Menopause Stages: Signs And Symptoms Of This Natural Stage Of Life

Menopause

The menopause journey is unique for every woman. The frequency, duration, and intensity of menopause symptoms can vary dramatically. And, for a small subset of women, the experience is really a non-event. The transition can last up to 10 years (or more), so preparing for each stage can help you manage the symptoms that come with this natural stage of life. 

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    What are the 3 stages of menopause? 

    When you think about menopause, which word comes to mind – mood swings and anger or sisterhood and transition? You may choose one word and your friend quite another. That’s how unique each journey can be.
     
    If a woman+ lives long enough, she will experience the menopause transition. It’s a natural part of life, and unavoidable.
     
    Menopause is the day when you have not had a period for 12 consecutive months.
     
    The times leading up to menopause and after that day are all part of the transition. While many women+ refer to this natural life cycle as menopause, there are distinct stages before and after these 12 months.
     
    It may be helpful to think of this stage in your life as a journey instead of a single point in time.
     
    There are three main stages to the menopause journey:
    • Perimenopause
    • Menopause
    • Post-menopause
    Go into this stage of life knowing your journey will be unique.
     
    Symptoms can come and go in each stage, evolve over time, and last up 10 years (or more).
     
    Symptoms can also vary. For example, differences can be seen across geographic regions, from country to country, from one race to another, and even between ethnicities within the same race.
     
    In a pausitive health survey, some women described menopause as relatively easy, while others called it unmitigated hell. The vast majority described it as eventful or worse.
     
    Prepare for each stage by knowing what may lie ahead. By taking action now, you might have fewer, less frequent, and/or less severe symptoms as well as improve your overall health and well-being, both now and for the future. That way, you can make a change for the better!

    When does perimenopause start?

    While you may typically hear women say they’re in menopause as soon as the hot flashes start, it’s probably perimenopause.
     
    Perimenopause is the first official stage of the menopause life cycle. It’s the time leading up to your last period.

    Perimenopause lasts about 7.5 years on average,

    and typically starts in your 40s.

    Perimenopause symptoms

    Perimenopause symptoms can be subtle for some women+ and life-altering for others, both at home and at work. For some women, the end of perimenopause may be the first sign they’re even in this natural stage of life. That can happen if symptoms are mild or otherwise go unnoticed throughout perimenopause.
     
    In a pausitive health survey of 125 women+ in the U.S., one said,
    “I didn’t realize what was going on. But, that’s when I started with weight gain, and I started a change in menses. It went from regular to being weird, lasting much longer. It was almost like being a teenager again. Didn’t know when it was coming or how long it would last.”
    75%-80% of women experience vasomotor symptoms (VSMs), i.e., hot flashes, night sweats, and palpitations.
    One of the first signs may be an irregular menstrual cycle.
     
    Other symptoms include:

    Less common symptoms include new/different body order, gas/bloating/constipation, burning tongue/metallic taste, cold flashes, dry mouth/cavities/loose teeth, and dry eyes.

    Studies have shown the likelihood of symptoms may vary depending on your race/ethnicity. For example:

    In another pausitive health nationwide survey of 1017 women+, 79% of women reported three or more perimenopausal symptoms, with an average number of seven.
     
    A respondent who was a nurse said she experienced headaches and mood swings.
    “I’ve been kind of tearful, almost like a guilt response maybe, or you feel responsible, you feel guilty. Just a kind of doom and gloom kind of thing. Noticeable to the point that my family and spouse can tell my period is coming. I’m boohooing. I’ve become very sensitive, is another way to put it.”
    She also described that she wanted to isolate herself during that time of the month because she was depressed from the terrible headaches.
     
    “I’m not available to my family and kids as much. It’s a two-to-three-day thing. It’s kind of better than worse. It fluctuates.”
    Women who experience menopause early or suddenly due to cancer treatments, surgery, or certain health conditions (such as premature ovarian failure) may also be at higher risk of depression and feelings of loneliness, isolation, loss, and grief.
     
    Another woman indicated,
    “It’s difficult at home and at work, sometimes talking in front of committees and hospital boards. I can’t really afford to be an emotional mess in front of people. So, it affects me in that way. It’s hard to schedule when you’re doing something around your period and your emotional response.”

    Throughout perimenopause, symptoms may change or evolve.

