3 Menopause Stages: Signs and Symptoms

What Is Menopause? 

Taken from the Greek root words for month and pause, the word menopause literally means the cessation (or pausing) of your monthly cycle. According to the Office on Women’s Health, menopause is defined as “when your periods stop permanently and you can no longer get pregnant.” More precisely, you have reached menopause when you have not had any period or form of bleeding for a full year. There are 3 menopause stages: The time leading up to that year is known as perimenopause, and once you’ve experienced menopause, you are in the postmenopause phase. 

The Three Stages of Menopause

Menopause is both a medical and a general term. Many people refer to the whole time period as menopause, but it really has three distinct phases: perimenopause, menopause, and postmenopause. 

Perimenopause

Peri, from Greek and Latin meaning around, is used to describe the phase around menopause. This is the time leading up to menopause when the body begins to naturally transition out of the reproductive phase of life. Changing hormone levels during this phase means you may see symptoms as early as 2 to 8 years before you officially hit menopause. 

Common Symptoms of Perimenopause 

Fluctuations in hormones and ovarian function are the hallmarks of perimenopause. 

Common symptoms include the following:

• irregular periods
• hot flashes or night sweats
• breast tenderness
• itchy, dry skin
• trouble concentrating and brain fog
• unexplained weight gain
• migraines
• mood changes
• vaginal dryness and loss of libido
• muscle and joint pain

How Long Does Perimenopause Last? 

Even though there are common symptoms, everyone experiences perimenopause differently and may not experience all of these symptoms. It is a gradual transition with fluctuating symptoms that can last for as long as 8 years. The average length of perimenopause is approximately 4 years, but your experience will be unique to you and your personal hormonal transition. There is no perimenopause test and your doctor can diagnose if you are experiencing menopausal symptoms and the best course of action for treatment. 

Menopause

What Is Menopause?

Menopause is the period in which a person with a uterus no longer has periods or a monthly cycle and they can no longer get pregnant. It is a permanent end to the reproductive stage of life and a normal part of aging. 

Defining Symptoms of Menopause

Menopause affects every part of your body and there are a broad range of changes that one might experience. 

According to the National Institute on Aging, here is a list of the most common and defining symptoms of menopause:

• changes in your period
• hot flashes or night sweats
• bladder issues
• sleep problems
• changes in vaginal health and sexuality
• mood changes
• overall body changes

How to Recognize Menopause Onset

Are they menopausal symptoms or just regular signs of aging? It can be hard to know the difference or recognize the onset of menopause. Only a healthcare professional can confirm your menopause stage, but testing certain hormones (like FSH) can help you understand if you are entering this phase or if your symptoms are related to other hormonal imbalances. 

Postmenopause

What Is Postmenopause?

Once you have gone 12 months in a row without a period and have experienced menopause, you are in the postmenopause phase. Like the name suggests, this is the phase after menopause and lasts the rest of your life. 

Symptoms and Health Considerations in Postmenopause

Those in postmenopause have special health considerations and have a higher risk for certain health conditions. Osteoporosis, cardiovascular disease, and genitourinary syndrome of menopause (formerly known as vaginal atrophy) are all concerns when you have decreased estrogen levels like you do in postmenopause. 

Common Signs and Symptoms Across All Three Stages

Irregular Periods and Menstrual Changes

As hormone levels fluctuate, you might notice changes in your menstrual cycle. This can mean longer cycles, shorter cycles, or even unpredictable bleeding. Irregular periods are often one of the first signs of menopausal symptoms but may also be due to other hormonal health concerns so it’s important to see a doctor to rule out anything more serious. 

Hot Flashes and Night Sweats

Although not everyone will experience hot flashes or night sweats, this hallmark of menopausal symptoms can plague up to 75 percent of people going through perimenopause. They vary in both intensity and frequency and not everyone will experience them in the same way. For some people, they can be so intense they disrupt normal life, while for others they are barely noticeable. The FDA recently approved a drug to treat hot flashes caused by menopause so see your doctor to discuss treatment options. 

Mood Swings and Irritability

Fluctuating hormone levels, especially estradiol levels in menopause, can lead to drastic changes in mood and irritability. Fluctuating levels of estrogen affect other neurohormones responsible for regulating mood resulting in mood swings. Healthy habits like proper sleep and exercise can help stabilize your mood during this time.

Sleep Disturbances

Whether your sleep is disturbed from night sweats or just general insomnia, many people experience sleep disturbances during the menopausal transition. For some it’s a difficulty falling asleep, while others report trouble staying asleep or being kept awake by anxiety. Getting a good night’s sleep starts well before bedtime though so practice good sleep hygiene and make sure you are treating all of your symptoms to help you get a better night’s sleep. 

Vaginal Dryness and Changes in Libido

As estrogen levels gradually lower, the blood supply to the vagina is decreased which can lead to vaginal dryness and atrophy. This can make sexual activities painful, which in turn makes it more difficult to become aroused. Neural pathways then start to link sex to pain creating a whole new level of complexity to the situation. 

Weight Gain and Metabolism Changes

Perhaps one of the most frustrating symptoms during the transition to menopause is weight gain and metabolic changes. Decreased levels of estrogen can slow your metabolism, and many people report increased belly fat as one of their pesky menopausal symptoms. It’s normal to gain weight as you age, but extra weight can increase your risk of other health issues, like cardiovascular disease, so it’s important to stay on top of it. 

Cognitive Changes (Memory, Focus)

Fuzzy thinking or trouble remembering things and focusing can be one of the most frustrating symptoms to deal with. Estrogen prompts the brain to burn glucose as energy so declining estrogen levels mean your brain no longer works as hard. You may find it more difficult to concentrate and have trouble remembering things. 

