Stages of Menopause Explained Clearly

Menopause is a life stage that every woman goes through, and it's commonly associated with the changes to our body, our periods, and fertility.

It's a given part of a woman’s life, but did you know that it’s actually made up of different stages? These are perimenopause, which occurs several years ahead of menopause, and menopause itself followed by post-menopause. 

In this guide, we’ll look deeper into these stages and the signs, symptoms, and changes to look out for, for each of these stages.

Menopause is a natural stage in every woman's life.¹ It marks the transition from the reproductive years to the years beyond fertility.¹

This change happens because the number of ovarian follicles declines, causing shifts in hormone levels and changes in your menstrual cycle.¹

There are three core menopause stages in your journey:²

• Perimenopause
• Menopause
• Post-menopause
• Each stage brings different symptoms as you move from regular or irregular periods to none.²
• Understanding these stages can help you manage symptoms and feel more in control, supporting your health and emotional well-being.

Perimenopause

What is Perimenopause?

Perimenopause is often confused with pre-menopause, which refers to the time of your life when you are fertile and having periods – whether regular or irregular.   

Perimenopause means “around menopause” and refers to the time when your ovaries gradually begin to make less estrogen.

At What Age Does Perimenopause Usually Start?

Perimenopause usually begins several years before menopause, and people start to experience it at different ages.

You may notice signs and symptoms of perimenopause sometime in your 40s, but they can start in your 30s or even earlier.

Common Symptoms and Signs You’re Entering Perimenopause

Here are some of the changes you might experience:

• Irregular periods 
• Worse premenstrual syndrome 
• Weight gain
• Hot flushes
• Mood changes 
• Breast tenderness 
• Tiredness
• Trouble sleeping
• Headaches 
• Lower sex drive 
• Urinary tract infections (UTIs) 
• Fertility issues  
• Vaginal dryness and/or discomfort during sex
• Urine leakage when coughing or sneezing
• Urinary urgency   

How Long Can Perimenopause Last?

Perimenopause lasts between four and 10 years, with the average being about four years.^3,4 The length and timing of perimenopause can vary from woman to woman.⁴

There are some factors that could influence the length of perimenopause:⁴

• Genetics
• Smoking
• Certain medical treatments (such as hysterectomy or oophorectomy – also known the removal of ovaries)
• A history of cancer

Underlying Causes of Perimenopause

Perimenopause often begins with changes in your menstrual cycle; periods may become more irregular than what you’re used to.³ Over time, other perimenopausal symptoms can appear, including the following:³

• Physical changes such as hot flushes
• Mental shifts like brain fog or trouble focusing
• Mood changes

These changes happen because your ovaries slowly produce fewer follicles.³ It leads to a drop in hormone levels, especially estrogen and progesterone.³

Menopause

What is Menopause?

Menopause is when your body stops producing as much estrogen and no longer releases an egg each month. This means that you stop having periods.

You won’t know that you’ve officially gone through menopause until you’ve gone a whole year without having a period.   

At What Age Does Menopause Usually Start?

The menopause age range is between 45 and 55, although the average is around 51 years.^2,6 Remember, menopause does not occur until you miss your period for 12 months straight.⁶

Common Signs You’re Entering Menopause

While you stop having periods, you can expect to experience many of the same symptoms as during the perimenopause stage. Some of the most common signs and symptoms of menopause include:

• Hot flushes 
• Night sweats 
• Difficulty sleeping
• Lower sex drive
• Menopausal incontinence
• Problems with memory and concentration
• Vaginal dryness and/or discomfort during sex
• Headaches
• Mood changes
• Heart palpitations 
• Joint stiffness
• Reduced muscle mass
• Recurring urinary tract infections
• Frequent urination 
• Changes in body odor
• Weight gain during menopause  

Whilst many of these may be best dealt with by lifestyle changes or speaking to your doctor or a medical professional, we can certainly help when it comes to frequent urination, which is a symptom of urinary incontinence.

Gaining weight while menopausal? Read 5 Ways to Lose Menopause Belly Fat.

Having trouble deciding what product to use for incontinence? Shop TENA: Women's Incontinence Products or Womens Incontinence Pads

How Long Can Menopause Last?