    Hot flashes, night sweats, and sleep disturbances may start to improve.

    Other symptoms like genitourinary syndrome (GSM) – a constellation of symptoms that includes vaginal dryness, painful penetrative sex, frequent UTIs, needing to get to the bathroom quickly to urinate (urgency), needing to urinate more often (frequency) – may appear or become more predominant.

    And remember, you can still get pregnant if you have an intact uterus and ovaries and are not infertile.

    The Menopause Society discussed perimenopause symptoms with Dr. Monica Christmas, discussing the most common and distressing symptoms, changes to your menstrual cycle, vasomotor symptoms, and mood swings.

    Preparing for perimenopause

    If you haven’t taken charge of your health and well-being, now is a great time to start. 
     
    Living a healthy lifestyle as soon as possible can make a difference. For example, learning which foods to eat and which ones to avoid can help with weight management and ensuring you’re getting the nutrition you need during a time of significant change. And being physically active can help with your mood, depression and anxiety, and the weight gain many women experience. 

    While many women seek relief from perimenopause symptoms, others suffer in silence. Don’t suffer in silence! Help is available.
     

    Be ready to ask questions and persist until you get answers, which may mean learning to be more assertive and moving out of your comfort zone.

    You may also find you need to search for an OB-GYN specifically trained in menopause management. Several studies have found the coverage of menopause during medical school is often scant and fewer than 7% of internal medicine, family practice, and OB-GYN residents surveyed said they felt adequately prepared to manage menopause.
     
    When she didn’t get the medical help she needed, one survey participant took matters into her own hands. Luckily, she had an advocate in one of her doctors too.
    “I had to take control of it. I think my gynecologist felt so bad when I was sobbing in her office,” she said. “My primary has been, I would say, the most beneficial healthcare provider in my life because she understands I’m not crazy…She takes matters into her own hands as well.”
    Find that advocate. And be one yourself. Being a healthcare rebel will help you to find the options that are best for you.

    What is menopause?

    In menopause, you haven’t had your period for 12 consecutive months due to hormonal changes. Your ovaries stop making estrogen, and the production of progesterone slows. That is the official end of your reproductive years and your menstrual cycle. You’ll no longer be able to have children.
     
    However, if you are on hormonal contraception that prevents bleeding, it can be difficult to tell when that point has been reached. You may be advised by your healthcare practitioner to select another method and periodically stop your birth control pills long enough to determine if you are still having a period. 
     

    What age does menopause start?

    Wondering when you’re going to be in menopause? If you can, ask your mom. That’s often a good indicator.
     
    Most women in the U.S. experience this stage of life between ages 45 and 55.
     
    The average age of onset is 51. However, among other factors, you may reach menopause at an earlier age if you smoke, have certain health conditions (e.g., autoimmune disease, chronic fatigue syndrome, Turner’s syndrome), have your uterus removed, never had children, are Black or Hispanic/Latina, being a vegetarian, engage in vigorous exercise on a regular basis, or are subjected to racism. 
     
    Some women experience the onset before age 40, in which case they are said to have premature menopause. For others it may arrive after age 40 but before age 45, in which case they are said to have early menopause. 
     
    Premature and early menopause may occur due to situations like premature ovarian insufficiency, surgery that removes the ovaries, chemotherapy, or radiation therapy.
     

    Factors that increase the likelihood of later onset than average include being overweight/obese, having a later age pregnancy/multiple pregnancies, having your first period at age 13 or older, eating habits (diet high in fruit, vegetables, oily fish, legumes, zinc, B6, high total calories), moderate alcohol consumption, and Japanese ancestry.

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    LEARN • SHARE • LAUGH • BOND

    The menopause journey community is a private online community powered by pausitive health. It’s a safe space for women+ to connect, learn, share, laugh, and bond through their menopause journey.

    It’s free to join! We hope to see you there.

    Let me in!

    Menopause symptoms

    Since every journey is unique, symptoms can vary.
     
    Many of those you experience during perimenopause continue but get better over time. Others, like GSM, can become more likely or severe. 
     
    One respondent in the survey had a hysterectomy in her 30s due to painful periods. So, she never experienced the early symptoms.
     
    While her doctors explained a lot, she indicated they mostly focused on hot flashes.

