more pronounced
  • growth spurt
  • breast tenderness
  • muscle aches
  • headaches
  • abdominal cramps
  • lower back pain
  • low energy/fatigue
  • moodiness, short tempered, emotional
  • difficulty concentrating
  • bloating, fluid retention
  • joint pain
  • food cravings
  • acne
  • diarrhea/constipation
  • trouble sleeping

Perimenopause to Menopause

  • Vasomotor symptoms VMS (hot flashes/ night sweats)
  • vaginal dryness or Genitourinary Syndrome of Menopause (GSM)
  • breast tenderness
  • muscle aches
  • headaches
  • abdominal cramps
  • lower back pain
  • low energy/fatigue
  • moodiness, short tempered, emotional
  • difficulty concentrating
  • bloating, fluid retention
  • joint pain
  • food cravings
  • acne
  • diarrhea/constipation
  • trouble sleeping

Providers should be approaching menopause in the same way as menarche:

  • -monitoring for normal functioning
  • -identifying issues early and treating
  • -initiating conversations prior to the transition at about age 6 with parent/guardian and 35 with client…regardless of whether the transition is asked about or not
  • -encouraging clients to make ‘healthy choices’ within their capability

Common Medical Concerns in the Menopause Transition that need identification and treatment include:

  • POI – Primary Ovarian Insufficiency (1% in US)
  • GUSM – Genitourinary Syndrome in Menopause (50-70% US)
  • Diseases of higher risk:
    • Cardiovascular (1 woman dies every minute from CVD)
    • Diabetes/Obesity
    • Osteoporosis
    • Dementia
    • Cancer (Breast & Uterine)

Regular Assessments to include:

  • Blood work – to establish baselines +/or eliminate other things thyroid, diabetes, etc, lipid levels every 2-3 yrs starting at age 40 yrs more often if CVD is a risk, calcium & Vit D, Hormones ONLY if there’s an indication
  • Height/Weight/ECG baseline
  • Bone density scan (age 40 yrs at least for baseline, repeat every 5 years as indicated)
  • Assess for sleep/rest habits (sleep apnea is prevalent here)
  • Assess for depression as it’s prevalence increases
  • Prescriptions that are immediately helpful (acne cream, smoking cessation aids, etc)
  • Referrals that are immediately helpful (Physio, PFPT, Mental health-CBT, Sleep Clinic, etc)
  • Gynecologist &/or Endocrinologist referral
  • Pap test
  • Mammogram beginning age
  • Colonoscopy age 55
  • Follow up Appointment
  • Encourage Clients to track S&S, to facilitate & direct care and review this regularly

Healthy Choices

  • **Exercise (aerobic, strengthening and balance) you can include sex in this repertoire
  • Diet/Nutrition
  • Stop smoking if you do, don’t start if you don’t
  • Keep alcohol intake within moderation moderation
  • Sleep
  • Relax/De-stress

Summing Up:

12% of a female’s lifespan is spent in ‘lead up’ to menarche, more people are aware these milestones and predictive benchmarks, like Tanners stages, but there’s a gap in the knowledge and practice regarding preparation for menopause.

In order to understand menopause it’s essential to understand the mechanisms that exist throughout the reproductive stage, that’s what we’ve discussed here. “The tip of the menopause iceberg.”

40% of a female’s lifespan will be spent in the menopause transition, therefore there is a significant amount more information that would focus on prevention, screening and treatment options. This is a positive period in a woman’s life provided she is prepared and given adequate health care.

Thank you for joining me. I hope this has been helpful.

There’s some reading material and videos as well as helpful references.

Links to helpful pages[edit | edit source]

References[edit | edit source]

Resources:

1) Menopause Practice: A Clinician’s Guide, 6th Edition. C.J. Crandall, Editior-in-Chief. North American Menopause Society, 2019

2) Female Development, 2021, Remien & Pillarisetty, National Library of Medicine, NIH

3) Physiology of Menarche, 2021, Lacroix/Gondal/Langaker, National Library of Medicine, NIH

4) Tanner Stages, 2021, Emmanuel & Bokor, National Library of Medicine, NIH

5) The Menopause Manifesto, Jen Gunter PhD OB/GYN, Penguin Random House Canada, 2021

6) Menopause Preparedness: perspectives for patient, provider, and policymaker considerations, 2021, Menopause: The Journal of the North American Menopause Society, Vol 28, No.10 pp.1186-1191

7) The Complete Guide to Menopause, Annice Mukherjee PhD, Penguin Random House UK, first pub by Vermilion, 2021

Videos:

What is Menarche? Everything you need to know.- May 2021 (4 ½ mins)

Medical Centric

https://www.youtube.com/watch?v=kNlmOe-e23k


Menstrual cycle, NHS site video (2:41 mins) October2020

https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/

What Really Happens to Your Body During Menopause - June 2021 (5 mins)

Dr Jen Gunter, TED Talks

https://www.ted.com/talks/jen_gunter_what_really_happens_to_your_body_during_menopause?language=en


Recommended for Providers:Recommended for Providers:

Menopause Health Tool, Dr Jean Hailes

https://www.jeanhailes.org.au/health-professionals/tools

Practitioner’s Toolkit, Monash University 2014

https://www.monash.edu/medicine/sphpm/units/womenshealth/toolkit-management-of-the-menopause

The toolkit is now published online in the journal Climacteric and can be accessed in full at http://informahealthcare.com/doi/full/10.3109/13697137.2014.929651

Menopause Preparedness Fact Sheet, The Society of Women’s Health Research -October 2021,

https://swhr.org/swhr_resource/menopause-preparedness-fact-sheet/

Recommended for Clients & Parents/Guardians :

Menopause Fact Sheet, August 2019, Dr Jean Hailes, Women’s Health, Available in English, Arabic, Chinese (Simplified), Farsi, Greek, Hindi, Italian, Turkish and Vietnamese. (This project was funded by the Victorian Government)

https://www.jeanhailes.org.au/resources/menopause-multilingual-fact-sheets

Menstrual Calendar, for tracking perimenopause phase, NAMS, 2015

http://www.menopause.org/docs/default-source/2015/menonote-menstrual-calendar-english.pdf

Video: Am I Normal?, Kids Health.org (2 mins)

https://kidshealth.org/en/kids/puberty-normal-video.html


Hormone Health Network from the Endocrinsociety (Meno Map) https://www.hormone.org/menopausemap/index.html

Red Hot Mamas

https://redhotmamas.org/

Menopause Barbie

https://menopausetaylor.me/

The North American Menopause Society

https://www.menopause.org/for-women

US Department of Health and Human Services

https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief

Healthy Women

https://www.healthywomen.org/content/blog-entry/7-effective-ways-deal-menopause Canadian Society of Obstetricians and Gynaecologists https://www.menopauseandu.ca/

https://www.yourperiod.ca/normal-periods/menstruation-around-the-world/

https://www.menopauseandu.ca/

https://www.menopause.org/for-women

https://www.imsociety.org/

  • Menopause Map (link here) is a great interactive tool to start with to personalize your journey.
  • https://www.hormone.org/menopausemap/index.html
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