Health Risks Associated with Menopause

Bone Health and Osteoporosis

In response to lower levels of estrogen in the body, many who have gone through menopause are at a higher risk of osteoporosis with some people losing as much as 20 percent of their bone density. 

Cardiovascular Disease Risk

As you age, the risk of cardiovascular disease rises, but the incidence of cardiovascular disease increases significantly after menopause. In fact, research suggests that the menopause transition is one of the factors that contributes to an increased risk of heart disease. Estrogen plays a protective role in cardiovascular health and as levels drop in menopause your risk for heart disease increases. 

Mental Health Concerns

Although not totally hormone-based, fluctuations in progesterone and estradiol may lead to an increase in depression symptoms. Anxiety, depression, and other mood disturbances may be driven by hormonal changes but can also be affected by the changes in your physical health as well like an underactive thyroid or lack of sleep. 

Urinary and Vaginal Health

As estradiol levels in menopause decline, it can affect the physical health of your urinary tract and vagina. The walls of the vagina may become thin, dry, or inflamed which can lead to painful sex or urination, and needing to pee more often. Formerly known as vaginal atrophy, these symptoms are now called genitourinary syndrome of menopause. 

Menopause Testing: How to Know If You Are in Menopause

Only a healthcare professional can diagnose menopause, but there are some common tests used along the way. 

What Are Menopause Tests?

Although not required to diagnose, there are blood and urine tests to determine hormone levels during menopause. Hormone testing for women usually involves estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). 

Hormone Testing: FSH, LH, and Estrogen Levels

Fluctuating hormone levels during this transition are responsible for many of the signs and symptoms you are experiencing. Hormone testing can tell you your exact levels of each hormone. Estrogen and progesterone levels are likely to decline, whereas FSH levels can be much higher. An FSH test can show your numeric FSH level and your doctor can advise whether it is elevated or not. 

At-Home Menopause Test Kits

Your doctor may want to run a blood test to see your exact estrogen, FSH, and LH levels but that will only give you a snapshot of your hormones at that time. If you need multiple tests it can get time consuming and expensive. Hormone testing for women has come a long way and there are now hormone tests from home.

Testing your levels of estradiol, progesterone metabolite, LH, and FSH with Mira’s digital fertility analyzer can help you track your hormone levels over time and allow you to keep track of your associated symptoms by logging them in the app. 

Whether you are approaching menopause or not, tracking your hormones can offer many insights into both your fertility and general health. Mira’s Menopause Transitions Kit tracks four key reproductive hormones (FSH, E3G, PdG, LH) to monitor and define your menopause stage. Paired with the Menopause Transition Mode in the app, you can manage menopause symptoms and associate it with hormone changes. 

When to Talk to a Doctor About Testing

It can be hard to know when to talk to your doctor about menopausal symptoms and menopause tests because it is often treated as a taboo subject. If your symptoms are interfering with your quality of life, it’s definitely time to talk to your doctor. 

If you are using the Menopause Mode in the Mira app you can let your data speak for itself. With comprehensive hormone reports you can present concrete evidence at medical appointments to be your own advocate. 

Interpreting Your Menopause Test Results

Your healthcare provider can help you interpret the results of your menopause test or perimenopause test. To get the basic knowledge on the topic, you can start with this guide on How to Transition into Menopause.

If you are looking for more guidance in interpreting these results, Mira’s own Hormone Health Coaches can help! Our coaches have field experience in fertility and can help assess your symptoms, analyze your hormone tests, and even provide practical lifestyle guidance to manage this transition. 

Managing Symptoms Across the Three Stages

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) is an effective and evidence-based treatment for many menopausal symptoms. Also known as menopausal hormone therapy (MHT), it involves supplementing with hormone medicines to treat symptoms like hot flashes and night sweats. Your doctor will work with you to find the dose and combination that works for your specific symptoms and it may involve taking progesterone, estrogen, or even testosterone. 

Non-Hormonal Treatments

Non-hormonal treatments available for menopausal symptoms include other medications like selective serotonin reuptake inhibitors. Some of these medications have been shown to help with hot flashes. Other drugs like gabapentin (meant for chronic nerve pain) may also help when prescribed for the treatment of menopausal symptoms. 

Lifestyle Adjustments (Diet, Exercise, Sleep)

There are many lifestyle adjustments you can make to help with overall wellbeing, making symptoms easier to deal with. Improving your diet, getting enough exercise, and plenty of sleep can set you up with the healthy foundation needed to handle your symptoms. 

You can also make practical adjustments to your lifestyle to help manage symptoms – from dressing in layers, wearing breathable fabrics, and avoiding spicy foods to reducing your alcohol and caffeine intake. 

Often meant to help you get pregnant, fertility tea has a blend of vitamins and minerals that could also help with menopausal symptoms. A relaxing ritual like steeping a cup of tea can help alleviate stress while providing you with a mix of antioxidants, vitamins, and minerals meant to support your reproductive health. Mira’s own Fertility Tea is packed with ingredients to balance your hormones and support your reproductive system while being caffeine-free and 100% organic. 

Mental and Emotional Support Strategies

Menopause can have a significant impact on an individual’s life and finding mental and emotional support strategies to guide you through this transition can make all the difference. Cognitive Behavioral Therapy (CBT) can help you cope with a range of both physical and mental symptoms. 

Other mental and emotional support strategies include yoga, breathing practices, acupuncture, and even hypnosis. Working with your healthcare provider you can find the right option for managing your symptoms. 

Frequently Asked Questions