Understanding the Stages of Menopause: A Comprehensive Guide

Last updated 01.20.2024 | by Dr. Karen Pike | 14 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Menopause is a natural process that continues gradually for several years and doesn’t happen overnight. 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 they 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. However, there are women who experience early menopause before age 40; it’s called premature menopause. No matter the case, the majority of women are unfamiliar with this phase.

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, taking you through each one in a clear and concise way.

Before It Begins

Before perimenopause symptoms start, women generally experience regular menstrual periods 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 and night sweats, and fewer mood swings or changes in libido compared to later stages. 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 is intermittent hot flashes. You may find yourself blasting the air conditioning when everyone else is comfortable. You may wake up at night covered in sweat.

These were the first symptoms I experienced in my own menopausal journey, and they were a surefire sign that I was entering this phase.

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 the menopausal transitional phase, the balance of estrogen ebbs and flows. At its onset, your menstruation will change unevenly. Your ovary 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 menopausal transitional 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 this in their mid-30s or 50s, although it commonly begins in the early 40s. Here are a few common menopausal 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, your ovary will stop producing eggs, and you will not ovulate, it marks the shift into menopause.

The Menopause Experience

The symptoms of menopause are closely aligned with the symptoms of the menopause transitional phase. Once you have had no menstrual cycle for 12 months straight, unrelated to medication, or getting 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 symptoms like 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 symptoms such as hot flashes but not 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 climacteric 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 from 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 menopausal transitional phase. 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 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.

Menopause may lead to 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 this 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 it 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 this stage can be saving money on contraceptives and menstrual products to absorb the monthly flow.

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

What are the possible complications of menopause?

The reason why doctors ask you to follow a healthy lifestyle, mainly after reaching 40, is to save you from the complications that you might encounter in postmenopause. Here are some of the complications or rather the aftereffects of menopause that you may encounter if you are not careful about your health.

  • Osteoporosis: Low estrogen levels result in a decrease in bone density when you are transitioning into menopause. The trend continues even postmenopause, and a constant fall in estrogen levels puts you at risk of osteoporosis. As per the criteria of the World Health Organization, around 30% of Caucasian women have osteoporosis in the postmenopause phase,m while 54% of them suffer from osteopenia.
  • Urinary Incontinence: The low estrogen levels cause the pelvic floor muscles and the ones near your urethra to lose their strength. When this happens, your bladder cannot carry urine for long, leading to urinary incontinence. Of the many things, one advice I often give my patients is to strengthen their pelvic floor through exercise.
  • Heart problems: A dip in estrogen levels could cause fat to build in the arteries, making them narrow. If you aren’t careful about managing your weight and keeping your cholesterol levels under control, you could be at risk of heart disease.
  • Cancer: When I say cancer, it might leave you panicked, right? This is not relevant for all. Women who have had their menopause late could be at risk of ovarian, breast, or endometrial cancer since they have ovulated for a long and had an increased exposure to estrogen.

What is the normal age for menopause?

If I were to talk about the age bracket for menopause, the tentative timeline is between 45 and 55 years.

If we look at the average menopausal age countrywise, there are variations. In the United States, it is 51. In Asia and Africa, 48-49 is considered the mean age. In Europe, it is around 50, while in Australia, 51 is the average. There are variations in ethnicity, too. Studies showed that black women reached menopause earlier than white women by approximately 8.5 months.

Remember that no two women will reach menopause at the same age. A lady I met the other day mentioned while she reached menopause at 52, her sister experienced it at 48. Her mother went into menopause at 43 after a surgery.

How long do you have symptoms of menopause?

Women who come to me for medical advice often ask this question. Don’t worry, you will not have them forever. Most of the symptoms you have faced while transitioning into menopause will continue into postmenopause and last for 4-5 years on average.

The good news is that for most women, the symptoms aren’t as severe as before. They eventually lessen in intensity and severity. This again varies from one woman to the other. If I were to talk about my menopause journey, my hot flashes lasted for around two years after menopause but weren’t as scary as before.

 The findings of a particular study surprised me. It mentioned 10.2 years as the average time frame for hot flashes to continue after perimenopause.

A 2022 review presented some interesting findings about menopause insomnia. It said that menopausal women were less susceptible to chronic insomnia that lasted for 3-6 months. Instead, they were more prone to short-term insomnia that spanned between 3 and 21 days.

Vaginal dryness, another common menopausal symptom, will remain after menopause as well. The wetness barely comes back, and most doctors advise patients to use vaginal moisturizers regularly.

Many things are considered when deciding the duration of your symptoms after menopause.By eating well, exercising properly, and staying healthy, you can manage most symptoms effectively during and after menopause.

How is menopause diagnosed?

Most of the time, menopause needs no diagnosis. It’s evident from the symptoms. If you consult the doctor, he will ask you questions like:

  • Your age
  • The time when you last had your periods
  • About the associated symptoms 

If you have had no periods for twelve consecutive months, that is the first indication that menopause has set in. Then there are the associated symptoms as well to indicate the onset of menopause. The blood tests are more relevant to confirm an early or premature menopause.

Suppose you are below 45 and haven’t had a period for a year. In that case, your healthcare provider may advise some other tests to confirm if menopause is the reason or whether any other underlying condition is responsible for the stopped periods. Some of the recommended blood tests include

  • FSH (Follicle Stimulating Hormone): When FSH levels are constantly high at 30 mIU/mL or more than that, alongside no periods for a year, it is considered that menopause has begun.
  • Estradiol: The estradiol levels lower with menopause (0 to 30 pg/mL). In premenopausal women, the levels vary between 30 and 400 pg/mL.
  • TSH: This doesn’t have a direct connection with menopause. However, when you have low thyroid levels, the signs are similar to the ones you may experience in menopause.

Sometimes, your healthcare provider may also do a vaginal swab to check the pH level. In menopausal women, the vaginal pH is as much as 6.

FAQ’s

What are the symptoms faced during menopause?

In the menopausal stage, you face many symptoms, such as vasomotor symptoms, weight gain, mood swings, and so on. These symptoms, if further worsens, can lead to osteoporosis and heart disease.

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 Postmenopausal.

When does a woman know she has hit menopause?

Menopause occurs when you’ve not had periods for 12 months straight since the last menstrual. This is the phase when women have reached menopause.

Do genetic factors influence your menopausal age?

Findings have shown the role of genetics in influencing the time of menopause. If your mother or anyone in your kin had early menopause, there are chances that you may follow suit. The same goes for late menopause.
However, your lifestyle and overall health also play a significant role in deciding your menopausal age. For instance, if you indulge in increased drinking or smoking, you can have menopause early.

Can you reverse menopause?

No, you cannot reverse menopause. However, when you maintain a healthy lifestyle, you can save yourself from early or very late menopause. E.g., underweight women may experience menopause early. In contrast, obese women are at an increased risk of late menopause.

Can you get pregnant after menopause?

It is not possible to get pregnant after menopause naturally since your menses stop entirely then. However, pregnancy through IVF is still possible. However, there is a lot of complexity, and hormonal treatment is also needed simultaneously.

Conclusion

The stages of menopause 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 menopausal stages.

Medical help is available to provide women with care during menopause. For example, hormone replacement therapy (HRT) or hormone therapy can make a big difference in a woman’s quality of life. However, after researching for several years now, I’ve discovered that simple diet and lifestyle changes can go a long way if you want to manage your symptoms.

Eating a balanced diet that is rich in iron, calcium, Vitamin D, and Vitamin C can help boost health conditions. 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 to help relieve menopause symptoms are available today than during any other era. Hang in there! You got this.

Author

  • 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.