Healthy Living

The Stages of Menopause

The Stages of Menopause

Key Takeaways

  • Premenopause is usually described as the entire life of a woman before the menopause
  • Perimenopause is the phase wherein both ovulation and fertility slow down. 
  • If a woman goes for about one year without receiving periods, then she has officially reached menopause
  • Postmenopause is characterized by a considerable reduction in the menopausal signs or symptoms as the body’s hormone levels stabilize. 

Menopause is a natural transition period where women progress from their childbearing years to a subsequent stage of their lives. The symptoms that come with this shift appear in overlapping stages.

It is very important for women to understand all the signs and symptoms that accompany menopause, especially if they are approaching middle-age.


Premenopause is usually described as the entire life of a woman before the menopause. Throughout this time, your menstrual periods occur frequently. You are capable of bearing children, and your sex hormones like progesterone and estrogen maintain a moderately stable balance. This transition stage often begins when women are at their early 40s.

Many years before your last menstrual period the physical signs of menopause begin. Pre-menopause refers to the fertile life of women from the first menstrual period to the last. It is a part of the natural aging process. Some get great relief when they reach this phase whereas some are unhappy since they have lost their fertile life. The period of premenopause may vary for every individual. 

However, the symptoms are the same. Usually when a woman reaches the age of 45 she may experience this condition. However, women in their 20s may show sign of pre menopause.  Some may exhibit signs in late sixties. The period of premenopause lasts for 1 -5 years Doctors may recommend about including certain vitamin in your diet, changing your lifestyle and your diet, doing regular exercise. Many over- the -counter medications are available which can provide some relief from the premenopause symptoms. However, take these medications only after doctor’s recommendation.

The following symptoms are common during this period:

These symptoms often occur as a result of hormonal fluctuations related to a woman’s menstrual cycle fluctuations. Most women encounter the premenstrual syndrome prior to their monthly periods.


This is the situation where both ovulation and fertility slow down. Hormonal levels drop and unpleasant side effects become more frequent

The drastic change that takes place in the body is fluctuation in hormone levels and menstrual cycle. Ovaries produce less estrogen.  There is decline in the estrogen level and the menstrual cycle shortens. Some may show different behavior. Some women may miss their periods whereas some may have less periods and their menstrual cycle is longer.

Women may also experience weight gain; breast becomes tender, headache, dryness of the vagina and lack of sleep. Emotional changes occur such as irritability, extreme anxiety, depression, difficulty in handling stress. Some common symptoms are hot fleshes and mood swings. Less common symptoms are lack of sexual desire, loss of hair, not able to hold urine. Some women enter this phase in their 40s whereas some may not experience this phase at all.

Recurring perimenopausal signs or symptoms include:

  • Hot flashes - The most common symptom accompanying menopause is the feeling of instant warmth or heat.  They are triggered by the inconsistent fluctuation of hormones that prompt the body to erratically try contending them. Hot flashes can occur at any time. It may occur during daytime or night. It can cause lot of discomfort. If the women get hot flashes at night, then she will experience night sweats. In this the women wakes up drenched in sweat.
  • Vaginal dryness - The sudden reduction in estrogen hormones leads to a significant decrease in the natural vaginal lubricant.
  • Mood swings - The fusion of unpredictable hormones and the uncomfortable symptoms can result in extreme mood swings. Some may experience depression or irritability.
  • Night sweats – An increase in body warmth causes excessive sweating on the individual’s body.
  • Loss of libido - A decreased level of estrogen production is associated with menopause, which can cause lower sexual motivations among menopausal women. The sexual desire decreases. Sometimes the couples get adjusted to the change in sexual activity so it might not be a problem, however in some this situation might lead to tension and problems between the couple.
  • Decreased ability to get pregnant - during perimenopause the ovulation rate goes down. The ability of the women to get pregnant reduces. However, if you do not wish to get pregnant it is safe to use birth control pills till menopause occurs.

It is very hard to understand when your perimenopause period sets in. The most common warning symptom, however, is infrequent monthly periods.