    “…it’s not just hot flashes. And I didn’t know that. It’s the sleep disturbances. When I lie awake in bed, I just have awful heart palpitations. The pulsating I even have up to my jaws. The most bizarre things.

    So, I did some research and see heart palpitations is something that seems related to menopause. 

    There are days you just feel so crazy and so out of control. And you can see yourself and feel yourself being a little nasty or whatever, and you just can’t help yourself. That’s just a hormone thing.”

    Another survey participant who experienced menopause in her early 40s said memory loss troubled her most.

    “Brain fog” can be scary; however, there’s typically no reason to panic. It’s usually not an early sign of dementia or Alzheimer’s, even though it may feel that way.
    “The mental fogginess was terrible, and it’s only gotten a little better after I‘ve completed menopause,” she said. 
     
    “…. I would go to my office and cry. Just thinking about it now brings some tears. Because I pride myself on knowing what I’m doing and doing a good job, and suddenly my brain just didn’t work like it used to. And I was going back to grad school at the time. It was terrible. It was awful,” she recalls.

    “If I could go back and tell myself, ‘look, you have to write this stuff down because you’re going to forget it,’ it would still be upsetting, but I think I wouldn’t have those embarrassing moments in the classroom.”
    She used her humor to get through memory loss. She created a coping strategy with sticky notes and a notebook to write everything down. Twenty-one years after her last period, she says she manages better with all her notes but doesn’t believe her brain ever returned to where it was.
     
    Post menopausal woman smiling

    Post-menopause symptoms

    Finally, post-menopause. That’s when you’re past the point of not having a period for twelve consecutive months.
     

    In the women we surveyed, respondents described their post-menopause journey as eventful to life-altering.

    For one, it was liberating.

    “You don’t have to worry about having periods, don’t have to worry about having tampons, don’t have to worry about pregnancy, and that’s a huge freedom.”

    Knowing she’s at this point, she looks back, reflects, and uses what she experienced on her journey to help three of her colleagues going through their own menopause journeys.

    “I tell them, watch out for the brain changes. I wasn’t ready for that, and I’m telling you, you’re not stupid,” she said.

    Showing empathy toward others can help you more than you imagine.

     

    What signals the end of menopause?

    So, once you’re past menopause and in the post-menopause stage, how soon until it all ends? Technically, never!

    The post-menopause stage of the journey is the rest of your life. You may experience fewer symptoms. However, they may not disappear completely and can stick around for years.

    The Penn Ovarian Aging Study cohort assessed women for 16 years. On average, women experienced moderate to severe hot flashes for nearly five years after menopause. The study found hot flashes did not return to premenopausal levels until nine years after the woman’s final menstrual cycle.

    And a Mayo Clinic study of 5000 women found some women in their 60s, 70s, and 80s continued to experience menopausal symptoms. Caffeine consumption appeared to increase the likelihood of symptoms in those older than 70.

    Treatment options throughout the life cycle of menopause

    The menopause journey is part of the natural life cycle. The number of menopausal women+ entering the menopause journey is estimated to be 1.1 billion worldwide by 2025.
     
    Six thousand women enter menopause every day in the U.S. You’ll be one of those women at some point. Although there is research underway, you can’t defy nature.
     
    So, prepare for this natural change. Mindset, physical activity, and nutrition are all important.
     
    No matter what stage of menopause you’re in, there’s help available. While hormone therapy is often the most discussed treatment option, it’s not without risk.
     
    Talk to your doctor about the risks and benefits, and know there are also non-hormonal options.
     
    Research treatment options in traditional medicine and integrative modalities like acupuncture and yoga.
    Middle aged woman smiling and embracing menopause

    Prepare yourself and embrace the menopause journey

    If there’s one takeaway – it’s preparation! Know what lies ahead and take action to ease symptoms before they become more challenging to manage.
     
    Menopause is like a marathon when you consider symptoms can last up to ten years (or more). Like a marathon, preparation is key to finishing the race.
     

    If you haven’t dialed in on a healthy lifestyle, now is the time to do it. Get a menopause roadmap to prepare for the menopause marathon and feel your best.

    A life-affirming mindset and lifestyle factors are powerful ways to improve your health and well-being.

