Understanding the Stages of Menopause: A Comprehensive Guide

Last updated 11.28.2023 | by Dr. Karen Pike | 9 Minutes Read

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Menopause doesn’t happen overnight; it’s a gradual process that continues for several years. This multi year journey encompasses three different stages: perimenopause, menopause, and postmenopause, and each stage comes with its own unique set of experiences. 

So, it’s important for all women to understand what to expect in each stage, so that you can manage any symptoms and embrace this natural transition.

I’ve met far too many women who lack even the most basic information about menopause. As a result, they’re taken by surprise when they reach their early to mid 40s, and the first signs of perimenopause begin. 

So, it’s my mission to educate more women about this natural transition. 

Are you unclear about what to expect from menopause, and when to expect it? Are you looking for a detailed and easy to understand guide that walks you through the various stages of menopause? 

If so, you’ve come to the right place. In this post, I’ll break down the three stages of menopause, taking you through each one in a clear and concise way.

Before It Begins

Before perimenopause symptoms start, women generally experience regular menstrual cycles occurring every 28 days with stable hormone levels, including estrogen and progesterone, that regulate the cycle. They often have consistent energy levels, minimal hot flashes or night sweats, and fewer mood swings or changes in libido compared to later stages of menopause. Overall, life during this stage is characterized by a predictable and stable hormonal pattern, enabling women to engage in daily activities without significant disruptions.

For many women, the first sign of a change are intermittent hot flashes. You may find yourself blasting the air conditioning when everyone else is comfortable. You may wake up at night covered in a sweat.

These were the first symptoms I experienced in my own menopausal journey, and they were a sure fire sign that I was entering perimenopause.

The Perimenopause Experience

“Peri” means “around” in Greek, thus referring to being around the time when you move into the end of reproductive years. During perimenopause, the balance of estrogen ebbs and flows. At its onset, your menstruation will change unevenly. Your ovaries will stop releasing eggs. Once you are not ovulating, you won’t have a period.

According to the National Institutes of Health’s (NIH) National Institute on Aging (NIA), the perimenopause stage can last about 7 years but also extend up to 14 years. Race, ethnicity, lifestyle and health all play factors in the duration.

Women can experience perimenopause in their mid-30s or 50s, although it commonly begins in the early 40s. Here are a few common symptoms, according to both the Johns Hopkins University and the Mayo Clinic:

It’s important to have annual checkups with your gynecologist and even more so as you experience symptoms. He or she can guide you in what to expect and suggest treatment options such as hormone-replacement therapy.

When you go 12 straight months with no menstruation, it marks the shift into menopause.

The Menopause Experience

The symptoms of menopause are closely aligned with the symptoms of perimenopause. Once you have had no menstrual cycle for 12 months straight, unrelated to medication or being pregnant, you can consider yourself “officially” in menopause.

This is commonly in the late 40s to 50s, but some women may experience it earlier. You may also experience menopause if you have had a hysterectomy. This is a process known as surgical menopause. However, in my experience, surgical menopause is a much more sudden process, with menopause symptoms such as hot flashes and mood swings appearing rapidly after surgery, rather than gradually over several years.

I’ve worked with countless menopausal women over the years, and they’ve all gone through a unique experience. You could have hot flashes but not have night sweats. Or you could have a decreased sex drive, or you might not. It is possible to experience all of these symptoms, but not every person will experience each symptom the same. Due to the nature of menopause being different for different women, it may be a good idea to seek assistance that is tailored to your own particular experience. 

Hot Flashes

When you are in menopause, hot flashes can happen at any time. The body goes hot, and you sweat regardless of the weather. When I was suffering with frequent hot flashes, I wore thin layers and sleeveless vest shirts underneath my clothes. This allowed me to remove any heavy clothing as soon as a hot flash began to rise. Once the sensation subsided, I would quickly put my layers back on to avoid getting cold.

Night Sweats

Night sweats may wake you up and cause difficulty sleeping. These changes occur when a woman experiences the end of monthly periods, as the hormones shift and change. I suffered particularly frequent night sweats during the end of perimenopause. I’d often wake up with soaking wet sheets and pajamas, sometimes several times a week. Thankfully these symptoms began to subside once I entered menopause, and my hormones settled down.