Menopause is a checkpoint in your journey, but it doesn’t end there.² It is a one-year trip that marks the transition from perimenopause to post-menopause.² During this time, you may experience symptoms both before and after menopause.⁶

These symptoms could affect your quality of life and daily activities.⁶ But, don't worry; it's all part of your menopausal years and with proper management, you can feel better and more in control.⁶

Symptoms and Underlying Causes of Menopause

During menopause, your ovaries produce less estrogen.⁷ This steady decline causes side effects by affecting multiple systems of your body. Some systems menopause affects include:⁷

• Urogenital: Lower estrogen levels could cause dryness or changes in the vulva and vagina.
• Cardiovascular: Hormonal shifts may affect cholesterol levels and how your blood vessels function.
• Bones: Less estrogen could increase the rate of bone loss, raising the risk of weaker bones over time.

Post-Menopause

What Can Happen Post-Menopause?

Post-menopause begins when it’s been a full year since your last period. By this stage, most symptoms of menopause will hopefully have eased, and you may notice an increase in energy.   

As a result of certain factors, including a lower level of estrogen, there is a chance you may experience an increased risk for certain health conditions, including osteoporosis, heart disease, and changes in the vagina and bladder. Keeping healthy and active positively impact the chances of some of these conditions occurring, but every woman is different, so speak to your doctor to learn what you can do to keep on top of things.   

If you have any concerns during any stages of menopause, visit your doctor for advice. They may be able to offer you hormone replacement therapy (HRT) medication, other medicines, or tips on how to alter your lifestyle to form new habits that will help as you go through menopause. For more information, check out our menopause support page or essential self-care tips for managing menopause.

At What Age Does Post-Menopause Usually Start?

Post-menopause, on average, begins at 52 years.⁸ Despite this, it could start at any age, after your period stops.⁸

Common Signs You’re Entering Post-Menopause

Some symptoms may ease as time passes, while others can continue into post-menopause.⁷

Symptoms that often improve over time ⁷:

• Hot flushes: These usually last 1–6 years but can sometimes continue for longer.
• Migraines
• Brain fog or memory issues

Symptoms that may persist or appear later: ^7,8

• Vaginal dryness
• Urinary issues
• Increased risk of osteoporosis

How Long Can Post-Menopause Last?

Post-menopause is a lifelong journey, though many symptoms may ease within 2 to 7 years.² During this time, watching your health and making lifestyle changes that support your well-being is important.⁷ If you're dealing with symptoms that disrupt your daily life, like painful sex, don't hesitate to call your doctor.²

Symptoms of Post-Menopause

Lower estrogen levels after menopause can increase your risk for certain health conditions, such as: ^8,9

• Osteoporosis, which can lead to weaker bones and a higher risk of fractures 
• Heart disease, including atherosclerosis (hardening of the arteries) 
• Vaginal dryness or discomfort 

Making healthy lifestyle changes like the following could help reduce these risks: ^2,7

• Quitting smoking
• Getting at least 150 minutes of moderate intensity exercise per week
• Eating a balanced, heart-healthy diet
• Maintaining a healthy weight
• Using vaginal moisturizers or lubricants to ease dryness

If you notice symptoms that disrupt your daily life, including pain during sex or ongoing discomfort, it’s a good idea to speak to a doctor.²

Premature Menopause

While early menopause happens within 40-45 years old,¹⁰ premature menopause occurs when you experience menopause before you’re 40.¹¹

Certain factors, such as the following, could cause premature menopause:¹¹

• Chromosomal abnormalities such as Turner syndrome
• Autoimmune disorders such as Addison's disorder
• Surgical procedures that remove the ovaries
• Smoking
• Genetic causes
• Enzyme deficiencies
• Infections such as mumps
• Metabolic syndrome

Premature menopause could affect your physical and emotional well-being as it could lead to:¹¹

• Infertility
• Osteoporosis
• Ischemic heart disease
• Angina

Not to worry, there are available treatments to support you; they include:¹¹

• Ovulation induction
• In vitro fertilization (IVF) if you’re looking to get pregnant
• Hormone replacement therapy, like estrogen replacement

No matter what stage you’re in, your experience is yours, and that’s okay. Knowing what’s going on, what to expect, and how to handle it can help you feel more calm, confident, and in control.

How Does Your Period Change Before Menopause?

During perimenopause, your periods may start to change. This is normal, and changes may include:12

• Heavier or lighter flow
• Shorter or longer cycles
• Missed periods
• Spotting between cycles

Every woman’s experience is different, but it’s a good idea to speak with a doctor if you notice any of the following:¹²

• Bleeding after sex or between periods
• Blood clots during your period
• Very heavy bleeding that disrupts daily life
• Periods that start coming unusually close together