Other symptoms of perimenopause are:

  • Longer or heavier than usual menstruation
  • Shorter length of menstrual periods
  • Irregular periods- the ovaries ovulate but not in a predictable manner. The period may get shorter than normal or longer than normal. Especially if the period is short then he flows may be very heavy. Sometimes the women may miss her periods which might cause her to worry that she might be expecting.
  • Sore breasts
  • Unusual menstrual cramps
  • Mid-sleep awakenings or middle-of-the-night insomnia
  • Increased frequency of migraines
  • Noticeable gain in weight
  • Bladder difficulties- the tissue or urethra responds to the estrogen. When the estrogen declines the tissue of urethra shrinks. This can cause incontinence or urine. Since the cervix no longer produces cervical mucus, intercourse can be painful.

The chance of becoming pregnant in this phase is still possible. Other forms of contraceptives can be prescribed by your doctor to avoid pregnancy. After your last menstrual cycle, the administration of birth control is suggested, which usually lasts up to one year.

Progestin Therapy

Progestin is a hormone that works similarly to the hormone progesterone. This hormone is used to help regulate a woman’s menstrual period. However, there are some women who cannot tolerate taking progestin because of its unpleasant side effects, which include:

  • Unusual bleeding
  • Spotting
  • Swelling of breasts
  • Feeling bloated
  • Weight gain
  • Terrible headaches
  • Nausea and vomiting
  • Acne breakouts
  • Unexplained depression


If a woman goes for about one year without receiving periods, then she has officially reached menopause. Unfortunately, the symptoms experienced in the perimenopause stage can manifest during menopause. Technically menopause refers to the date of your last period. Because of the reduced production of estrogen hormones in a woman’s body, she may encounter the following:

  • Severe hot flashes (the sensation of extreme heat followed by chills). Face and neck might become red the. The women may feel sweaty or flushed. The intensity of hot flashes may range from mild to very strong and lasts between 30 seconds and ten minutes.

      Some may experience this symptom a year or two after the first menstrual period. In some women hot flashes may continue even after menopause but over a period of time it lessens.

  • Urinary tract infections- the low estrogen levels and the changes in the urinary tract may make the women susceptible to infection. Signs include persistent urge to urinate, frequent urination, feeling of burning sensation while urinating. The doctor may ask to do urine test and give antibiotics.
  • Reduced libido - the experienced low libido during this phase is similar to that in perimenopause. Reduced libido may be due to physical changes brought by the lower levels of hormone estrogen. The changes include slow or absent orgasmic response, and delayed clitoral reaction time.
  • Vaginal atrophy- it is characterized by thinning and inflammation of the walls of the vagina. This may cause painful sexual intercourse. Over -the -counter medications such as localized estrogen therapy which includes estrogen cream vaginal ring are available.
  • Skin hair and other tissue changes- skin becomes dry due to loss of fatty tissue and collagen. This affects the elasticity and lubrication of the skin near the vagina and urinary tract. Low level of estrogen cause loss of hair or make the hair brittle and dry. Avoid harsh chemical treatment to hair 
  • Night sweats that occur due to hot flashes (women may encounter this symptom for more than ten years). During menopause it is difficult to fall asleep. Try getting as much as rest as possible. Try relaxation and breathing techniques. Take measures to keep you cool while sleeping, avoid foods and drinks such as chocolate, alcohol or caffeine.
  • Vaginal dryness- signs include itching around the vulva, stinging or burning, frequent urination. It may make intercourse painful. Try using a vaginal moisturizer or water based lubricant. 
  • Anxiety – menopausal women may feel unusually anxious or irritable at times
  • Frequent urination- women may feel a constant urge to urinate

Usually, women stop having menstrual periods when they reach the age of 50. However, there are women who are still in their 40s who experience menopause as well. Studies have shown that female smokers are more likely to experience early menopause compared with women who do not smoke.

Various menstrual changes happen when women are in the menopausal stage, particularly in the rhythm of their menstrual cycles. They may skip their period for months or experience heavy bleeding for some other months. These menstrual changes can be experienced by women before they totally stop menstruating.

Outlook for menopause

The symptoms for menopause can lasts for months to years. It varies form person to person. Check with you doctor regularly so that they can monitor your health.

Signs that you should not ignore

After your period has stopped for a year, and you notice that you are bleeding again, consider visiting your doctor as soon as possible to rule out other reproductive system diseases such as endometrial or uterine cancer.

Seek advice from your health provider if your menopausal symptoms are overwhelming for you to manage in your everyday life. Your doctor can give you prescription medicines to alleviate the symptoms you are experiencing.


Once the women completed the menopause transition she is considered to be in the stage of post menopause. Low levels of hormone may bring their own symptoms.

