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 Stella’s clinical advisor Dr Lucy Wilkinson’s guide to the different stages of menopause: 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, oestrogen levels fall dramatically. This causes a number of symptoms including hot flushes, night sweats, mood swings and more. Your periods will also slow down and eventually stop altogether.
This does not usually 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 this time. It is normal to have easier and more difficult times throughout your menopause.
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 HRT help during premenopause?
HRT is not helpful in premenopause, because your body is still producing oestrogen and progesterone effectively. If any symptoms are troubling you at this point, see your doctor for advice and investigation.
Perimenopause
Perimenopause is the time leading up to your final period. Over the course of several years, your body gradually begins to produce less oestrogen and progesterone. During perimenopause most women experience menopausal symptoms and may choose to try HRT 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, trouble concentrating or poor sleep.
Unsurprisingly, these subtle changes can easily be missed or put down to other things. However, as you move through perimenopause, symptoms often become unmistakeable. The most common symptoms include:
- Hot flushes
- 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 which 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 doctor 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 or any signs of anaemia. There are a number of possible causes other than menopause and – you’ll be relieved to hear – treatments are available to help slow down your bleeding. You should also see your doctor if you have bleeding in between periods or after sex, any bloating, urinary or bowel changes, or any other new worries.
Learn more about the signs of perimenopause.
Will HRT help during perimenopause?
HRT is highly effective at treating menopausal symptoms, many of which appear during perimenopause. Many women successfully use HRT at this stage. If you would like to explore your treatment options, speak to your doctor or try Stella’s free online assessment.
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 pass 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 actually be quite complicated to work out when you have reached menopause. This includes those who do not have regular periods for medical reasons (e.g. if you have PCOS) or because of medication (including certain contraceptives).
If you are unsure, your doctor 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 doctor has diagnosed you as having been through menopause.
Even though you are now officially postmenopausal, you may find that the symptoms you experienced in perimenopause continue. For example, some women continue to have hot flushes several years after their final period. If this is the case for you, you can continue to use HRT as long as your doctor feels it is safe and appropriate.
This is also true for those with genitourinary syndrome of menopause (GSM), which includes vaginal dryness, discomfort, urinary symptoms and painful sex. Many with these symptoms need to use vaginal HRT (including vaginal tablets, gels or creams) on an ongoing basis. Due to the particularly low risk nature of vaginal HRT, this treatment is commonly used for decades after menopause if needed.
Will HRT help during postmenopause?
HRT can be helpful for menopause symptoms well into your postmenopausal years. While you may find that your symptoms settle after this point, you can also keep using HRT if needed.
However, HRT is not for everyone and the risks of taking it increase as we age. Speak to your own doctor if you would like to learn more about your own personal options.
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 (e.g. endometriosis) or as a preventive measure against ovarian cancer (if you carry the BRCA gene).
Because of the removal of your ovaries, you will experience a sudden and dramatic decrease in oestrogen levels. This often means that you experience more pronounced menopause symptoms. Speak to your doctor if your symptoms are troublesome. They may be able to recommend HRT or other, non-hormonal treatments.
In terms of stages of menopause, surgical menopause can mean that you transition quickly from pre- or peri-menopause 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 doctor to find out about the best options for you.
Harlow, S.D., Paramsothy, P.. Menstruation and the Menopausal Transition, Obstetrics and Gynecology Clinics of North America, 38(3) p595-607, https://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. https://doi.org/10.1001/archinte.168.8.840
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