It’s important to note that an infection can also cause night sweats. So, be careful if this is the only symptom, as it may or may not be associated with menopause.

Mood Swings

When your body goes into menopause, the hormone levels can fluctuate dramatically. This can lead to mood swings, and feelings of anger and irritability. I’ve also worked with several women who developed depression during their menopause journey. Thankfully, most find that their emotions settled down once they entered post menopause, and their hormones stopped fluctuating.

Decreased Sex Drive

When going through menopause, a woman may experience a decreased desire to have sex. Lower estrogen levels can decrease the amount of libido. This is not the same for all women, and some women may not experience this at all. However, in general, a decreased sex drive can happen when a woman is no longer ovulating and no longer has monthly cycles.

Weight Gain

Menopause can be accompanied by weight gain and a shift in the shape of her body. A woman can gain tummy fat.

Memory and Concentration Loss

When the hormonal balance changes and estrogen is no longer present, some women experience memory loss or loss of the ability to focus and concentrate. This can be described as having “brain fog”.

Vaginal Dryness

Women may experience vaginal dryness. The thinning and drying of vaginal tissues lead to this symptom. Vaginal dryness can be accompanied by itching or irritation. It can be painful to have sex if the area is dry. When there is no natural lubrication or wetness, a woman can get vaginal infections or urinary tract infections more easily. This can put a strain on intimate relationships.

Each of these symptoms has potential remedies. A woman experiencing menopause does not have to go through it alone. It’s a good idea to seek help.

The Postmenopause Experience

The Postmenopause Experience

Once a woman has gone through menopause, the symptoms go away. Ovulation doesn’t happen. When eggs are no longer being released, the production of estrogen and progesterone decreases significantly. This continues from the end of menopause through the remainder of a woman’s life. Here are some of the signs that a woman has entered into the postmenopause stage:

  • No more night sweats
  • Sleep is more normal
  • Hormone-influenced mood swings decrease
  • Aging may be accompanied by a slower metabolism
  • Sex drive may not return to pre-menopause levels
  • Trouble losing weight
  • Bone density may decrease
  • Focus and concentration may be more difficult
  • Dry skin
  • Hair loss
  • Loss of bladder control

Not everyone experiences postmenopause in the same way. For instance, no longer having a period means you cannot become pregnant. If you were worried about becoming pregnant, then this worry is no longer present. A few other advantages to moving into the postmenopause stage can be saving money on contraceptives and menstrual products to absorb the monthly flow.

A woman who is going into the postmenopause stage can be more susceptible to diabetes, joint pain, gout, and gum disease. You can seek professional help to offset many of these symptoms.


What are the symptoms faced during menopause?

In the menopausal stage, you face many symptoms, such as hot flashes, night sweats, weight gain, mood swings, and so on.

How many stages are there in the menopausal journey? What are those? 

There are three common stages in the journey of menopause. They are Perimenopause, Menopause, and Postmenopause.

When does a woman know she has hit menopause?

When the person has not experienced menopause for 12 months straight, that’s the start of menopause.


The stages of menopause include perimenopause, menopause, and postmenopause. These begin when a woman is in her 30s or 40s and continue through life. The changes in hormones present in the body are generally the cause of the changes in life cycles. As a woman begins to ovulate, typically in her teens, she will begin to have a monthly cycle. As these reproductive years wane, she will go through the three stages of menopause.

Medical help is available to provide women with care during menopause. For example, hormone replacement therapy (HRT) can make a big difference to a woman’s quility of life. However, after researching the stages of menopause for several years now, I’ve discovered that simple diet and lifestyle changes can go a long way when it comes to managing symptoms.

Eating a balanced diet that is rich in iron, calcium, Vitamin D, and Vitamin C can help. Some women may also choose to wear clothing made from natural materials, like bamboo.

Most experts recommend reducing or cutting out alcohol and caffeine. Hot spicy food can also be a trigger for some of the menopause symptoms. For good sleeping, you may wish to install a fan or be able to control the temperature to adjust for changes in your body. Yoga, mindfulness meditation, and soothing music can assist with mood swings and anxiety.

More tools for helping cope with the stages of menopause are available today than during any other era. Hang in there! You got this.


  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.