The different stages of menopause, explained

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Julia Walker RN, BSN, is a women’s health nurse, writer, and member of the Perry team. Perry is a social network that connects like-minded warriors in the same stage of life. This community offers a safe space for women to unite and tap into knowledge and resources from menopause experts.

Over 2 million women reach menopause annually, according to the American College of Obstetrics and Gynecologists. That means nearly 6,000 women enter menopause each day. Despite these large numbers, people know very little about menopause. But perhaps what is more regrettable is that women themselves do not have an understanding of what this transitional life stage entails.

Many people look at menopause as the last frontier in women’s reproductive health. After all, we already see more stories about what postpartum looks like, along with premenstrual dysmorphic disorder, polycystic ovarian disease, endometriosis, and infertility. It is now high time we start educating ourselves about this completely natural life stage.

Let’s take a small step in our learning by talking about the different stages of menopause and what you can expect with each stage.

A woman reaches menopause when she has been 12 months without a period. This absence of menstruation signals that the ovaries are no longer ovulating, and a woman cannot conceive naturally. It also means that her estrogen levels are much lower than they were during her reproductive years.

Menopause is often the term used to capture the entire menopause journey. Surprisingly though, menopause only lasts one day in a woman’s life - the 365th day after your last period. The time before that is known as perimenopause, where women are notorious for suffering from hot flashes, night sweats, (and over 30 other symptoms).

The day after you reach menopause is the beginning of postmenopause, which lasts for the rest of a woman’s life.

1. Premenopause: This first stage is loosely defined as the time before you begin to notice subtle changes in your body. For example, women in premenopause do not have any usual changes to their periods and are still fertile.
2. Perimenopause: This term literally means “around menopause.” Perimenopause is the “official” start of the menopause journey because this is where you begin to notice changes in your body. An irregular period is the hallmark sign of perimenopause. However, there are 34 symptoms of perimenopause, and that list continues to grow. Fluctuating estrogen and progesterone levels are the primary culprits behind these 34 symptoms.
3. Menopause: A woman is considered in menopause when her ovaries no longer release eggs and her periods stop. This change in ovarian function results in the loss of estrogen production. Menopause starts when you have not had a period in at least 12 months. Women in menopause can still experience some uncomfortable symptoms for a few years after their final period, like hot flashes and insomnia, but are no longer able to get pregnant naturally.
4. Postmenopause: After women reach menopause, they spend the rest of their life in postmenopause. This final stage in the female reproductive cycle is marked by consistently low levels of estrogen, which means that many frustrating “menopausal” symptoms resolve. Other challenges do arrive, such as osteoporosis.

Premenopause:

Age of onset: Generally, women in their 30s and early 40s are premenopausal if they are still having normal periods and are not experiencing any symptoms associated with fluctuating estrogen levels.

Keep in mind that some women enter menopause in their 30s (called premature menopause), so age is not necessarily an indicator when it comes to this, or any, stage.

Duration: Because premenopause is loosely defined, there is no average duration of this phase. Instead, the duration is the time before you start to experience changes.

Signs and Symptoms: There are no unusual changes related to menopause that occur during this stage.

Perimenopause:

Age of onset: Age 45 is the average age women reach menopause. However, many women experience perimenopausal symptoms earlier in life, whereas others may notice changes well into their fifties.

Duration: Perimenopause lasts on average about 5 years, although some women will experience symptoms for nearly a decade. This means that we can spend a good portion of our life in this transitional period.

Signs and Symptoms: Irregular periods are one of the first signs that you are entering perimenopause. Changes to your period can include it becoming unpredictable, heavier, longer, and you may experience spotting in between cycles.

There are 34 symptoms associated with perimenopause. Alongside irregular periods, there are 4 other highly common symptoms: hot flashes, night sweats, loss of libido, and vaginal dryness. Women can experience a range of symptoms that can be physical or mental.

Some perimenopause symptoms may even sound bizarre, including heart palpitations, electric shocks, and burning mouth. The cause behind all of these symptoms is fluctuating estrogen levels. While your estrogen levels will be trending downward during perimenopause, it is not a slow, steady decline. Instead, hormone fluctuations are somewhat erratic, which affects all body systems.

Menopause:

Age of onset: The average age women reach menopause is 51. We don’t really know what factors determine when a woman will reach menopause. But, there may be similarities among female relatives, so if you would like to know when you may expect it, check in with your mother, sisters, aunts, grandmothers, etc.

Duration: Women are considered in menopause once they have been period-free for 12 months. On average, women continue to experience menopause symptoms for 3-5 years after reaching menopause.

Signs and Symptoms: While you can finally say goodbye to unpredictable periods, there are still symptoms you may experience, including:

• Vaginal dryness
• Hot flashes and night sweats
• Sleep problems
• Moodiness
• Weight gain
• Thinning hair
• Dry skin
• Loss of breast fullness
• Joint pain

Postmenopause:

Age of onset: A woman can be considered postmenopausal anytime after reaching menopause.

Duration: We spend the rest of our lives in postmenopause once we have had our final period.

Signs and Symptoms: Symptoms generally begin to resolve a few months to years after the final menstrual period. Yet, some women may notice that new symptoms arise or existing symptoms can worsen if you experienced them in perimenopause, including:

• Weight gain
• Thinning hair
• Joint pain
• Dry skin

It is never too early to start learning how to prepare for your menopause journey. If you think you are entering perimenopause or are struggling with some unusual symptoms that have you stumped, meet with your women’s health provider to talk about proactive steps to support your body during this transitional period.

If you do not have a provider who is interested in working with you during menopause, or you wish to connect with a menopause specialist, you can search for this type of provider at the North American Menopause Society.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.