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Stages of Menopause

Stages of Menopause

Menopause is only one of several stages in the reproductive life of a woman. The whole menopause transition is divided into four main stages known as:

  1. Premenopause — refers to the entirety of a woman's life from her first to her last regular menstrual period. It is best defined as a time of "normal" reproductive function in a woman.

  2. Perimenopause — means "around menopause" and is a transitional stage of two to ten years before complete cessation of the menstrual period and is usually experienced by women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations, which cause the typical menopause symptoms, such as hot flashes.

  3. Menopause — represents the end stage of a natural transition in a woman's reproductive life. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally.

  4. Postmenopause — refers to a woman's time of life after menopause has occurred. It is generally believed that the postmenopausal phase begins when 12 full months have passed since the last menstrual period. From here a woman will be postmenopausal for the rest of her life.

Some women go through menopause before the age of 40. This is called premature menopause. It can happen naturally or as a result of certain medical treatments.

What is Premature Menopause?

Premature menopause is menopause that happens before the age of 40 — whether it is natural or induced. Women who enter menopause early get symptoms similar to those of natural menopause, like hot flashes, emotional problems, vaginal dryness, and decreased sex drive. For some women with early menopause, these symptoms are severe. Also, women who have early menopause tend to get weaker bones faster than women who enter menopause later in life. This raises their chances of getting osteoporosis and breaking a bone. Premature menopause can happen for the following reasons:

  • Chromosome defects. Defects in the chromosomes can cause premature menopause. For example, women with Turner's syndrome are born without a second X chromosome or born without part of the chromosome. The ovaries don't form normally, and early menopause results.

  • Genetics. Women with a family history of premature menopause are more likely to have early menopause themselves.

  • Autoimmune diseases. The body's immune system, which normally fights off diseases, mistakenly attacks a part of its own reproductive system. This hurts the ovaries and prevents them from making female hormones. Thyroid disease and rheumatoid arthritis are two diseases in which this can happen.

  • Surgery to remove the ovaries. Surgical removal of both ovaries, also called a bilateral oophorectomy [OH-uh-fuh-REK-tuh-mee], puts a woman into menopause right away. She will no longer have periods, and hormones decline rapidly. She may have menopausal symptoms right away, like hot flashes and diminished sexual desire. Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But because their uterus is removed, they no longer have their periods and cannot get pregnant. They might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they might have natural menopause a year or two earlier than expected.

  • Chemotherapy or pelvic radiation treatments for cancer. Cancer chemotherapy or pelvic radiation therapy for reproductive system cancers can cause ovarian damage. Women may stop getting their periods, have fertility problems, or lose their fertility. This can happen right away or take several months. With cancer treatment, the chances of going into menopause depend on the type of chemotherapy used, how much was used, and the age of the woman when she gets treatment. The younger a woman is, the less likely she will go into menopause.

How to Find Out if You Have Premature Menopause

Your doctor will ask you if you've had changes typical of menopause, like hot flashes, irregular periods, sleep problems, and vaginal dryness. Normally, menopause is confirmed when a woman hasn't had her period for 12 months in a row.


However, with certain types of premature menopause, these signs may not be enough for a diagnosis. A blood test that measures follicle-stimulating hormone (FSH) can be done. Your ovaries use this hormone to make estrogen. FSH levels rise when the ovaries stop making estrogen. When FSH levels are higher than normal, you've reached menopause. However, your estrogen levels vary daily, so you may need this test more than once to know for sure.


You may also have a test for levels of estradiol (a type of estrogen) and luteinizing hormone (LH). Estradiol levels fall when the ovaries fail. Levels lower than normal are a sign of menopause. LH is a hormone that triggers ovulation. If you test above normal levels, you've gone through menopause.

What is Perimenopause?

Perimenopause marks the time when your body begins the transition to menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last OR how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years.

Signs and Symptoms

Perimenopause causes changes in your body that you may or may not notice. For most women, the discomforts associated with perimenopause are minimal and manageable. Some things you might experience in the perimenopause years include:

  • Changes in your menstrual cycle (longer or shorter periods, heavier or lighter periods, or missed periods)
  • Hot flashes (sudden rush of heat from your chest to your head)
  • Night sweats (hot flashes that happen while you sleep)
  • Vaginal dryness
  • Sleep problems
  • Mood changes (mood swings, sadness, or irritability)
  • Pain during sex
  • More urinary infections
  • Urinary incontinence
  • Less interest in sex
  • Increase in body fat around your waist
  • Problems with concentration and memory

You can’t always tell if physical or emotional changes are related to menopause, the normal aging process, or something else. But by monitoring your menstrual cycle and recording your signs and symptoms for several months, you'll gain a better understanding of the changes occurring during this time. You will also have valuable information to discuss with your doctor should you have a concern.


Oral contraceptives (birth control pills) are often the treatment of choice to relieve perimenopausal symptoms — even if you don't need them for birth control. Today's low-dose pills regulate periods and stop or reduce hot flashes, vaginal dryness, and premenstrual syndrome.


Making lifestyle changes may help ease the discomfort of your symptoms and keep you healthy in the long run.

  • Good nutrition. Because your risk of osteoporosis (bone disease) and heart disease increases at this time, a healthy eating plan is more important than ever. Adopt a low-fat, high-fiber eating plan that is rich in fruits, vegetables, and whole grains. Add calcium-rich foods or take a calcium supplement. Limit alcohol or caffeine, which can affect sleep. If you smoke, try to quit.

  • Regular exercise. Regular physical activity helps keep your weight down, improves your sleep, strengthens your bones, and elevates your mood. Try to exercise for 30 minutes or more on most days of the week.

  • Stress reduction. Practiced regularly, stress reduction techniques such as meditation or yoga can help you relax and tolerate your symptoms more easily. 

