The Stages of Menopause

Menopause is the end of your menstruation cycle and child-bearing years.

For most people with female reproductive organs, this process typically occurs around age 51, and has three stages: perimenopause, menopause, and postmenopause.

Menopause can be difficult for some due to fluctuating hormones, bodily changes, and symptoms related to menopause.

Knowing what to expect and how to manage your symptoms can help you cope with these stages more easily.

In this article, I’ll talk more about what menopause is and how it’s diagnosed.

I’ll then talk about each of the three stages of menopause in more detail, including the symptoms of each stage, and how long each stage typically lasts.

I’ll also outline some treatments that can help with menopause symptoms.

What is Menopause?

Menopause occurs when people with ovaries stop producing the hormones estrogen and progesterone, and the ovaries stop releasing eggs.

It is usually defined as occurring when it has been 12 or so months since your last menstrual cycle, especially if you are at the typical age of menopause (between 40-50 years old).

How is Menopause Diagnosed?

Changes to your menstrual cycle and hot flashes at the common age of menopause are tell-tale signs you may be in the the first phase of menopause, the perimenopause phase. 

To get formally diagnosed, there are blood tests available that your doctor can give you to check your levels of follicle-stimulating hormone (FSH) and estrogen (estradiol).

When your body is ovulating, FSH levels increase to stimulate the body to release eggs.

When menopause occurs, your FSH levels also increase, while estradiol levels decrease. 

You can also get over-the-counter home tests to check the FSH levels in your urine.

These tend to be a little less reliable as FSH levels rise and fall during the course of your menstrual cycle, so the results won’t be as definitive as a blood test.

The Stages of Menopause

Menopause happens in three main stages: perimenopause, menopause, and postmenopause.

Perimenopause

Perimenopause means “around menopause.”

When your body starts to make the natural progression to menopause in your forties, or even as early as your mid-30s, you may experience this as menstrual irregularities.

Your cycles may lengthen or shorten, or you may not release an egg between periods.

You may also experience menopause-like symptoms, such as hot flashes, sleep problems, and vaginal dryness.

Treatments are available to help ease these symptoms.

Symptoms

• Irregular periods
• Spotting 
• Brown vaginal discharge following your period
• Hot flashes
• Difficulty sleeping
• Night sweats
• Vaginal and bladder infections
• Mood swings, irritability, or depression
• Decreased fertility
• Changes in sexual function
• Decreased libido
• Loss of bone
• Changes in cholesterol levels

Irregular periods are usually the first sign you may be going through menopause.

As ovulation becomes less predictable, you may find you have longer or shorter periods than normal, the time in between your periods may also change, and your flow may be heavy or light.

When the duration between your periods stretches further, you may be entering the menopause stage.

How long does perimenopause last?

Once you’ve gone through 12 consecutive months without a menstrual period, you’re no longer considered to be in the perimenopause phase, and have reached menopause.

Menopause

Menopause is when you’ve stopped producing the hormones that cause your menstrual period, and have gone without a period for 12 consecutive months.

Symptoms

Symptoms of menopause are the same as the symptoms of perimenopause.

You may also experience these additional symptoms:

• Occasional racing heartbeat
• Weight gain
• Vaginal itching
• Difficulty concentrating
• Joint and muscle aches
• Hair thinning or loss

How long does menopause last?

Menopause can last four to five years as your body adjusts to hormonal changes.

Postmenopause

The years after menopause are called postmenopause.

During the first few years of this time, the symptoms of menopause will usually continue, though they’ll become less frequent and less intense. 

Symptoms

• Hot flashes
• Night sweats
• Insomnia
• Vaginal dryness 
• Sexual discomfort
• Decreased libido
• Dry skin
• Weight changes
• Hair loss
• Urinary incontinence
• Depression

How long does postmenopause last?

During postmenopaise, menopause symptoms usully continue less frequently and less intensely for four to five years.

After that, the postmenopause phase lasts for the rest of your life.

Treatment to Relieve Symptoms of Menopause

If you are struggling with menopause, talk to your healthcare provider about your medical history and your current symptoms.

They will be able to determine the best treatment plan for you.

Hormone replacement therapy

Hormone replacement therapy can be effective for relieving hot flashes and other symptoms of menopause.

It can also decrease your risk of osteoporosis caused by declining estrogen levels.

If you still have your uterus, you’ll need progestin as well as estrogen.

Long-term use of hormone therapy may have some cardiovascular and breast cancer risks, so your doctor may only want to consider this for a short time period.

Vaginal estrogen

Vaginal creams, tablets, or rings release small amounts of estrogen into your vaginal tissues.

This can relieve discomfort during sexual intercourse, vaginal dryness, and some urinary issues.

Clonidine

Clonidine comes in pill or patch form, and is used to treat high blood pressure.

It can also be used to relieve hot flashes.

Gabapentin

Gabapentin is used primarily to treat seizures, but can also be prescribed to reduce nighttime hot flashes. 

Low-dose antidepressants 

If you are struggling with mood changes, depression, or irritability from menopause, low-dose antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help.

They may also decrease menopausal hot flashes.

Osteoporosis medications 

Declining levels of estrogen can put you at a greater risk of osteoporosis, your doctor may recommend medication to prevent or treat during menopause.

There are several osteoporosis medications that can help reduce bone loss and the risk of fractures.

Your doctor may recommend you take these in conjunction with calcium and vitamin D supplements to help strengthen bones.

When to See a Doctor 

Tell your doctor if you are experiencing symptoms of menopause earlier than 45 years old, or if your menopausal symptoms are affecting your daily life.

They will be able to carry out tests to confirm menopause and offer treatments to relieve your symptoms.

Talk with your doctor or specialist if you experience any vaginal bleeding after menopause, or if you have severe side effects from any of the medications prescribed to relieve your menopausal symptoms.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app? Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.