A woman’s journey to menopause is not linear, and it is certainly not identical to the woman next to her. Rarely do women scrape by without any bumps in the road. Nonetheless, while the length of a woman’s journey and the challenges she faces can be unpredictable, arrival at menopause is certain.
Menopause is the time in a woman’s life when menstrual periods stop and you can no longer get pregnant. There are different stages of menopause. Although there are certain hallmark ages and symptoms associated with each stage, there is a lot of variation as your menopause journey is highly individual. Read on to get a general road map of what to expect on your way to menopause.
What are the different stages of menopause?
There are four different stages of menopause, each with their own age range, symptoms, average hormone levels, and duration. The four different stages are premenopause, perimenopause, menopause, and postmenopausal. What is the difference, you may ask? Let’s take a look.
Pre – Premenopause is the time when you have no symptoms that suggest you are in perimenopause or menopause and you are having regular periods. In this stage, you are fertile and may even have irregular periods if that has been the trend throughout your menstruating years. The age range for premenopause is loosely defined as it can really be anytime that you are following a menstrual cycle up until you are in perimenopause. However, in general women in their 30’s and even early 40’s can be considered premenopausal if they are not experiencing changes in their bodies from hormone fluctuations.
Peri – Perimenopause is the time in which you start to experience changes in your body that are similar to menopause. One of the first signs of perimenopause is your period becoming irregular. There are many other symptoms that can accompany perimenopause – 34 to be exact. Perimenopause symptoms are due to fluctuating hormone levels, specifically estrogen and progesterone. As women near menopause, the ovaries begin to produce less and less estrogen and progesterone. Some women glide through perimenopause without too much disturbance from symptoms whereas others can be more severely affected. Most women enter perimenopause in their 40’s, however, it is not uncommon for women to enter perimenopause in their 30’s.
Menopause –A woman is considered in menopause when her ovaries are no longer releasing eggs and her periods cease. Menopause is officially diagnosed when a woman has not had a period for 12 months. The average age for menopause is 51, although some women can enter menopause in their 40’s or even their 60’s. Premature menopause is diagnosed when a woman enters menopause at age 40 or younger. Certain factors that can cause a woman to enter menopause earlier include:
- Smoking
- Family history of early menopause
- Hysterectomy or surgical removal of the ovaries (oophorectomy)
- Certain cancer treatments
Postmenopausal – A woman is considered postmenopausal after she has been without a period for 12 months and for the remainder of her life. Postmenopause is associated with very low levels of estrogen which can lead to an improvement or even resolution of some of the symptoms that were experienced in perimenopause and menopause. However, some women can still experience symptoms such as hot flashes and fatigue in postmenopause. Because of lower levels of estrogen (and progesterone too), postmenopausal women are at greater risk for certain diseases including osteoporosis and heart disease.
How long does it take at each stage?
Pre –Because premenopause can be anytime before you begin to experience perimenopause symptoms, there is really no set time for how long premenopause lasts. Fortunately, this time is not associated with any symptoms of perimenopause or menopause but you do have to be active in preventing pregnancy if you do not wish to get pregnant.
Peri – The “typical” perimenopause transition is around 5 years but perimenopause can last between 8-10 years before a woman officially is in menopause. However, every woman has a different experience with perimenopause and they may have a very short transitional period whereas others may experience symptoms for longer than average.
Menopause – When a woman has not had a period for one year, she is in menopause. After being period-free for one year, many women still experience menopause symptoms including hot flashes, night sweats, and vaginal dryness.
Postmenopausal – A woman is in postmenopause from the time she has not had a period in 12 months to the end of her life. Postmenopause indicates that a woman is no longer fertile or having
menstrual periods.
What are the symptoms at each stage and what are the signs of premenopause, perimenopause, menopause, and post-menopause?
Pre –Women who are premenopausal do not experience menopause symptoms.
Peri – There are 34 symptoms perimenopause, and their severity can vary from woman to woman. Furthermore, perimenopause symptoms may worsen over time as you get closer to menopause. Some of the most common symptoms of perimenopause include:
- Hot flashes
- Low libido
You can view the complete list of the 34 symptoms of perimenopause here.
Menopause – Women who are in menopause are likely to encounter the following symptoms according to the Mayo Clinic:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats and temperature instability
- Sleep problems
- Moodiness
- Weight gain and slowed metabolism
- Thinning hair
- Dry skin
- Loss of breast fullness
Postmenopausal –The main symptom in postmenopausal women is no period. Even though a woman may not have had a period of 12 months or more, some women do still experience symptoms of menopause as noted above for around 5 years after menopause.
Do symptoms differ, do they get worse or better from stage to stage?
A woman’s experience of menopausal symptoms is highly individualized. In general, symptoms tend to worsen the closer you get to reaching menopause but then are likely to improve a few years after you have hit menopause. If you are suffering from menopausal symptoms at any stage, it is important to connect with your doctor to learn about options for managing your symptoms. Some women can experience symptoms for many years so it is important to live as fully and comfortably as you can during this season.
What are the hormone levels at each stage?
There are many hormones that can be implicated in the female reproductive cycle. Rarely are a woman’s hormones ever still and balanced unless she is postmenopausal or has had her ovaries removed. Therefore, hormone testing can be challenging, especially in perimenopause when hormones can jump around erratically.
FSH, LH, and Estradiol
The hormones immediately involved in a woman’s reproductive cycle include estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). When a woman is premenopausal, her hormones follow a cyclical pattern of hormones rising and falling that gives rise to her monthly (usually) cycle.
Perimenopausal women experience fluctuations in estrogen and progesterone that do not always follow a predictable pattern and can change even within a single day. When a woman is in menopause, her doctor may order an FSH blood test. If FSH is greater than 30mIU/mL, a woman is likely in menopause because her brain is releasing more and more FSH to try to encourage the ovaries to release an egg, but the ovaries no longer ovulate. Similarly, estradiol (a form of estrogen) levels may also be tested. If they are less than 30pg/mL, that also may indicate that a woman is in menopause.
So, our journey ends in post-menopause. What does it mean to be post-menopausal?
Donate your pads and tampons and toss out the birth control – you are free from periods for the rest of your life! However, as you open up bathroom cabinet space from period products, you likely will need to fill the space with calcium and vitamin D supplements and a good personal lubricant.
Postmenopausal women are at greater risk for osteoporosis and bone fracture so your doctor will likely recommend you take a calcium/vitamin D supplement to support bone health. Similarly, because your body will have very low levels of estrogen for the remainder of your life, you will likely suffer from vaginal dryness and atrophy. Vaginal dryness can make intercourse and even everyday life uncomfortable so have a good lubricant at the ready.
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.
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