Menopause is a journey that can take a decade or more. It is not surprising that there are many different stages to a typical menopause journey. Here is a guide to the different stages of menopause, including when they happen, what they mean, and what to look out for.
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What is menopause?
During menopause, your body undergoes a dramatic shift in the amount and types of hormones that it produces. Most notably, estrogen levels fall dramatically. This causes several symptoms including hot flashes, night sweats, mood swings, and more. Your periods will also slow down and eventually stop altogether.
This does not happen overnight. Most menopause journeys take several years, and in some cases over a decade. Your menopause symptoms will be unique to you and can change radically over time. It is normal to have easier and more difficult times throughout your menopause journey.
Read more about the 34 symptoms of menopause.
Premenopause
Premenopause means the time before any menopausal changes begin. You are likely to be having a regular monthly period and will need to be on reliable contraception to prevent pregnancy. Most women are premenopausal throughout their young adult life.
Will HT help during premenopause?
HT is not helpful in premenopause, because your body is still producing estrogen and progesterone effectively. If any symptoms are troubling you at this point, see your healthcare provider for advice and investigation.
Perimenopause
Perimenopause is the time leading up to your final menstrual period. Over several years, your body gradually begins to produce less estrogen and progesterone. During perimenopause, most women experience menopausal symptoms and may choose to try HT and/or other approaches.
For many, the earliest signs of perimenopause begin in your early 40s and can be quite vague. Perhaps you notice a slight change in your mood, occasional trouble concentrating, or poor sleep.
Unsurprisingly, these subtle changes can easily be missed or attributed to other things. However, as you move through perimenopause, symptoms often become unmistakable. The most common symptoms include:
- Hot flashes
- Night sweats
- Brain fog and fatigue
- Aches and pains
- Mood changes including anxiety, irritability, and feeling low
Your periods will probably change during perimenopause too. One of the earliest signs of perimenopause is often a shift towards more irregular periods after the age of 40. This happens on average between six and eight years before your final period.
Early perimenopause (sometimes called ‘early transition’) is often marked by more frequent periods. Late perimenopause (‘late transition’) tends to bring periods that are further apart. However, this is not the case for everyone and approximately one in four will experience no change to their periods right up until their menopause.
Bleeding can change at this time too. It is common to experience heavy periods during perimenopause and this can be problematic for many. Check-in with your healthcare provider if:
- Your periods are heavy, especially if you notice that you are changing pads or tampons every hour or more if you have blood clots
- You have any signs of anemia, including tiredness, pale skin or reduced exercise tolerance. There are some possible causes other than menopause and – you’ll be relieved to hear – treatments are available to help slow down your bleeding
- You have bleeding in between periods or after sex
- You have any bloating, urinary or bowel changes, or any other new worries
Learn more about the signs of perimenopause.
Will HT help during perimenopause?
HT is highly effective at treating menopausal symptoms, many of which appear during perimenopause. Many women successfully use HT at this stage.
Menopause
Menopause is diagnosed when it has been 12 months or more since your last period. After this, you are said to be “postmenopausal”.
For most, this happens in your early 50s although you can experience menopause at any age. Early menopause is when you have your final period before age 45. Premature menopause – also known as primary ovarian insufficiency or premature ovarian failure – is when your final period happens before age 40.
While the milestone of your final period may be important, it can be underwhelming in the wider context of your menopause journey. This is especially true because you only know which was your final period when you look back on it a year down the line!
For some, it can be quite complicated to work out when you have reached menopause. This includes those who do not have regular periods for medical reasons, such as polycystic ovarian syndrome (PCOS), or because of medication, including certain contraceptives.
If you are unsure, your healthcare provider will be able to advise and may recommend testing for menopause.
Postmenopause
You are postmenopausal if it has been over a year since your last period, or if your healthcare provider has diagnosed you as having been through menopause.
Even though you are now officially postmenopausal, you will likely find that many of the symptoms you experienced in perimenopause continue. For example, some continue to have hot flashes years after their final period. If this is the case for you, you can continue to use HT as long as your healthcare provider feels it is safe and appropriate.
This is also true for those with genitourinary syndrome of menopause (GSM), which includes vaginal dryness, urinary symptoms and painful sex. Many with these symptoms need to use vaginal HT (including vaginal tablets, suppositories, or creams) on an ongoing basis. Due to the particularly low-risk nature of vaginal HT, this treatment is commonly used for decades after menopause if needed.
Will HT help during postmenopause?
HT can be helpful for menopause symptoms well into your postmenopausal years. While you may find that your symptoms settle after menopause, you can also keep using HT if needed.
However, HT is not for everyone and the risks of taking it increase as we age. Speak to your healthcare provider if you would like to learn more about your options.
Read more about HRT benefits and risks.
What about surgical menopause?
Surgical menopause happens when you have an operation to remove your ovaries. This is not uncommon as part of a treatment for other conditions, such as endometriosis, or as a preventive measure against ovarian cancer. For example, if you carry a gene mutation, such as BRCA, that increases your risk of developing ovarian cancer.
Because of the removal of your ovaries, you will experience a sudden and dramatic decrease in estrogen levels. This often means that you experience more pronounced menopause symptoms.
Those who experience sudden menopause, usually due to surgical removal of the ovaries, often need higher initial and ongoing doses of estrogen to control their symptoms than those who experience a more gradual decline in hormones.
Speak to your healthcare provider if your symptoms are troublesome. They may be able to recommend HT or other, non-hormonal treatments.
In terms of stages of menopause, surgical menopause can mean that you transition quickly from pre- or perimenopausal to postmenopause
Final word
Everyone has a different menopause journey and will progress through the various stages of menopause at their own pace.
If you are struggling with menopause symptoms, a range of treatments are available and suitable for use from perimenopause right through to postmenopause. Speak to your healthcare provider to find out about the best options for you.
Read more about menopause on our blog or in our symptoms library.
- Harlow, S.D., Paramsothy, P.. Menstruation and the Menopausal Transition, Obstetrics and Gynecology Clinics of North America, 38(3) p595-607, doi.org/10.1016/j.ogc.2011.05.010
- Huang AJ, Grady D, Jacoby VL, Blackwell TL, Bauer DC, Sawaya GF. Persistent Hot Flushes in Older Postmenopausal Women. Arch Intern Med. 2008;168(8):840–846. doi.org/10.1001/archinte.168.8.840
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