Menopause is a normal part of aging. As normal as it may be, menopause can feel anything but. Changes to your body and mood may have you flashing back to memories of puberty: Is this normal? What comes next? Do I need to do something?
Your experience with menopause will be unique to you – from when it starts to the types of menopause symptoms you’ll feel as you age. But there are usually some signs to tell you where you‘re at in the process.
Knowing what stage of menopause you’re in can help you know what to expect and how to best manage your symptoms. It can also help you understand what’s normal, and when it’s a good idea to talk with a women’s health specialist.
We’re here to help. Read on to learn about the three stages of menopause, the symptoms you may experience at different ages, and when to seek care for menopause symptoms.
What are the three stages of menopause?
There are three stages of menopause: perimenopause, menopause and post-menopause. In everyday terms, those names can be translated to: when changes begin, when your menstrual cycle stops, and your new normal afterward. Here’s a closer look at what happens during each one.
Perimenopause: The beginning of menopause
Perimenopause – or pre-menopause – is a word that means “around menopause” and it’s when symptoms begin, leading up to menopause. This stage typically starts about 4-8 years before menopause. The age at which perimenopause begins varies – some women notice it in their 40s, but others can experience it as early as their mid-30s.
When you enter perimenopause, you’ll probably start to notice some early menopause symptoms, like changes to your period or mood shifts. These changes happen because your body’s estrogen and progesterone levels are starting to naturally decline. As your ovaries produce lower amounts of these hormones, your body adapts. It’s basically the reverse of what happened to your hormones as a teenager.
Menopause: The end of your menstrual cycle
Menopause refers to a specific point in time when your periods stop. You’re only in the menopause phase for one year, because when you’ve gone 12 consecutive months without a period, you enter post-menopause.
Reaching menopause means that you’re no longer able to bear children (become pregnant). Every woman – except for those who’ve had their ovaries removed before puberty – will go through menopause.
At what age does menopause start?
The average age for menopause is around 51. But some women experience menopause in their 40s – with a small percentage experiencing signs of menopause earlier. Some women may not reach menopause until their 60s.
There’s no way to know your exact menopause age until it happens, but genetics seems to play a strong role. You may get a general idea of when to expect menopause based on when your family members went through it, particularly your mother.
Genetics isn’t the only thing that can impact when menopause starts. Medical factors can also influence menopause timing. For example, if someone’s ovaries are removed, symptoms will begin to show immediately.
Certain medical conditions like autoimmune diseases have also been associated with early menopause. Women who’ve undergone treatments like radiation therapy or chemotherapy are also more likely to show symptoms earlier.
Post-menopause: After menopause
Post-menopause simply means “after menopause”, and you reach this point when it’s been 12 months since your last period. Post-menopause signals the end of your reproductive years, and you’ll be in this stage for the rest of your life. While your ovaries are still making low levels of the hormones estrogen and progesterone, you are no longer ovulating (releasing eggs), so you can’t become pregnant.
You’ll continue to experience menopause symptoms for about 2-7 years after your final menstrual cycle (it can be longer for some people), but after that time, symptoms often get milder or completely go away.
Women in post-menopause are at a higher risk for certain health conditions like heart disease and postmenopausal osteoporosis. You and your primary care doctor can work together on a plan to prevent or manage those conditions.
Menopause symptoms by age
Menopause symptoms evolve over time as your body slowly decreases the levels of reproductive hormones it’s making. Here’s a breakdown of menopause symptoms you may experience by age.
Menopause symptoms at age 40
For the majority of women, menopause symptoms don’t start this early. If menopause happens before age 40, it’s called premature menopause. If it happens between ages 40-45, it’s known as early menopause. Fewer than 10% of women experience premature or early menopause.
But if you’re in your early 40s and are regularly experiencing symptoms such as changes to your period’s timing or flow, hot flashes, mood changes or sleep problems, don’t ignore them. Talk with a women’s health specialist.
A specialist like an OB-GYN or certified nurse-midwife (CNM) can work with you to determine whether your symptoms are related to menopause, or another reason such as hormonal disorders or other health conditions.
Menopause symptoms at age 45
Around the age of 45, many women enter pre-menopause and start to notice the first signs that menopause is coming. For some women, the symptoms are mild and short-lasting. For others, menopause symptoms can be disruptive and long-lasting.
Some of the earliest signs of menopause may include:
Changes to your period
Period changes are usually the first signs of menopause. For example, your period may start to happen every 6-8 weeks. Or you may miss a couple months before it comes back again. You may also have a heavier flow or a lighter flow from time to time.
That said, it’s important to know you can still get pregnant during perimenopause. So, continue to use birth control in the lead up to menopause as you normally would. Also, if you’ve missed your period and you’re not sure whether perimenopause has started, consider taking a pregnancy test as a first step.
