The 3 Stages of Menopause: What to Expect

Be prepared with this mini manual

by The North American Menopause Society
female woman stomach torso belly picture
Photograph: Sheryl Griffin

Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has not had her period for 12 consecutive months (unless there are other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. Occurring on average around age 51, it marks the end of a woman’s ability to bear children. Some women experience menopause at an earlier age for a variety of reasons.

Moving from the reproductive years through menopause and beyond, a woman experiences many physical changes caused by both menopause and aging. Some normal changes related to menopause include hot flashes, difficulty sleeping and vaginal dryness. Changes that can occur due to age include diabetes, thyroid disorders, sleep apnea (disordered breathing, high blood pressure, and an increased risk for heart disease and certain cancers). For women who also have an unhealthy lifestyle, high stress or unlucky genes, the changes due to menopause and aging can be particularly challenging.

Each woman experiences menopause differently. How she responds to the physical changes may be similar to or different from how her mother or sisters responded. A woman’s own expectations of this time of life are important, too. The menopause experience varies around the world and within ethnic groups, suggesting that both culture and genetics influence it. A woman may view the end of fertility as freedom from concerns about birth control, or she may regret the end of her childbearing ability. Some women will have troublesome symptoms, while others may have few or no symptoms at all.

Menopause is better understood and more openly discussed than ever before. Many women look back on menopause as a passage to a new part of life in which they feel confident, empowered, involved and energized. Menopause is an ideal time to begin or reinforce healthy changes in your life.

The Three Stages of Menopause
Let’s learn more about what you can expect in the transition through menopause. First, here are some essential terms.

Physical clues that you are approaching menopause may start years before your final menstrual period. This time is called “perimenopause” (meaning “around menopause”). It is the result of changing levels of ovarian hormones in your body. Estrogen levels decline, but they do so unevenly. Sometimes they can even be higher than when you were younger. Irregular menstrual periods, hot flashes, vaginal dryness, sleep disturbances and mood swings are common, normal signs of perimenopause. At this time, women may still be able to get pregnant, although it does not happen often. Birth control is recommended until one year after the last period if pregnancy is not desired.

Natural Menopause
Natural menopause is a spontaneous, permanent ending of menstruation that is not caused by any medical treatment. In North America, most women experience natural menopause between ages 40 and 58, averaging around age 51. Some women reach natural menopause as early as their 30s and a few as late as their 60s. Today, most North American women spend at least one-third of their lives after menopause. Women often experience menopause around the same age as their mothers and sisters. Smokers may reach menopause about two years earlier than nonsmokers. No clear connection has been found between age at menopause and race, age at first period or use of birth control pills or fertility medications.

Postmenopause is the time after menopause. Some menopause-related symptoms (such as vaginal dryness and hot flashes) may still occur because your body is only making a small amount of estrogen. In this time, your risk increases for diseases associated with low estrogen levels, including osteoporosis.

How Can I Confirm Menopause?
The most common symptoms women in their 40s notice are changes in periods and the onset of hot flashes. To date, there is no simple test to predict when menopause will occur but research continues.

During perimenopause, hormone tests are often not helpful because hormone levels change throughout a menstrual cycle. Sometimes testing is done to check specific hormone levels, especially with fertility problems or when periods stop at an early age. This can help women make decisions about beginning or adjusting medications. For some women, it may make sense to test for other causes of symptoms that can seem like perimenopause, such as thyroid disease.

Follicle-stimulating Hormone
Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause, especially in women who have had a hysterectomy and have no menstrual period to follow to let them know what is happening. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

However, a single FSH level can be misleading in perimenopause since estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. One elevated FSH level is not enough to confirm menopause. More importantly, a low FSH level in a woman who is having hot flashes and changing periods does not eliminate the likelihood of perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid.

Saliva Testing
Some clinicians recommend testing a woman’s saliva for estrogen or other hormone levels. Saliva hormone levels are not recommended in this setting and should not be used to evaluate or treat menopausal symptoms.

For more information on symptoms and solutions visit

Next: Join the Club: How to Confirm Your Menopause Status

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First Published Mon, 2012-04-02 11:12

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