It begins after the first menstrual period and it lasts till the rest of the women’s life. In this phase the period finally has stopped. The ovaries do not produce much estrogen. Usually the symptoms may become less but many continue to have dryness of vagina.

This stage is characterized by a considerable reduction in the signs or symptoms as the body’s hormone levels stabilize. Remember that during this period, the body releases less estrogen; hence, women undergoing this transition are susceptible to contracting serious health problems including insomnia, breast cancer, osteoporosis, heart disease, and urinary tract infections.

You doctor can also request some tests to determine the levels of the follicle stimulating hormone (FSH) in your blood. The pituitary gland, which can be found at the base of the brain, is the one responsible for the production of the follicle stimulating hormone. Your FSH level will help your doctor confirm if you are indeed postmenopausal. Moreover, if there is an increased level of FSH in your blood, it means that you have a dwindling ovarian reserve (a woman's normal egg supply).

If a year has gone by and you haven’t had your period, the possibility to become pregnant is slim. However, you may still continue using forms of contraception unless advised by your doctor to stop.

Identification of post menopause

  • Frequency- symptoms occur less often
  • Intensity- symptoms such as vaginal dryness may become more prominent
  • Diuration- symptoms If not treated may last life long

Around 7% women have intense menopause in their sixties

Around 97 percent women by the age or 58 are postmenopausal

In U.S around one quarter of women die due to heart disease which is likely to develop in postmenopausal women.

Imbalance of hormones particularly low estrogen level increases the risk of osteoporosis. Other causes include:

Genetics- some women are more sensitive to changes.

Diet-if the diet is not balanced then the symptoms may become worse and it increases the risk of health problems.

Habits- regular exercise and not smoking helps to control the symptoms.

The symptoms of post menopause are

  • Vaginal dryness
  • Urinary incontinence
  • Hair loss and thinning
  • Insomnia or sleep problems
  • Memory lapses
  • Loss of libido
  • Difficulty in concentrating

Some less common symptoms may appear which are linked to hormonal imbalance and aging.


The follicle stimulating levels are high (over 70 IU /L)

The estrogen levels are low (less than 30 pg/ml)

The bone density T- score is less than -1

The women may not get period for consecutive 12 months.

To determine the transition of menopause the doctor may perform certain procedures such as medical history, physical; exam and laboratory test.

The risks that come with postmenopause include:

  • Polyps- are benign or noncancerous growths that can develop in your uterus, cervix, or within your cervical canal. These growths can cause bleeding.
  • Atrophic endometrium - is also called as thinning of the endometrium. This condition usually happens after menopause when the tissue of the uterine lining (endometrium) becomes very thin due to a diminished level of estrogen. For this reason, sudden bleeding may occur.
  • Endometrial hyperplasia – is described as an abnormal thickening of the uterine lining. The most usual cause for this condition is the excessive production of estrogen without progesterone because of the absence of ovulation. As a result, unusual bleeding may occur. Moreover, in some cases, the abnormal overgrowth of cells in the uterine lining can also develop into endometrial cancer.
  • Endometrial cancer - is an illness that is related to estrogen. The more frequent a woman’s menstrual cycles are, the higher the risks of developing endometrial cancer. Those with tiny body mass indexes are less susceptible to the disease.
  • Osteoporosis - estrogen is an essential element for healthy bone growth and protection. Thus, when a woman’s body ceases to produce enough of the hormone, the bones have a higher risk of turning brittle.
  • Coronary artery disease It is usually described as the sudden narrowing of the arteries bordering the heart due to unnecessary cholesterol. Women undergoing post menopause are likely to experience excessive levels cholesterol, a phenomenon catalyzed by menopause.

Conditions associated with post menopause

Post menopause is a natural phase but the symptoms caused by it may interfere in daily routine and cause discomfort. Some may need treatment.

Lifestyle Changes

The good news is that all menopause symptoms are manageable. Postmenopausal women can modify their lifestyle to feel better and healthier. Some of the beneficial steps to lifestyle modification include:

  • Limiting the intake of salt and sugar
  • Avoiding excessive caffeine and alcohol consumption
  • Incorporating nuts, grains, fresh vegetables in the diet
  • Taking foods rich in calcium and Vitamin D supplements for bone strength
  • Choosing foods that have minimal saturated fat and cholesterol
  • Quit smoking
  • Daily exercise