What To Expect in Each Stage of Menopause

Menopause is a natural part of aging that marks the end of the female reproductive years — but many people don’t know what to expect until they’re in the midst of it. Did you know, for example, that you could experience symptoms up to a decade before menopause actually begins?

Menopause specialist Pelin Batur, MD, walks us through the stages of menopause and what you may be able to expect during each one.

How many stages of menopause are there?

The menopause process is all about hormones. Your body begins to produce less of the hormone called estrogen, which regulates your menstrual cycle, and your ovaries start running low on eggs. But it doesn’t happen all at once.

Here’s a quick overview of the three stages of menopause:

• Perimenopause: This transitional period, which marks the early stages of menopause, can last for years — sometimes, even a decade. You may start to have menopause-like symptoms like irregular periods, hot flashes and more.
• Menopause: You’ve reached menopause when you haven’t had a menstrual period for one full year (in the absence of any other medical condition or medication that would have an impact on your periods). Your ovaries have stopped producing most of their estrogen and no longer release eggs.
• Postmenopause: Once you’ve reached menopause, you enter the post-menopausal stage. Your symptoms will most likely lessen and eventually go away — though, you’re now at an increased risk for conditions like osteoporosis and heart disease.

Dr. Batur explains each stage in greater detail, including the symptoms you might experience and how to find relief.

Perimenopause stages

You can think about perimenopause as the runway to the big event. It can start as early as a decade before menopause, though the average amount of time spent in perimenopause is four years.

During this time, your body is, little by little, winding down its natural ovulation process. The most common sign of perimenopause is irregular periods and menstrual cycles.

“As your estrogen levels start to decrease, your periods and menstrual cycles may start getting a little wonky — sometimes, closer together, sometimes skipping cycles,” Dr. Batur explains. “You may also have some of the typical menopausal symptoms.”

Not everyone experiences noticeable symptoms during perimenopause, but they can include:

• Irregular or skipped periods.
• More or less bleeding than usual during periods.
• Hot flashes.
• Vaginal dryness.
• Frequent urination.
• Sleep problems, like insomnia.
• Mood changes, including irritability or depression.

There are two stages to perimenopause — early menopause transition and late menopause transition — though they’re not always cut-and-dry and distinguishable from one another.

The early menopause transition

This first stage of perimenopause is the very beginning — when your body is just starting to experience hormonal changes. During this time, your periods and menstrual cycles are still coming regularly, but you may notice other symptoms:

• Hot flashes: “It’s normal to have a few days of hot flashes, especially just before or during your period, when your estrogen levels drop,” Dr. Batur notes.
• Weight gain: Most people gain some weight with each passing decade. This is common during the same time of the early menopause transition.
• Sleep changes: You might start to experience some insomnia, especially if you’re having hot flashes at night (aka night sweats).

“This is a natural phase of life, so if your symptoms are mild, you may be able to make do with lifestyle changes like getting more sleep and upping your cardio,” Dr. Batur says. “But if they’re really bothersome, speak to your healthcare provider, even if you’re still having regular menstrual cycles.”

The late menopause transition

The late menopause transition is when you’re getting a little closer to menopause. You’re more likely to start experiencing irregular periods and menstrual cycles.

“During perimenopause, you’re not ovulating as regularly,” Dr. Batur says. “You have up-and-down levels of estrogen, and you may not make progesterone as consistently, so you may skip a menstrual cycle and then have heavy bleeding during the next period because your uterine lining has thickened up from the impact of the estrogen.”

“Eventually, as you get closer and closer to menopause, you start skipping periods for months at a time,” she continues.

If this happens, bring it up with your healthcare provider — especially if you’re in your early 40s or younger, which can be a sign of premature menopause or a condition called primary ovarian insufficiency.

Menopause

When you’ve gone a full 12 months without having your period, you’ve entered menopause (assuming you haven’t stopped bleeding because of another medical condition or a medication).

“That typically happens around age 52,” Dr. Batur shares, “and then, you live the rest of your life in menopause, where you’re no longer ovulating and you no longer have the ability to bear children.”

Menopause symptoms typically last for seven to 10 years (though your timeframe may vary), and they can range from mild to severe. If you’re in the latter camp, experiencing bothersome symptoms that you just can’t shake, don’t feel like you have to soldier on in silence.

“Just saying, ‘grin and bear it’ and ‘eat healthier and lose some weight’ doesn’t cut it for people who are really suffering during this time in their lives,” Dr. Batur states. “Your healthcare provider will also want to make sure that your symptoms aren’t related to other medical conditions.”

Postmenopause

Once you enter menopause, you’re “in menopause” for the rest of your life; this is also called the postmenopause stage.

But now, you’re at a higher risk for other health concerns. A decrease in estrogen is a risk factor in conditions like:

• Cardiovascular disease: Estrogen is a protective factor against heart disease, so less estrogen means a higher risk of conditions that impact your heart and blood vessels.
• Osteoporosis: “Many hormones, but especially estrogen, are very important for bone development and maintenance of bone density,” Dr. Batur explains. “After estrogen loss, there is a rapid drop in bone density.”
• Genitourinary syndrome of menopause (GSM): Lack of estrogen thins the vaginal lining, which can cause pain during sex and frequent urinary tract infections.
• Mental health issues: Hormonal changes can play a role in anxiety and depression.

The older you get, the more tuned in your healthcare provider should be to menopause’s impact on your health. But if they’re not bringing it up, you definitely should — even if you’re feeling fine, but especially if you’re not.

When to see a doctor about menopause symptoms

The stages of menopause shouldn’t make you feel miserable. If your symptoms are especially bothersome and having an impact on your quality of life, it’s time to ask for help.

“Tell your Ob/Gyn or your primary care doctor, ‘Hey listen, I think my hormones are going haywire,’” Dr. Batur advises. They can talk you through the options, which may include any of the following (or a combination of them):

• Holistic approaches: “These include the good old-fashioned lifestyle tricks of eating a balanced diet, getting your sleep and managing your stress,” Dr. Batur says. But stay away from supplements for menopause relief unless your provider specifically recommends them.
• Hormone therapy: Various types of hormone therapy boost your hormone levels to try to ease your symptoms. “This requires a complicated, individualized discussion with your healthcare provider,” she says.
• Medication for vasomotor symptoms: The U.S. Food and Drug Administration (FDA) has approved two medications specifically to treat menopause-related hot flashes and night sweats: Veozah™ (fezolinetant) and Brisdelle (paroxetine mesylate).
• Other nonhormonal treatment options: There are a variety of nonhormonal options — including depression medications called selective serotonin reuptake inhibitors (SSRIs), as well as gabapentin and oxybutynin — all of which have been shown in studies to help relieve some of the symptoms of menopause, like hot flashes and mood changes.

Just remember: There’s no quick fix for the symptoms of menopause. If you raise concerns about them during an annual visit, your healthcare provider may ask you to come back for another appointment so the two of you can go more in-depth about what you’re experiencing — and that’s OK.

“This is a very individual thing, and it can be very complicated, especially depending on your medical history,” Dr. Batur says. “Schedule another appointment, if you need it, and make sure your concerns are being addressed during dedicated time with your provider.”