Naming Women’s Midlife Reproductive Transition
Among health care providers, consumers, and media, confusing use of terminology exists relating to women’s midlife reproductive transition (such as “menopause,” “perimenopause,” “the change,” “menopausal transition”). In the midst of this confusion, this important and sometimes symptomatic transition may be lost, or conflated with the end of reproductive-related life.
As a Society that listens to and aims to facilitate women’s understanding of, and self-advocacy about, their own health, we claim what bell hooks has called the “privileged act of naming,” because we believe that presently midlife naming “obscure(s) what is really taking place” (Ms. Magazine, July 1992; 3:80-2). Our aim here is not to criticize women’s language, nor to tell women how to describe what they are experiencing but rather to alert both women and society to the ambiguities and potential miscommunications in the current language.
We want to promote the use of clearer terminology in the interest of reducing confusion and improving midlife women’s quality of life, as well as access, if desired or needed, to appropriate health care.
These concerns led to the following Position Statement.
Whereas There is a normal reproductive life transition for women* between premenopausal potential fertility** and the final reproductive-related life phase that starts one year after the last menstruation (that may be called menopause^ or postmenopause^)
Whereas The midlife transition differs from premenopause and the final reproductive-related life phase in both:
- Women’s experiences and experience changes
- Women’s hormone levels and hormonal changes
Whereas Hot flushes/flashes and night sweats occur during both women’s midlife transition and in women’s final reproductive-related life phase.
Currently the term, “menopause” is confusing because it is used too widely. It is used to include what are actually three different “events” or meanings:
The word, “menopause,” can mean any or all of the following
- To women in general, “menopause” means everything changing or symptomatic in midlife and/or beyond.
- To those trained in obstetrics/gynecology/reproductive endocrinology, the word, “menopause” means the literal first day of the “final” menstrual period (also called FMP). The irony is that this flow can only be known to be final when a further year has passed without any more bleeding.
- To those in public heath and epidemiology, “menopause” means the normal women’s life phase beginning one year after the final menstruation.
We, of the Society for Menstrual Cycle Research, believe and declare that:
- The use of the term, “menopause”^^ (or “post-menopause”^^), should refer specifically, and only, to women’s last reproductive-related life phase that begins one year after the final menstruation.
- “Perimenopause” is the general term for women’s whole midlife reproductive transition; the “menopause transition” is specific for the phase from irregular cycles up to the final flow—these two terms are the appropriate language with which to describe women’s normal midlife transition.
- The words hot flushes/flashes and night sweats are strongly preferable to the over-used and non-specific term, “menopausal symptoms.” Hot flushes can and do occur during both the perimenopause and menopause/postmenopause. It is appropriate, therefore, when describing hot flushes, to preface with the life phase in which they occur (e.g. “perimenopausal hot flushes”). This is important because treatment that is effective and safe for menopausal hot flushes may be neither safe nor effective for perimenopausal night sweats.
*We recognize that the term “women” is problematic. Some women do not posses features of sexed female anatomy while others who do may not identify as “women.” We appreciate that those who identify as transsexual, transgender, intersexxed or genderqueer may also experience perimenopause and menopause.
^Although sometimes the menopause/postmenopause life phase is further divided, for our purposes that is not necessary. We also use these two terms synonymously although “menopause” may be preferable since it is perhaps more clear.
^^Natural midlife menopause should be distinguished from menopause that is experienced by women prior to the age of 40. This can occur through removal, injury, or compromise of ovaries through surgery; cancer treatment that permanently destroys ovaries; or premature ovarian insufficiency due to autoimmune conditions, genetic factors, chromosomal irregularities, smoking, certain viral infections, environmental toxins, and other causes, including those that are unknown. Although early or premature menopause is not typical, it is also not rare.