The Stages of Menopause: When it Begins, and What to Expect
Aug 08, 2019
In this day of endless information and communication, it is puzzling that women are often unprepared for menopause -- the unpleasantness of the symptoms, the disruption to our lives, or the psychological impact of realizing we’re approaching “the change.”
The transition won’t be half as daunting if you have a good idea where you are on in your menopause transition, and what to expect as you move through the stages of menopause.
Knowing which stage of menopause you are in will help you not only understand and be better prepared for the physiological changes and symptoms you may experience, but even more important, will shine a light on the options that are available to you at each stage for symptom relief.
Okay, so what are the stages of menopause?
Menopause, as it is commonly referred to, is the natural process a woman’s body undergoes as her ovaries gradually produce less estrogen and eventually stop releasing eggs.
But menopause doesn’t happen all at once. It is a gradual transition that takes place over a period of years and happens in distinct stages. It starts with perimenopause as estrogen production begins to rise and fall unevenly and your periods become irregular. Once you’ve gone a full year without a menstrual cycle, you’ve officially hit menopause, which technically last only a single day, after which you are postmenopausal.
Let’s take a closer look at each stage in greater detail.
Stage 1: Perimenopause
Perimenopause is the stage leading up to menopause proper that can last anywhere from one to seven years. During perimenopause, estrogen production fluctuates and the first signs of menopause begin to appear. Your symptoms could include:
· Irregular menstrual cycles
· Hot flashes
· Mood swings
· Sleep disturbances
· Vaginal dryness
Most women begin seeing signs of perimenopause in their 40s, but it’s not uncommon for women to see signs of early menopause (premature menopause) in their 30s as well.
Many women have no idea perimenopause is even a thing until they’re in it. There are a couple of reasons for this. For one, perimenopause and menopause too often get lumped in together. But, even more so, we simply don’t talk enough about either stage. There is an alarming lack of conversation around menopause altogether, which leads to confusion. As a result, most of us just aren’t prepared when we enter perimenopause, so here’s everything you need to know.
The prefix “peri” means “around” or “near.” So, perimenopause pretty much means, “near menopause.” As the name implies, it’s the stage just before a woman enters menopause proper and stops having periods altogether.
But, the name is also a bit deceptive, because it’s actually during perimenopause that we start experiencing many (maybe all) of the symptoms classically associated with menopause.
This is because your body is in hormonal upheaval during perimenopause, and estrogen levels, in particular, fluctuate wildly.
Estrogen is one of the body’s great multitaskers, assisting with numerous important physiological functions. Your heart, bones, brain, bladder, vagina, and colon all have estrogen receptors and rely on this hard-working hormone to do their jobs effectively.
When your estrogen levels drop during perimenopause, it can disrupt many aspects of your health and well-being. These disruptions can appear as menopause symptoms, including hot flashes, night sweats, vaginal dryness, reduced libido, anxiety, mood swings, forgetfulness, brittle bones, muscles aches, and joint pains. Your body also may change in noticeable ways, such as thinning hair, weight gain (especially around the middle), and sagging skin.
How long does perimenopause last?
Perimenopause usually starts in our forties and can last anywhere from a few years to a decade, but for most women will last between four to eight years. However, some women start perimenopause much earlier, in their thirties.
How do you know if you’re perimenopausal?
The first sign of perimenopause is usually an irregular or unpredictable menstrual cycle. You may skip cycles, then, a few months later, get your period again. You may have two periods in a single month, have periods that last longer, have heavier or lighter flows, or constant spotting.
What’s the difference between perimenopause and menopause?
One big, big difference between perimenopause and menopause is that, during perimenopause, you are still menstruating, meaning you can still become pregnant. In fact, perimenopausal women are second only to teens in unexpected pregnancies, possibly because erratic cycles give women a mistaken belief that they aren’t fertile enough to conceive, so perimenopausal women have to remain vigilant about birth control.
The other major difference is that your body is still producing its own estrogen and progesterone. The problem is that it’s not producing these hormones as steadily or reliably as before, and levels can fluctuate wildly, making you feel like you’re riding a hormonal roller coaster.
What can I do to relieve my symptoms?
Because your body is still producing its own hormones during perimenopause, hormone replacement is not an option for dealing with symptoms during this stage, so you may want to explore diet and lifestyle interventions as well as nonprescription remedies such as supplements, and speak with your doctor about other prescription options such as low-dose birth control pills and antidepressants that have been shown to reduce hot flashes and other menopause symptoms.