Mood changes
As your hormone levels change, you may find yourself feeling more irritable, anxious, sad or forgetful than usual. Your sex drive (libido) can also decrease or increase.
These changes are very typical as your body approaches menopause. So be kind to yourself, practice self-care and ask for help if you’re having trouble.
Sleeping problems (insomnia)
You may find it difficult to fall asleep, or you may wake up in the middle of the night. Sleep trouble can contribute to a persistent feeling of tiredness, which can also affect your mood.
The good news is that sleep issues like insomnia can be treated. Lifestyle changes such as cutting back on caffeine, limiting screen time before bed and exercise can be extremely helpful. There are over-the-counter medications and supplements like melatonin that can help – but ask your doctor for a recommendation before you start taking something. Sleep medicine is an option, too.
Menopause symptoms at age 50
Most women will have their last period around the age of 50. After 12 months without a period, menopause is complete and post-menopause begins.
As menopause gets closer, your estrogen and progesterone levels start to decline more rapidly. As a result, your symptoms will likely become more intense.
Your periods will probably become more irregular until they finally stop. You may experience greater mood swings and an increase in insomnia. And you’ll likely start experiencing new symptoms that are common right around, or right after, reaching menopause, including:
Hot flashes and chills
Hot flashes are sensations of heat that develop around your face, neck and chest, and may spread to other areas of your body. They usually last for just a few minutes.
Alongside the feeling of heat, your skin may redden, you may sweat, your heart rate might increase, and your mood may change. Afterward, you may feel chills.
Doctors aren’t sure why hot flashes happen, but there are ways to lessen their impact. Some tips include:
- Try to stay in cooler environments
- Dress lightly or wear layers you can remove
- Find effective ways to manage stress
- Monitor your diet (foods that are spicy, processed or fatty can trigger hot flashes)
- Reduce how much caffeine or alcohol you drink
Hot flashes can happen during pre-menopause, but they’re most often reported right around menopause and in the first few years of post-menopause.
Night sweats (hot flashes during the night)
When hot flashes occur at night, they’re called night sweats. Night sweats can prevent you from getting a good night’s sleep and make you more irritable the next day. Sleeping with fewer blankets, in lighter clothing and with a fan can be helpful to stay more comfortable.
Weight gain
Some people find that, even without changing their diet or lifestyle, they begin to gain weight during menopause. This is because the drop in estrogen levels also lowers your ability to maintain muscle mass, which can slow down your metabolism. This means that during and after menopause, you won’t need as many calories to maintain your current weight.
Menopause symptoms at age 55 and above
Around age 55, most women have entered their post-menopausal years. After menopause, your body adjusts to the lower amount of estrogen and progesterone, and many women feel more productive, alert and free – now that they don’t have to worry about birth control or managing a period.
Post-menopausal years do bring some new symptoms with them, however. Some things to expect include:
Dryer or thinner skin and hair
Estrogen plays a role in collagen production. Collagen makes up your skin, hair, bones and many other tissues around your body. Because your estrogen levels are lower after menopause, your skin or hair may become dryer or thinner.
Vaginal dryness or sensitivity
Lower estrogen levels can also cause vaginal tissue to become dryer and thinner. This may result in discomfort or pain during sex.
Vaginal dryness or sensitivity usually happens after menopause, but it isn’t unusual to notice it earlier. A moisturizer or lubricant can often relieve these symptoms and help you feel more comfortable.
Pelvic floor muscle problems
Did you know that estrogen also helps support the sides of your bladder? Less estrogen can lead to weaker pelvic floor muscles. That’s why urinary incontinence and frequent urination can be common after menopause. Your doctor can help you identify the best treatment options to improve your symptoms, including lifestyle changes, pelvic floor therapy or medication.
When should I see a doctor for menopause help?
The way you experience each stage of menopause will be unique. For example, maybe you don’t get hot flashes, but insomnia leaves you feeling tired and irritable. Or perhaps the first sign of change is vaginal dryness.
Menopause symptoms can often be managed by maintaining a healthy diet, exercising regularly and taking advantage of home remedies or over-the-counter medications.
But if your symptoms are intense enough to affect daily activities or keep you from doing the things you love, it may be time to seek advice and care for menopause symptoms.
OB-GYNs and certified nurse-midwives, along with experienced nurse practitioners and other women’s health experts, can listen to your concerns and symptoms, and work with you to create a personalized care plan. Care options might include lifestyle changes, hormone replacement therapy (HRT), and supplements or medications.
Some menopause symptoms might be harder to talk about than others – but don’t wait. Women’s health specialists have heard it all, and they have the expertise needed to help you manage menopause symptoms. The sooner they know what’s bothering you, the sooner they can help you find the right way to manage your symptoms.