    Take these healthy lifestyle steps early:

    • Eat a well-balanced diet, and avoid saturated fat, preservatives, processed foods, sugary beverages, and grilled/charred foods. Try these foods for menopause.
    • Engage in physical activity regularly for at least 150 minutes a week with a regimen that includes cardio, weight-bearing, strength training, and flexibility and balance. Try these exercises.
    • Avoid being sedentary for extended periods.
    • Maintain a healthy weight.
    • Limit or eliminate alcohol.
    • Get enough sleep of good quality (7 – 9 hours). If you’re struggling, try this sleep hygiene routine.
    • Learn techniques to manage stress and build resilience.
    • Stop the use of tobacco products.
    • Engage in mentally stimulating activities.
    • Nurture your relationships.

    The pausitive health menopause grocery list contains a combination of foods specifically selected to help you feel better today and even better in the future.

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    This menopause grocery list contains a combination of foods specifically selected to help you feel better today and even better in the future.

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    Talking to your doctor

    If your gynecologist or PCP doesn’t bring up the menopause journey, don’t hesitate to ask questions and start the conversation. If you cannot get the help you need, try to find a healthcare practitioner with specific training and expertise in menopause.
     
    And DO seek professional help from a mental health practitioner without hesitation. If you had diabetes, you likely wouldn’t see it as a sign of weakness and not seek medical care. How is your emotional health any different? 
     
    Prepare for your doctor’s visit by tracking your menopause symptoms in the Menopause Diary.
     
    Menopause Diary Toolkit Mockup

    Menopause Diary

    How are you doing today? Better than yesterday, or are you experiencing more symptoms? Make it easy to track your symptoms with the Menopause Diary.

    Please send the following:(Required)
    Remember, many options are available to help address your symptoms, both hormonal and non-hormonal.
     

    While the focus of menopause is often on unwelcome symptoms, think about how you can positively impact your future.

    Your mindset can play a major role with regard to your experience. A study performed by Yale found:

    • Menopausal symptoms were less of an issue in countries where older women are more highly regarded in general.
    • In countries where a phrase like “old age” was viewed negatively and was attached to the menopause stage of the life cycle of women (like the U.S.), symptoms were often more pronounced.

    Although it might sometimes be challenging, you can make menopause a positive journey to vibrant living!

    Investigating Health for Mid-Life and Older Women | SWAN

    Primary ovarian insufficiency | Mayo Clinic

    Perimenopause: Signs, Symptoms, and Solutions | The Menopause Society [YouTube]

    Find a Menopause Practitioner | The Menopause Society

    Eleni Armeni, Nicoletta Mili, Elina Siliogka, Dimitrios G. Goulis, Irene Lambrinoudaki. Menopause medical education around the world: The way forward to serve women’s health. Current Opinion in Endocrine and Metabolic Research. 2022, Vol 26, pages 100387. https://doi.org/10.1016/j.coemr.2022.100387

    Kling J, MacLaughlin K, Schnatz P, Mara K, Fohmader Hilsaca K, Faubion S. Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey. Mayo Clinic Proceedings. 2019. Volume 94, Issue 2, P242-253. doi: https://doi.org/10.1016/j.mayocp.2018.08.033

    Be a Healthcare Rebel: How to Get the Best Medical Care | PeopleTweaker

    What is Menopause | National Institute on Aging

    25 years of research shows insidious effect of racism on Black women’s menopausal transition, health | University of Michigan

    Alejandra Andrea Roman Lay, Carla Ferreira do Nascimento, Bernardo Lessa Horta, Alexandre Dias Porto Chiavegatto Filho. Reproductive factors and age at natural menopause: A systematic review and meta-analysis. Maturitas. 2020. Volume 131, P57-65. DOI:https://doi.org/10.1016/j.maturitas.2019.10.012

    Menopause: Mindfulness may reduce symptoms | Healthline Media

    About Guided Imagery | Images of Wellness 

    News flash about hot flashes: They can last longer than you think | Science Daily

    Culture may influence how women experience menopause | Reuters

    Freeman EW, Sammel MD, Sanders RJ. Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort. Menopause. 2014 Sep;21(9):924-32. doi: 10.1097/GME.0000000000000196. PMID: 24473530; PMCID: PMC4574289.

    Vaze N, Joshi S. Yoga and menopausal transition. J Midlife Health. 2010 Jul;1(2):56-8. doi: 10.4103/0976-7800.76212. PMID: 21716773; PMCID: PMC3122509.

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