Perimenopause & Menopause

The Stages of Menopause

Written by Dr. Staci Tanouye, OB/GYN, MD
8 Feb, 2023
2 min. Read
The Stages of Menopause

The Stages of Menopause

Menopause is a natural part of a woman aging and is caused by changes in the body. Learning about the different stages, signs and symptoms of menopause can help you prepare and better understand your body.

Three Main Stages of Menopause:

  • Perimenopause:

    This is the first phase of menopause, also referred to as the menopause transition, beginning anywhere from seven to ten years before menopause. Most often it begins when a woman is in her 40’s, which is when the ovaries slowly become less responsive to the hormonal signals from the brain that usually tell the ovaries to produce estrogen. This can cause more erratic estrogen production by the ovaries that generally declines over time. Menstrual cycles may still occur during Postmenopause and pregnancy is still possible. Signs perimenopause is ending include increasing symptoms of menopause, such as hot flashes and consecutive months without your menstrual period.

  • Menopause:

    Menopause is a single point in time that is marked by the final menstrual period. At menopause, your ovaries stop releasing eggs and estrogen levels drop, ending your menstrual period. Once you reach menopause, you are no longer able to get pregnant because the body is no longer able to ovulate. You may be surprised to learn that menopause can only be diagnosed in retrospect. That is because the final menstrual period is only confirmed once you have gone 12 full months without a period. Once 12 months passes, you can say you reached menopause 12 months ago with that final menstrual period.

  • Postmenopause:

    This is the final phase of menopause and lasts through the remainder of your life. Postmenopause starts after the final menstrual period but is only officially known after you’ve experienced 12 consecutive months without a period. It is also common to say “in menopause” when referring to people who are postmenopausal. Menopausal symptoms tend to last approximately two to seven years, but eventually decrease as you continue through postmenopause.

When discussing menopause with my patients, I’m often asked two main questions.

  1. When does menopause start? The average age of menopause or the final menstrual period is age 51, but it is normal to experience menopause anywhere between the ages of 40 and 58. If menopause begins before the age of 40, the experience is known as premature menopause.

  2. How long does menopause last? The menopausal transition can last on average seven years but up to 14 years, depending on lifestyle factors such as age, smoking, race and ethnicity.

Menopause Symptoms:

Throughout these different stages of menopause, hormonal and physical changes can result in weight gain, hair loss, headaches, joint and muscle aches, memory lapses and a racing heart. One of the most common and widely talked about symptoms of menopause is hot flashes. Caffeine, alcohol, smoking, hot weather, stress and spicy foods are known to trigger or worsen hot flashes.

  • Perimenopause:

    Women might begin to experience changes in their normal menstrual cycle including irregular periods, heavier or lighter periods, as well as worsening PMS symptoms. Breast tenderness is another common symptom. Signs perimenopause is ending can be more time between periods, increased hot flashes, hair changes, weight gain and vaginal dryness.

  • Menopause:

    The most important symptom that defines menopause is the end of menstrual periods. The most common symptoms around this time include vaginal dryness, hot flashes, night sweats, difficulty sleeping, urinary urgency, bladder leaks, emotional shifts and changes in libido.

  • Postmenopause:

    During the final phase of menopause, hormone levels remain low as your ovaries are making very little estrogen and progesterone. Menopausal symptoms can begin to decline over time, however, many symptoms can linger for years after the final menstrual period. It’s important to seek medical advice if menopausal symptoms persist and negatively impact your daily life.

Managing new or unexpected symptoms while going through menopause can be tricky as your body gets used to these new changes. I always recommend Poise® Ultra Thin Pads with Wings for any unexpected bladder leaks to my patients because they offer up to 100% clean, dry, fresh protection.

Menopause Treatment Options:

If you experience discomfort caused by menopause, talk to your doctor about treatment options tailored to your health needs.

  • Hormone replacement therapy (HRT).

    HRT is one of the most common ways to treat hot flashes and restore hormone levels during menopause. Estrogen plays a large role in HRT therapy and progestin therapy. Progestin is a synthetic, lab created hormone that mimics progesterone in the body. Progestin is added to estrogen in HRT to reduce the risk of uterine cancer in women who still have their uterus.

  • Low-dose antidepressants.

    Certain antidepressants related to SSRIs (selective serotonin reuptake inhibitors) can decrease hot flashes. This can be a good option for women who can't take estrogen.

  • Vaginal estrogen.

    Creams, tablets or rings with estrogen can be applied directly to the vagina and can relieve vaginal dryness, urinary symptoms, UTIs, and discomfort during intercourse.

  • Gabapentin.

    This medication is typically used to treat seizures but has also been shown to reduce hot flashes.

  • Clonidine.

    This medication comes in a pill or patch form and is normally used to treat high blood pressure but can also help with hot flashes. It is not used as often due to increased side effects.

  • Nutrition and Exercise.

    Both important while going through menopause and entering life postmenopause. Supplements such as Vitamin D can help strengthen bones and regular exercise can benefit your heart and bones as well as boost overall mood.

Menopause is a period of great change and looks different for everyone. The length of symptoms as well as physical changes can vary. It’s important to take note of what stage of menopause you are in and seek advice from your doctor as you go through each stage.

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Author Summary: Dr. Staci Tanouye, MD, board-certified OB-GYN is a physician in a private practice and an expert in adolescent health, sexual health, reproductive health, and menopausal health. She has become one of the leading gynecologists on social media with the mission to educate women and all people with vulvas to love their bodies through knowledge and empowerment.


Kimberly-Clark makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.