MENOPAUSE. It seems like a simple word, but there’s actually a lot of confusion around it. As a teenager, you probably didn’t even hear anyone mention menopause. In your twenties, your mom or aunties may have whispered (or cursed) about it.  

But now menopause is relevant in your life. And no matter your age, you may have questions such as:

• What IS menopause? A time period? A set of symptoms? A phase of life?  

• When does menopause begin and end?  

• Do all women experience menopause in the same way?

• Is menopause the same thing as perimenopause or postmenopause?  

• What is premenopause?

So many questions. And we have some answers.

A peek at “pre” terminology

There’s a reason that teenage girls and twenty-something women don’t often think about menopause. They’re busy experiencing their reproductive years, which are sometimes called “premenopause.” In this phase of life, women have menstrual periods. While periods may be regular or irregular, there are no menopausal symptoms in premenopause.  

Sometimes people use the terms “premenopause” and “perimenopause” as if they’re the same thing. They’re not. “Pre” means “before” menopause. But, premenopause isn’t really a label that’s used in official medical terminology.  

Another “pre” term you may hear is “premature menopause.” When a woman experiences menopause at age 40 or younger, it’s called premature menopause.

The three stages of menopause explained

We typically think of the menopause transition as having three stages: perimenopause, menopause, and postmenopause.  

Most women go through all the stages, but it’s a unique experience for each person. While the “change of life” is a natural transition, that doesn’t mean it’s easy or pleasant. Some fortunate women breeze through with few noticeable symptoms. Others suffer with myriad uncomfortable, and even life-changing, symptoms. Either way, hormone levels fluctuate, causing changes in many systems of the body.

Stage 1: Perimenopause

Perimenopause is also known as the menopausal transition. It’s the time leading up to menopause, and can last as few as two years, more than 10 years, or anywhere in between. For many women, it begins in the mid-to-late 40s, around age 47 on average, but symptoms may begin as early as your late 30s.

During perimenopause, sex hormones slowly dwindle, and the gradual depletion of eggs in the ovaries is getting closer to the end.

If perimenopause could be described in one word, it would be “disruptive.” Most women experience symptoms that affect their day-to-day lives.

Here are a few common symptoms of perimenopause:

• Irregular periods may become the norm in early perimenopause as the body produces less and less estrogen. Periods may be heavier or lighter, and they may be shorter or longer than they used to be. As you progress through perimenopause, you may skip a month or two at a time, and then periods may become sporadic. It’s actually nice to not have a period every month, but when it does show up, it’s like, “Surprise!” Ugh.

• Mood changes, like irritability, impatience, and dramatic mood swings, may show up as hormones wane. This may be related to lower levels of progesterone, which is a calming hormone. Levels of mood-stabilizing serotonin can also drop when estrogen decreases. I feel on edge all the time and can’t seem to deal with even small challenges. What is going on?

• Hot flashes, which affect up to 80% of perimenopausal women, can be mild to severe. They can influence everything from clothing choices to social activities. Hot flashes can be terribly problematic for about one in three women. Will I be soaked with sweat and my face flushed red in a meeting today?

• Vaginal dryness and thinner vaginal tissues can make sex painful. Throw in a lower libido, and the relationship with your partner can suffer. I want to feel physically close again, but I can’t muster up the desire—plus it just hurts too much.

• Sleep issues like insomnia can affect your rest and contribute to daytime fatigue. You may have trouble falling asleep when you go to bed, or you may wake up during the night and be unable to get back to sleep. Or you may awaken with soaked bedsheets from night sweats. I used to sleep so well! But how can I get enough restful sleep when I have to change my wet pajamas in the middle of the night?

These are just a sampling of the most common symptoms, and not all women experience all symptoms. But there are many others, even some weird symptoms. As women transition into late perimenopause, their symptoms may worsen.  

However, for some women, the brunt of symptoms caused by hormone fluctuations may not get into full swing until after they hit the next stage: menopause.

Stage 2: Menopause

You have reached menopause when it’s been 12 consecutive months since your last menstrual period. While we often talk about menopause like it’s a long period of time, it really isn’t. It is essentially a moment in time. If you happen to be at the doctor around that time, you’ll be “diagnosed” with menopause. If not, try to remember the anniversary of your last period, as your gynecologist will want to record your age at menopause.  

The average age of menopause is 52, but it can occur anytime in your 40s and 50s. You might go through menopause around the same time your mother did.

Menopause typically happens naturally. But some women experience “surgical menopause” when they’ve had both ovaries removed to treat cancer or another medical condition. Removal of the ovaries produces an abrupt drop in hormones that can lead to a quick onset of menopause-related symptoms.

Stage 3: Postmenopause

After the 12-month anniversary of your last period (menopause), the postmenopause stage begins—and you’ll be in this phase for the rest of your life.  

In postmenopause, certain symptoms may continue, such as hot flashes, vaginal dryness, and sleep irregularity. For most women, hot flashes eventually stop.  

Estrogen and progesterone levels are now permanently lower, which raises your risk for developing a variety of health problems, including osteoporosis, heart disease, and stroke. Lack of estrogen in postmenopause may also contribute to eye diseases, muscle loss, slower wound healing, vaginal prolapse, and varicose veins.

Can balancing your hormones help?

The list of perimenopausal symptoms can be overwhelming, and the postmenopausal health risks can be downright scary.  

But Belmar Pharma Solutions medical director, Dr. Angela DeRosa, says using hormone replacement therapy can diminish both the symptoms and the risk for menopause-related medical problems. There are hormonal options, such as compounded bioidentical hormone replacement therapy (BHRT), which may be appropriate and helpful throughout the menopausal stages.  

Be aware that BHRT will look different depending on whether you’re in perimenopause versus postmenopause because the body needs different levels of support during each stage. An experienced provider with hormone expertise can prescribe the right dose and form of hormones for your individual needs. There are several types of qualified providers, so look for someone near you.