Ask Barbie! Barbara Taylor MD's Q&A addressing your burning questions about Menopause

Ask Barbie: What’s the Difference Between Gradual and Sudden Post-Menopause?

and what difference does it make TO YOU?

The Essence of the Terms

Welcome to Ask Barbie, where I answer your burning gynecologic questions. This episode’s question pertains to menopause.

The question is: What’s the difference between gradual post-menopause and sudden post-menopause? Does the difference even make a difference to you?

I always like to start with a definition. This is especially true when a term sounds like common sense. Often , the common-sense meaning doesn’t capture the essence of the term. This is the case with the terms:

“Gradual post-menopause”
and
“Sudden post-menopause.”

Gradual Post-Menopause

So, let’s address “gradual post-menopause” first.

Gradual Post-Menopause is when you experience the entire prolonged process of peri-menopause.

In other words, you gradually transition from pre-menopause … through peri-menopause, … and then to post-menopause.

Peri-menopause can last for two to ten years. So gradual post-menopause is when you have some degree of peri-menopause between your pre-menopause and your post-menopause.

Of course, you never know how long your peri-menopause will last until you’ve become post-menopausal. Your post-menopause is always something that we determine retrospectively. You don’t know that your final menstrual period is your final menstrual period … until you’ve stopped having them. So the precise duration or degree of peri-menopause is not relevant. What matters is that you had all three phases. The duration of any of them is irrelevant.

Gradual post-menopause is when your periods peter out on their own. It doesn’t matter whether it takes two years or ten years. The bottom line with gradual post-menopause is that your body transitions through the entirety of whatever constitutes your peri-menopause.

Your Transition from Peri-menopause to Post-menopause

When you look back on your gradual transition from peri-menopause to post-menopause, it’s likely to have transpired something like this:

First, your periods got a little wacky,
and then your mood got a little testy.
All the while, you felt anxious.
Then, you started noticing symptoms of estrogen deficiency, including any or all of the following:

Absent periods
Anxiety
Heart palpitations
Hot flashes
Night sweats
Insomnia
Fatigue
Forgetfulness
Mood swings
Irritability
Depression
Joint pain and stiffness
Dry skin
Hair loss
Vaginal dryness
Urinary tract infections
Urinary incontinence
Weight gain
Decreased sex drive
Headaches
Difficulty having an orgasm
Lack of energy
Thinning pubic hair
Decreased muscle mass
Decreased feelings of well-being
Deepening voice
Acne
Whiskers
Aggression
Anger

You remember your transition as a process.In retrospect, you see that you started having some of these symptoms long before you realized that they constituted peri-menopause.

Even if you started using hormone replacement therapy (HRT) before your final menstrual period, you still became post-menopausal gradually. You merely masked the symptoms with HRT.

Sudden Post-menopause

So, what’s the definition of “sudden post-menopause”?

Sudden Post-Menopause is when you do not experience the entirety of your peri-menopause. Instead, you either skip it altogether, or you curtail it.

There are two possible scenarios for creating sudden post-menopause:

No peri-menopause
Interrupted peri-menopause.

With no peri-menopause in between the two, you jump directly from pre-menopause to post-menopause.

Interrupted peri-menopause means that you start peri-menopause, but then curtail it suddenly and enter post-menopause.

If you go directly from pre-menopause to post-menopause, you skip peri-menopause altogether.

In either case, your final menstrual period is suddenly your final menstrual period, with nothing to suggest that it’s your final menstrual period beforehand. Alternatively, your ovaries suddenly stop producing estrogen, without a gradual decrease in the quantity of estrogen. Instead of the transition from pre- or peri-menopause to post-menopause taking years, it happens overnight.

