Just like it does during your menstrual cycle, lower estrogen levels in menopause signal your body to produce more FSH.
Before puberty - 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
During puberty - 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
Women who are still menstruating - 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L)
After menopause - 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L).
Testing for menopause through FSH levels is not an exact science, as your hormones will fluctuate during your cycle, and some cycles will produce more estrogen than others. However, an FSH level of more than 30 IU/L would indicate perimenopause. And a consistently higher FSH level (accompanied by no periods) would indicate menopause.
Normal estrogen (estradiol) levels in menopause
The ovaries produce the female hormone estrogen, more specifically estradiol. As women progress through perimenopause and there are fewer eggs available to release, the body slows down its hormone production.
Before menopause, a normal level would be 30-400 picograms per milliliter (pg/mL).
After menopause, it falls below 30 pg/mL.
The fluctuating amount of estradiol released into the body is responsible for many physical and psychological changes during menopause, which is why some women explore hormone replacement therapy.
Is it normal to bleed during menopause?
While menopause is signaled by twelve months without a period, having lighter or heavier periods during perimenopause is quite normal.
If you are spotting or bleeding post-menopause, then be sure to talk to your doctor as there may be underlying health concerns that need to be addressed.
Heavy bleeding in perimenopause
Some women are surprised to find they bleed more during perimenopause. Once again, it has to do with your changing hormone levels.
Estrogen plays a role in creating the uterine lining. While estradiol helps grow the uterine lining, progesterone controls its thickness. More progesterone relative to estrogen means a thinner lining and lighter periods. Less progesterone relative to estrogen means a thicker lining and heavier periods.
Although estradiol and progesterone levels fall during perimenopause, progesterone levels may fall faster (as fewer eggs are released). This means there is more estrogen to build up the uterine lining than progesterone to keep its thickness in check. This can result in heavier and longer periods.
Over time the balance between progesterone and estradiol becomes more balanced, and the uterine lining thins. At this time, your periods should become lighter.
Irregular cycles in perimenopause
While there is an overall trend of estrogen and other hormones reducing during perimenopause, it doesn’t happen linearly, and you are likely to experience hormone fluctuations. This means that you can expect changes to your cycle as well. It is perfectly normal during perimenopause for your periods to become:
Shorter
Longer
Heavier
Lighter.
Or any combination of the above.
Spotting in perimenopause
Spotting during perimenopause may also happen every now and then, but if you are experiencing regular spotting, then be sure to discuss this with your doctor.
What is a normal libido for menopause?
Even before perimenopause, there is no ‘normal’ libido. Your sex drive and preferences are as unique as you are. So if you feel that during menopause your libidio is lower, or higher, than other people⸺don’t be too quick to judge!
Research shows that around half of all women experience a reduction in their sex drive during this time, partly due to the changing levels of estrogen.
Other menopause symptoms can also play their part. Weight gain, thinning hair and increased facial hair can all affect feelings of desirability. Hot flashes and vaginal symptoms such as dryness can also impact the desire to be intimate.
Not everyone experiences a lowering of their libido though. Interestingly, some women report a renewal in their sex drive post-menopause. This is thought to be driven by lifestyle factors such as no risk of pregnancy and time for relationship building, once children have grown.
What is normal blood pressure during menopause?
Estrogen is thought to play a protective from in women from cardiovascular disease. One school of thought is that as estrogen reduces, the risk of hypertension, or high blood pressure, increases.
Other studies have shown that lifestyle factors such as diet, smoking, and body mass index may have an equal or greater influence on blood pressure than hormone changes.
In general, blood pressure is classified as:
Low blood pressure is below 90/60 mmHg
Normal blood pressure is below 120/80 mmHg
Elevated blood pressure is 120-129/80-89 mmHg
High blood pressure is above 130/90 mmHg.
It’s important to see your doctor if you have any concerns about your blood pressure.
What if my menopause isn’t normal?
If you are experiencing any menopause symptoms that cause you concern, affect your quality of life, or you are just not sure of, then it is important that you talk to your healthcare practitioner. They will be able to give you advice on what is or isn’t normal and will be able to recommend appropriate treatments and menopause management tools.
The Wrap Up
There is no ‘one-size fits all’ menopause experience. However, many symptoms are considered ‘normal’ to experience. The perimenopause stage commonly starts in the mid-40s, and the time of menopause (your last period) usually occurs in the early 50s. There are 34 different symptoms that are considered normal during menopause, but just because they can be expected, doesn’t mean you need to this doesn’t mean you have to ‘put up with them.’ There are treatments and management tools available to help you navigate this time of life. If you are ever unsure of whether your symptoms should be of concern, talk to your healthcare practitioner.
References
Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063
Bansal R, Aggarwal N. Menopausal Hot Flashes: A Concise Review. J Midlife Health. 2019;10(1):6-13. doi:10.4103/jmh.JMH_7_19
Cifkova R, Pitha J, Lejskova M, Lanska V, Zecova S. Blood pressure around the menopause: a population study. J Hypertens. 2008 Oct;26(10):1976-82. doi: 10.1097/HJH.0b013e32830b895c. PMID: 18806621.
Elkins, G. 2014, Relief from Hot Flashes: The Natural, Drug-Free Program to Reduce Hot Flashes, Improve Sleep, and Ease Stress, (1), Demos Health, LLC.
Follicle-stimulating hormone (FSH) blood test Information | Mount Sinai - New York. Mount Sinai Health System. https://www.mountsinai.org/health-library/tests/follicle-stimulating-hormone-fsh-blood-test. Published 2021. Accessed December 16, 2021.
How Do I Know I'm in Menopause? | The North American Menopause Society, NAMS. Menopause.org. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-when-i%27m-in-menopause-. Published 2021. Accessed December 16, 2021.
Johannes CB, Crawford SL. Menstrual bleeding, hormones, and the menopausal transition. Semin Reprod Endocrinol. 1999;17(4):299-309. doi: 10.1055/s-2007-1016240. PMID: 10851570.
Lugo T, Tetrokalashvili M. Hot Flashes. 2021 Jan 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30969649.
Mason AS. The menopause: the events of the menopause. R Soc Health J. 1976 Apr;96(2):70-1. doi: 10.1177/146642407609600208. PMID: 951489.
Menopause | Penn Center for Women's Behavioral Wellness | Perelman School of Medicine at the University of Pennsylvania. Med.upenn.edu. https://www.med.upenn.edu/womenswellness/menopause.html. Published 2021. Accessed December 16, 2021.
O'Connor KA, Holman DJ, Wood JW. Menstrual cycle variability and the perimenopause. Am J Hum Biol. 2001 Jul-Aug;13(4):465-78. doi: 10.1002/ajhb.1078. PMID: 11400217.
Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina (Kaunas). 2019 Sep 2;55(9):559. doi: 10.3390/medicina55090559. PMID: 31480774; PMCID: PMC6780739.
.webp)