Pregnancy and Perimenopause

If you're still having periods, even if they are not regular, you can get pregnant. Talk to your doctor about your options for birth control. Keep in mind that some methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from sexually transmitted infections (STIs), including HIV.

Sexual Health and Perimenopause

Many aging women enjoy an active sex life. Yet, many women are not aware of their risk of getting sexually transmitted infections (STIs), including HIV. If you have more than one sexual partner or have started a new sexual relationship, talk with your partner about using condoms before having sex. Latex condoms used correctly and every time you have any type of sexual contact offer the best protection against STIs. Dental dams (used for oral sex) and female condoms also can help protect you from some STIs.

What is Menopause?

Menopause is a normal change in a woman's life when her period stops. It is often called the "change of life." During perimenopause, a woman's body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change. As you near menopause, you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You can feel better by learning all you can about menopause, and talking with your doctor about your health and your symptoms. If you want to treat your symptoms, your doctor can tell you more about your options and help you make the best treatment choices.

Symptoms of Menopause


Every woman's period will stop at menopause. Some women have no other symptoms. But many women notice changes in body, mind, and mood at this stage of life. We don’t always know if these changes are related to menopause, aging, or both. Some changes you might notice include:

  • Changes in your period. The time between periods and the flow from month to month may be different.

  • Abnormal bleeding or "spotting." This is common as you near menopause. But if your periods have stopped for 12 months in a row, and you still have "spotting," you should talk to your doctor to rule out serious causes, like cancer.

  • Night sweats. Hot flashes that occur while a woman is sleeping and cause her to perspire. They can make it hard to get a good night’s sleep.

  • Sleeping problems. Lack of sleep can affect your mood, health, and ability to cope with everyday stress.

  • Vaginal changes. The vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.

  • Thinning of your bones. This may lead to loss of height and bone breaks (osteoporosis).

  • Emotional changes. May include mood swings, sadness, tearfulness, and irritability. Although menopause does not cause depression, women are at a higher risk of depression in the years leading up to menopause. Some researchers think that the decrease in estrogen levels plays a role in the onset of depression in some women. Also, lack of sleep can strain a woman’s emotional health.

  • Urinary problems. You may have leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.

  • Problems with memory and staying focused. You may notice you are more forgetful or have trouble concentrating.

  • Sex drive decreases. You may have less interest in sex and changes in sexual response.

  • Weight fluctuation. Weight gain or increase in body fat around your waist.

  • Hair loss or thinning. Hair thinning or loss is a problem for some women.

Symptom Relief


Many women are able to cope with minor discomforts of menopause. Try these tips:

  • Hot flashes. Keep track of when hot flashes happen. You might be able to identify a pattern or triggers, which you can avoid. Dress in layers and keep a fan in your home or workplace. If lifestyle changes don’t seem to help, ask your doctor about menopausal hormone therapy or nonhormonal prescription drugs. Research has found that nonhormonal prescription drugs, such as antidepressants, help hot flashes in some women.

  • Vaginal dryness. Try an over-the-counter water-based vaginal lubricant. Prescription estrogen replacement creams and tablets also can help restore moisture and tissue health. If you have spotting or bleeding while using estrogen creams, you should see your doctor.

  • Problems sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But avoid physical activity close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Keeping your bedroom cool and dark also can help. Avoid napping during the day and try to go to bed and get up at the same times every day.

  • Memory problems. Some women complain about problems with memory and concentration. But there is no proof that menopause causes memory problems. Try to get enough sleep and engage in physical and social activity. If forgetfulness or other mental problems worry you or are affecting your everyday functioning, talk to your doctor.

  • Mood swings. Try to get enough sleep and be physically active. Set limits for yourself, and look for positive ways to ease daily stress. Think about going to a support group for women who are going through the same thing as you, or getting counseling to talk through your problems and fears. Talk to your doctor if mood swings are causing you distress. Medicines might help. For instance, menopausal hormone therapy might help if mood swings are related to disrupted sleep caused by night sweats. Also, your doctor can look out for signs of depression, which is a serious illness that needs treatment.

Two other common health problems can start to happen at menopause, and you might not even notice.

  • Osteoporosis. Day in and day out your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss. So losing estrogen around the time of menopause causes women to begin to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis.

  • Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may develop other problems, like high blood pressure or weight gain, which put you at greater risk for heart disease.


Male Menopause

Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that their male patients are reporting some of the same symptoms that women experience in menopause.

Men go through aging male syndrome (AMS) between the ages of 35 and 65 when their hormone levels (especially testosterone) decline. Testosterone is a hormone that helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone. The decline of testosterone is normal in healthy males as they age. Unlike women who lose their fertility (ability to get pregnant) when they reach menopause, men do not lose their fertility. But the hormone change may cause other symptoms. All men have different experiences — some men's hormone levels go down more than others, and some men have more symptoms than others.


A decline in testosterone can affect a man's body. AMS has many signs:

  • Feeling fat/weight gain
  • Problems sleeping
  • Less interest in sex
  • Feeling irritable or angry
  • Erection problems
  • Nervousness
  • Problems with memory and concentration
  • Muscle loss
  • Increased urination
  • Depression
  • Loss of energy
  • Bone and hair loss

If you're having these symptoms of low testosterone, talk to your doctor. You can get your testosterone level tested with a simple blood test. Get the test in the morning, when the testes release more testosterone. Because a normal level of testosterone is different for each man, it may be hard to know if you have low testosterone — it helps if you had a testosterone test earlier in your life, so you'll be able to see any change. If you do have low testosterone, think about visiting a specialist, such as an endocrinologist or urologist, who can work with you to treat this problem.


*Reprinted from womenshealth.gov.

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