So, how does sudden post-menopause come about? Well, something causes it. And there are four ways for sudden post-menopause to come about:

The most common is due to any surgery that removes both of your ovaries. If surgery removes both ovaries, menopause occurs the second they’re gone. You have to remove both of them to cause post-menopause. If you remove only one of them, it does not cause post-menopause.
The second most common cause of sudden post-menopause is radiation therapy. Radiation is a form of intense energy that is so strong it kills things. And your ovaries are fragile. So, if you have radiation therapy that comes into contact with your ovaries, it can kill your ovaries. With radiation, your ovaries are still present, but they’re burned to a crisp, and do not function.
The third most common cause of sudden post-menopause is with certain chemotherapeutic drugs. The goal of chemotherapy for cancer is to kill cells. And some chemotherapeutic agents kill the cells of your ovaries such that they stop producing estrogen. Once again, your ovaries are still present, … but they do not function.
Fourthly, and least commonly, your own body just skips the peri-menopausal transition phase spontaneously, in whole or in part. Sometimes, this can happen as a result of a disease, sometimes, after pregnancy. Sometimes, we don’t know what caused it.

So, the four ways sudden post-menopause happens are:

With surgical removal of both ovaries
With radiation therapy
With chemotherapy
Spontaneously

Symptoms of Estrogen Deficiency

Now, think about how miserable you can be with gradual post-menopause. All those symptoms happen from time to time for a long time.

But, with sudden post-menopause, all those symptoms happen all of a sudden, all at once. And their severity is usually much greater than with gradual post-menopause. Talk about shock! Your body has no time to adjust.

Diseases of Estrogen Deficiency

And, so far, I’ve only mentioned the symptoms of post-menopause. What about the diseases?

How do you think these two different kinds of post-menopause affect the diseases that are due to estrogen deficiency? You already know that your risk for heart attack, osteoporosis, and Alzheimer’s Disease increase dramatically with gradual post-menopause.

Do you think the effects of sudden post-menopause are any different? You bet they are! And the differences are not favorable. Sudden things are more shocking. That’s true with just about anything.

If there’s no warning, or you have no ability to prepare in advance, the effects are more severe. And the same is true with sudden post-menopause.

Women who have sudden post-menopause are at higher risk for heart attack, osteoporosis, and Alzheimer’s Disease simply because of the abrupt loss of estrogen.

They may need to consider using HRT more seriously than women who have gradual post- menopause. It’s like anything else that you do “cold turkey.” If you’re a drug addict, and you stop your drugs suddenly, you go through a terrible withdrawal. If you’re an alcoholic, and you stop your alcohol suddenly, you go through a terrible withdrawal. If you’re a smoker, and you stop smoking suddenly, you go through a terrible withdrawal.

If your body is used to something and it disappears suddenly, your body reacts violently.

Likewise, sudden post-menopause can have a huge impact on the dosage of estrogen your body needs for:

Preventing the symptoms of estrogen deficiency
And preventing the diseases of estrogen deficiency

Almost always, sudden post-menopause requires much higher dosages of estrogen replacement than gradual post-menopause. And the need for a higher dosage of estrogen is usually permanent.

Gradual post-menopause is like a slow leak of air from a balloon.

Sudden menopause is like popping a balloon.

It’s very dramatic, and it makes much more of a mess.

Menopause is Not Natural

There’s nothing “natural” about menopause in the first place. Other animals don’t even have menopause. They die.

We humans are living so much longer than Mother Nature intended that we’re literally outliving our ovaries. So, here you are, experiencing something you’re not supposed to experience in the first place because you were supposed to die instead.

If it happens gradually, you’re pretty darn miserable, and your risks for diseases increase significantly. But if it happens suddenly, it’s a total shock to your system; your symptoms are even more miserable, and those disease risks skyrocket.

So, this is why it’s so important for you to know the difference between these two types of post-menopause.

The Answer: The Difference is…

Gradual post-menopause entails experiencing the entirety of peri-menopause, and becoming post-menopausal gradually, so your body has the opportunity to acclimate to symptoms and diseases of estrogen deficiency.
Sudden post-menopause entails skipping or curtailing peri-menopause, and becoming post-menopausal suddenly, so your body does not have the opportunity to acclimate to symptoms and diseases of estrogen deficiency.

Watch the video version on YouTube

Ask Barbie: What’s the Difference Between Gradual and Sudden Post-Menopause?

The Essence of the Terms

Gradual Post-Menopause

Your Transition from Peri-menopause to Post-menopause

Sudden Post-menopause

Symptoms of Estrogen Deficiency

Diseases of Estrogen Deficiency

Menopause is Not Natural

The Answer: The Difference is…

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