Dealing with perimenopause symptoms
Diet and lifestyle interventions
Reduce stress as much as possible
Avoid alcohol, spicy foods, and caffeine
If you smoke, quit
Strive to maintain a healthy weight
Try controlled-breathing and self-calming exercises like yoga
Some women also find a measure of relief in eating estrogenic foods, including soy products such as soy nuts, edamame and tofu, as well as yams, flaxseeds and other plants that contain phytoestrogens. Estrogenic foods contain compounds like soy isoflavones. Daidzein, a soy isoflavone, is changed by gut bacteria into S-equol, a compound that is structurally similar to estrogen and mimics some (but not all) of its actions in the body, helping to reduce hot flash symptoms. (S-equol is not estrogen or a hormone.)
Since only about 20-30 percent of women in the U.S. can metabolize soy foods in a way that utilizes the S-equol, (and production depends on how much soy you actually intake in your diet) some women find taking an S-equol supplement helpful* to reduce hot flashes.
Doctors will sometimes prescribe a form of low-dose birth control that evens out estrogen and progesterone levels to help perimenopausal women manage their symptoms
Another (non-hormonal) prescription option is antidepressants that have been shown to help alleviate a range of perimenopause symptoms, from the obvious (anxiety and mood swings) to the not-so-obvious (hot flashes and night sweats)
Stage 2: Menopause
Once your body has gone a full 12 months without a period, you’ve reached menopause. During this time, your ovaries stop releasing eggs and your estrogen levels remain low, leading to a wide range of symptoms that could include:
· Hot flashes
· Muscle aches & joint pains
· Mood swings
· Sleep disturbances
· Weight gain
Now we’ve arrived at the Big Show: menopause proper.
Strictly speaking, menopause means “the end of the period.” From a medical standpoint, a woman is considered to have reached menopause only when she has gone twelve months in a row without a period. So, menopause begins immediately after you’ve had your last menstrual cycle.
Most women enter natural menopause in their early fifties, though the transition can happen anywhere between the ages of forty and the late fifties. There are exceptions, of course. Some women will experience premature menopause, meaning they stop menstruating before the age of forty. And women who’ve had their ovaries removed surgically are said to have surgical menopause, because their bodies have stopped producing estrogen and progesterone.
Menopause technically lasts only one day ― the very first day after you haven’t had a period for one full year. Before that day, you are perimenopausal, and after you’re postmenopausal.
But, for the sake of simplicity, let’s look at this another way ― menopause is the period of time after you stop having periods but continue having symptoms such as hot flashes, sleep disturbances, aches and pains, vaginal dryness, and mood swings.
But, wait ― if the symptoms of perimenopause and menopause are basically the same, does it really matter which stage of menopause you’re in? After all, a hot flash is a hot flash, right?
Actually, it matters very much. Menopause is physiologically very different from perimenopause. The major difference being that our bodies no longer make estrogen or progesterone. So, while your symptoms may be similar, your options for symptom relief are different.
Most importantly, once you reach menopause proper, you are eligible for hormone therapy, unless you have a personal or medical issue that makes taking hormones too risky, such as liver disease, blood-clotting disorder, a history of heart attack or breast cancer.
Stage 3: Post-menopause
There’s good news and bad news for postmenopausal women ― but mostly good news.
During the years after menopause, most women see a reduction in their hot flashes, mood swings, and sleep disturbances, along with general improvement in mood and mental clarity.
Post-menopause does, however, come with its own health challenges. Signs of postmenopausal health risks can be tough to spot, but because the body’s estrogen levels remain low, there are several new health conditions women in post-menopause need to be aware of, including:
· Increased risk of heart disease
· Increased risk of osteoporosis
Menopause is technically only one day of a woman’s life. The day she hits one full year without a period is the day she reaches menopause. After that, she is postmenopausal.
Once you stop having periods, and as long as you no longer have periods, you are postmenopausal. So, unless you spontaneously (and miraculously) begin menstruating again, you will be postmenopausal for the rest of your life (just to clarify, so you don’t have a panic attack about your periods returning: This scenario is medically impossible and has never happened).
You may continue to have some menopause symptom, but they should become less frequent, less intense, less disruptive to your life. Hormone levels will decline to a steady level, and your body will eventually reach a new hormonal balance.