Are Women Fertile in Menopause? Depends on Your Hormone Stage

When it comes to women in menopause, and what symptoms to expect and how long to anticipate they will last it's important to understand what phase you are in. The physicians of an important workshop in 2001 developed a formal list of the menopause transition phases. The physicians call these special phases the Stage of menopause you are in. Which 'Stage' is important to help you and your physician understand how symptomatic you are, how much bleeding there is, and how long this is going to continue. Specifically they rely on definite menstrual period descriptions and actual recommendations regarding the FSH levels.  There are Five Stages before the final period (FMP, Final Menstrual Period), and two after the Formal “Menopause.” The fie stages are labeled from -5 to -1 and after menopause the stages are +1 and +2. In 2011 a group met to fine tune the stages and their conference was called "ReSTAGE". ReSTAGE took information from the TREMIN study, the Melbourne Women's Midlife Health Project, the Seattle Midlife Women's Health study and the Study of Women's Health Across the Nation. In the April issue of Fertility and Sterility this is discussed further. It is also important to point out that the researchers specifically looked at healthy women who were transitioning through menopause; therefore these stages do not cover women with medical conditions that may muddy the symptoms.

When we want to discuss these stages, lots of confusion starts in. Not all patients, and not all physicians have been on the same page. Sometimes us girls just have 'period' conversations that make no sense. And here’s why: You might be a typical Stage 1b ( the late transition right after menopause) sitting around worried about spotting that came out of the blue when your best friend, a newly a Stage -3 (just leaving the last phase of periods and becoming menopausal) who had her first hot flash but perfectly regular periods was told by her doctor that it was just nonsense to worry she couldn’t still have kids when she still thought she no longer had mid-cycle spotting. So it gets confusing fast, especially since some experts think we can still have some ovulation through the early and late transitions! According to SWAN, the name of a group of experts that have partitioned all of us into one of these categories of  reproductive stages, if you knew your number you could just skip to the chase with your gyno and get to the important questions at hand.  There is some connection between the blood test levels and the physical symptoms of menopause and the newer staging has tried to add in the newest menopause tests like the ultrasound test of menopause which is counting how many eggs are waking up in a particular cycle, as well as, the blood testing of  Inhibin B and AMH to make this more specific to try to get women to be more easily categorized into their "correct stage" not just a formal number of years since the first hot flash. For other women the symptoms are not really important, but they fundamentally want to know: are they still fertile and do they still need to use contraception.

Most women will have regular cycles and yet begin to have elevated FSH levels and the hint of symptoms in that -3 stage. By -2 the cycles are beginning to change, and your cycles are more irregular. The -1Phase of the SWAN group is what we used to call 'the transition' is usually characterized by skipping greater than two cycles and periods of no bleeding lasting greater than 60 days. The +1 phase is one of the few phases that is given a real time: 5 years: 1a being that first year after menopause and 1b being the next 4 years. And all the tests we discuss can be helpful, but the newest data from the ReSTAGE group is that some of these tests may be very useful to you when trying to get the big picture. So you probably won't be gabbing with your gyno too much about these actual stages, given how complex they are, and how much science is still to be done to interpret this system, but it's the "backdrop" of how she's interpreting what you tell her about your menopause, so hopefully this helps you understand what sequence to expect.

And now in August 2012 the SWAN group has a further refinement to how hormones change. Researchers determined four distinct ways that estrogen levels change during menopause. About a quarter of women will have what is called slow decline (26.9%),  another quarter will have flat levels (28.6%), and others exhibit completely different hormone changes showing estrogne levels rising before the slow decline occurs (13.1%), and others will have estrogen rise followed by a steep decline (31.5%) in the levels. Most likely the pace these hormones change will affect how a patient feels and the type of symptoms she has, and whether she will be fertile longer into menopause.