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Menopause- the great taboo

Miyara's Guide to Midlife and Menopausal Transition: Part 1

Menopause is a natural part of a woman's life but is heavily stigmatized with a woman having to suffer her symptoms behind closed doors. No woman's menopause journey is similar and what makes it worse for some is they are not prepared for it.

This article has been written to give you an overview of what happens prior to and during menopause. Hope it helps!

What defines menopause?

Well, the clinical definition is missed period for 12 months in a row.

However, from surveys and research, we know for a fact that women go through a huge change both physically and psychologically during this transitional phase and later.

In fact, when we asked a group of women what menopause means to them personally, we had an array of responses (both positive and negative) during our social media interaction.

So, there is evidently more to this phase than just the stoppage of menstruation at an individual level.

Why is menopause greater than just the end of menstruation?

To make sense of the array of bodily and mental changes women experience through the menopausal transition, it is essential to understand the reproductive hormones.

It is well known that estrogen is the dominant hormone in the female body. However, over the years, scientists gather that the general notion of estrogen being just a reproductive hormone is a gross oversimplification.

In fact, several systems in a woman’s body have receptors that can bind with circulating estrogen, which aids their smooth functioning. The MANY PHYSIOLOGICAL ROLES of this “supposedly” female hormone have been very well-established, including energy homeostasis, cardiovascular health, fat metabolism/ weight gain, brain function, bone health, and even digestion. That is pretty much all the organ systems, isn’t it?

How does estrogen affect the female body?
Effects of estrogen on the body

With such a great impact on bodily functions and certain aspects of the brain, it is not surprising that we see a host of symptoms as estrogen levels plummet during the menopausal transition (MT). Some obvious associations are as follows:

  • The risk of osteoporosis increases as estrogen modulates bone mineralization and remodeling.

  • Due to estrogen's role in energy metabolism, muscle integrity may also be affected during MT (soreness/ aches).

  • Hot flashes and cognitive decline (brain fog, poor memory, etc.) happen at MT as estrogen has a huge impact on temperature regulation and brain functions, respectively, increasing the risk of Alzheimer's disease.

  • Mood swings are mainly the result of alterations in the gut-brain axis, as the estrogen lifecycle is deeply intertwined with the gut microbiome composition in a two-way relationship.

  • Estrogen plays a protective role against cardiovascular diseases.

  • Changes in the menstrual cycle, sexual characteristics (body hair, etc), vaginal health, breast changes and a decline in libido can be expected.

  • Acne, dark spots, discoloration and wrinkles, as well as hair thinning and greying, can happen as estrogen usually helps in maintaining skin health.

  • Weight gain, especially in the abdomen area, is commonly seen during MT as altered estrogen levels change the pattern of fat deposition.

  • The incidence of gastrointestinal reflux has recently been associated with the slump in estrogen, which seems to regulate the passage of food through the esophagus.

Is estrogen the only hormone at play during menopause?

As we know, menstrual cycles are dominated by variations in estrogen and progesterone levels.

Progesterone is necessary to sustain pregnancy i.e. cervix thickening and vaginal health. With dwindling ovarian function, progesterone levels undergo a steep drop, leading to vaginal dryness and other pelvic changes. In this scenario, the estrogen-to-progesterone ratio is higher than usual, leading to menstrual changes.

At a certain point, estrogen levels start to fall as well. However, both hormones fluctuate before reaching a steady low state (as the adrenal glands and fat tissues also produce estrogen in small quantities), causing irregular and heavy/ light/ painful periods.

Testosterone is produced in small quantities in the female body and is essential for several body functions, including bone/ muscle health, libido, mood, metabolic functions, cardiovascular health and cognitive aspects. However, with age, testosterone production falls and halves by age 40. Ovarian dysfunction lowers testosterone levels further, resulting in vaginal dryness, weak bones, and poor cognition in the post-menopausal phase. Acne and facial hair growth can also occur.

Image credit: Front. Physiol. 9:1834. doi: 10.3389/fphys.2018.01834

Follicle-stimulating hormone (FSH) stimulates ovulation every month, while luteinizing hormone (LH) stimulates the release of the egg and triggers progesterone production. With insufficient follicles (receptor organs) in the ovaries around menopause, the feedback mechanism (estrogen and progesterone levels) to shut down FSH and LH production is inefficient. Thus, their levels keep rising as ovarian function declines (due to natural or surgical menopause, and genetic/ autoimmune conditions). This is associated with bone deterioration and weight gain around the waist.

How to know if you are in Perimenopause?

It is important to understand that there is NO DEFINITE TEST to diagnose perimenopause. When we seek medical intervention for symptoms, which can sometimes interfere with daily life or even be debilitating, medical professionals try to rule out all other possible causes before zeroing in on perimenopausal status.

FSH and LH levels can be used as a guide besides age and other gynecological factors in the identification of perimenopause. Yet, it is not a straightforward diagnosis because….

The symptoms can span a huge spectrum and involve multiple organ systems and mental health. The severity and sensitivity in individual cases largely depend on basal health status, heredity, risk factors for lifestyle diseases, and stress (both physical and mental).

What are the range of menopause symptoms?
Menopause symptoms

Links in this section lead to useful resources and some solutions Miyara has to offer. DO NOT MISS THEM!

  • Menstrual irregularities

  • Hot flashes and night sweats

    • Sudden heat followed by chills

    • Flushed skin

    • Dizziness/ nausea

    • Palpitations

  • Mood and cognitive changes

    • Irritability

    • Brain fog

    • Poor memory

    • Difficulty in decision making

    • Poor concentration

  • Mental health [Click here to get professional help]

    • Anxiety

    • Depression

    • Lack of confidence/ motivation

  • Musculoskeletal problems [Try our fitness program for bone strengthening]

    • Loss of bone strength/ porous bones

    • Joint pains

    • Muscle stiffness/ aches

  • Breast changes

    • Tingling

    • Soreness

    • Tenderness

  • Migraines/ periodic headaches

  • Neurological symptoms

    • Burning of the tongue

    • Tingling in the arms and legs


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Please consult your physician for personalized medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition. To check out our symptom page on tips/ products and services that can help you sleep better, click here To check out our women's health products, click here. Join our women's health community on WhatsApp or FB This article is written by Ayshwarya Ravichandran

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