Menopause and Healthy Aging

First question people always ask is what is menopause? And so I don't expect the lay audience to understand this, but you'll oftentimes hear people saying, is it right after my period? Is it a year after? Is it when this hormone in my brain goes up? Is it when a hormone in my ovary goes down? Or is it all of that? And the truth is there's actually one very clear definition.

The definition is that menopause is literally the day that somebody goes one year without a period.

So it is one day of your life, essentially.

Everything leading up to that day is premenopause and everything after that is menopause.

Now, some people don't get their periods, and that's because they either had a surgery to remove their uterus, they had an ablation to remove the lining, they're on a contraceptive or a hormonal method that suppresses their periods.

And in those cases, there are lab tests that we can do, but those lab tests require six months between them because sometimes you can see hormones fluctuating.

And the hormone we're looking at is a follicle stimulating hormone.

FSH is what we call for short, and that is basically how hard is the brain working to tell the ovary to get an egg ready? And if there are no eggs left, the brain's working really hard, so you see high levels.

Now, we don't test people for ovarian hormones to see when are you going to go through menopause? Are you in perimenopause? If they're over 40, because if someone's having symptoms of perimenopause or menopause, it's pretty much a slam dunk.

But when they're younger, some people do go through an early menopause and we always do want to try to diagnose that.

All right.

So let's think about why testing sometimes isn't always the answer.

And I'm just going to go over the menstrual cycle.

And the reason that I talk about the menstrual cycle is in a normal ovulating person, there is a hormone that comes from the brain.

So that is kind of the third row down.

There's luteinizing hormone and follicle stimulating hormone.

And that hormone tells the ovary to get an egg ready.

And when it does that, there is a hormone called estradiol.

We're familiar with estradiol that goes up and estradiol stimulates the lining of the uterus and gets it ready for an egg to implant after ovulation.

That's the second half of the cycle.

So if you look at the bottom here, you'll see luteal phase.

The second half of the cycle is basically dominated by the hormone progesterone.

And so you can see that just one below the bottom, that progesterone then becomes the dominant hormone.

And this is important.

because progesterone's role in the uterus is to protect the lining and get it ready for an egg to implant and progesterone is really necessary to counteract the effects of estrogen in the uterus and this comes into play when we talk about hormone therapy but there also are progesterone receptors just like there are estrogen receptors all over the body that means that most of our tissues are sensitive to these hormones not just the uterus So when we're looking for labs, basically there's all these labs that people are oftentimes asking us for.