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The stages of menopause

The stages of menopause

Every woman is different when it comes to menopausal symptoms, but knowing what’s possible will help you know when it’s time to seek professional advice.

Lifestyle insight
Reading time: 4 minutes

A natural transition

Menopause may not feel ‘normal’, but it’s is a natural part of life, and occurs gradually over several years – it marks the end of a woman’s reproductive years. Strictly speaking, menopause is the 12 months that follow your last period. The years leading up to this 12-month phase are called perimenopause, and the years after it are called postmenopause.

Across these phases, it’s common to experience symptoms like hot flushes and night sweats, changes to your mood and sleeping patterns, and some vaginal discomfort and urinary issues. But every woman is different and can experience a different range of symptoms. A key to getting through it is learning about the different things you can tray that can help manage your symptoms.

What is the natural process? 

While menopause can be triggered suddenly by events such as certain medical procedures, natural menopause happens very gradually. This is because the functions of your ovaries essentially slow down – they progressively make less of two important reproductive hormones (oestrogen and progesterone), until eventually they stop releasing eggs. Other hormones play a part too – levels of testosterone, and luteinizing hormone may also drop.

Hormones can affect many different parts of our bodies and are involved in communication throughout our body. So the hormonal changes of menopause can naturally result in a range of symptoms, including physical and emotional changes. It can be thought of as a bit like puberty in reverse – instead of getting you ready for potential reproduction, your hormones are winding up that phase of your life.

Learn more about the hormonal changes that occur during menopause:
Hormonal fluctuations during premenopause, pwerimenopause, and post menopause

Excerpted from the September 1999 issue of the Harvard Women’s Health Watch, 1999. President and Fellows, Harvard College.

What are the natural symptoms?

You might find that the symptoms you experience during the three phases of menopause can leave you not feeling your best. Or you might find that you have difficulty coping with mood fluctuations. Whatever your experience, try to remember that the symptoms you experience can be as natural as getting acne while you go through puberty – because these are both periods of hormonal chaos that normally settle in time. It is always a good idea to speak to your health professional to get medical advice if unsure about symptoms, they worsen unexpectedly, or if you want specific advice about how to manage your symptoms.

Here’s a general guide to what you could experience at each phase, and what you should keep in mind as you go through each phase.


What the journey can look like...

Phase I: Perimenopause

Perimenopause usually starts in your late 40s or early 50s, and on average lasts around 4 years. But it’s different for every woman, so it can be much shorter or longer.

What to expect: Irregular periods – generally less frequent, and either heavier or lighter than what’s normal for you.

You may experience some of these possible physical symptoms:

Hot flushes

Chills Vaginal dryness Urinary issues
Weight gain Joint pain

Thinning hair

Dry skin

Acne

Loss of breast fullness

Sore breasts

Night sweats 

You may experience other symptoms, including emotional changes:

Mood changes Loss of libido Sleep disturbances  
Mild anxiety Headaches Memory problems

 

What to keep in mind: Start looking at simple ways to reduce discomfort (keeping cool, exercising regularly, a good skincare routine), and keep in mind that it is possible to still get pregnant during perimenopause.

See your healthcare professional if you are worried about symptoms or have other concerns. Also see your healthcare professional if you experience perimenopause symptoms before age 45 years.
 

Phase II: Menopause

Menopause is the phase from your final period until 12 months later (ie, your first year with no periods at all). The average age for menopause is about 51-52 years.

What to expect: No more periods.

You may experience some of these possible physical symptoms:

Hot flushes

Chills Vaginal dryness Urinary issues
Weight gain Joint pain

Thinning hair

Dry skin

Acne

Loss of breast fullness

Sore breasts

Night sweats 

You may experience other symptoms, including emotional changes:

Mood changes Loss of libido Sleep disturbances  
Mild anxiety Headaches Memory problems

 

What to keep in mind: You won’t be sure that you’ve been in this phase till you reach 12 months without a period. 

Remember, it is technically possible to fall pregnant until you are sure you have transitioned through menopause, as you might still be in perimenopause.

See your healthcare professional if you find any symptoms severe or difficult to cope with, or have other concerns.

 

Phase III: Postmenopause

You are in the postmenopause phase when it’s been more than 12 months since your final period.

What to expect: Still no more periods (>12 months).

Physical, emotional and other menopausal symptoms may ease throughout postmenopause. You can be at higher risk of some other health conditions once in postmenopause – eg, weaker bones, heart health issues, and urinary/bladder issues.

What to keep in mind: Keeping your bones strong and looking after your heart health is important post menopause, so talk to your healthcare professional to monitor and discuss lifestyle changes or any recommended medicines. Also speak with your healthcare professional if you have any ongoing symptoms, or if symptoms worsen unexpectedly.


But it doesn’t feel normal!

While menopause and its symptoms are natural, it doesn’t mean that the changes you experience necessarily feel normal. So if you are concerned, or symptoms persist or worsen, keep up regular visits with your doctor –– they can talk to you about what you’ve noticed and help you work through any concerns. Remember, you are not alone and it is always helpful to seek support from your community. Speaking to family and friends about your feelings and concerns can help them be more understanding and supportive; the other women in your life might also be able to share their own menopausal tips and experiences! And always see a doctor if you’re experiencing symptoms that you’re not coping with – don’t suffer in silence.  

References available on request.

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