Let us start with premenopause, the stage in women's reproductive lives that is oftentimes confused with the subsequent stage, called perimenopause.
When to Expect Premenopause?
Premenopause encompasses women's childbearing years, from the time they reach puberty until the onset of perimenopause in their 40s.1 While it varies among women, most spend about 30 years of their lives in premenopause.
What to Expect in Premenopause?
Except for occasional irregularities, most premenopausal women will have healthy menstrual cycles, with regular monthly periods and ovulation. They are also likely to experience normal period symptoms, such as mild cramps and breast tenderness.
More intense symptoms or prolonged period abnormalities may signal an underlying menstrual disorder, including premenstrual syndrome (PMS) or irregular periods, both of which should be promptly treated.
The next menopause stage is the turbulent perimenopause, which - adding to the confusion - is very commonly referred to as menopause.
When to Expect Perimenopause?
Perimenopause starts with the first hallmark menopause symptoms and ends when women reach menopause. This stage of the menopausal transition typically begins in women's mid-40s and can continue for a few months to over 10 years.2
What to Expect in Perimenopause?
During perimenopause, the ovaries start running out of eggs, leading to intense hormonal fluctuations. Those shifts of estrogen and progesterone cause symptoms, including irregular periods, hot flashes, loss of libido, mood swings, and more.
Because of the declining number of eggs in the ovarian reserve and a high percentage of chromosomal abnormalities within them, fertility at 40 is generally compromised. As a result, women can still get pregnant, but it may take longer and prove more challenging.
Menopause, the penultimate stage of the menopausal transition, is simply a date when women have not had their periods for 12 consecutive months.3
When to Expect Menopause?
The average age of menopause in the United States is 51, which means that women generally reach their final periods between the ages of 45 and 55.4
What to Expect in Menopause?
The most meaningful event of menopause is the confirmation of the end of women's reproductive abilities. After not having periods for a year, their ovaries are believed to have run out of eggs. As a result, they no longer ovulate and cannot conceive.
By now, many of the symptoms that plagued women throughout perimenopause have lessened or disappeared. Some, however, may continue for several years.
Once a woman is confirmed to have reached menopause, she enters the final of the menopause stages: postmenopause.
When to Expect Postmenopause?
Postmenopause starts the day after the confirmed menopause date and spans the rest of women's lives. Depending on the age at which women reached menopause, they may spend a third or half of their lifespan in postmenopause.
What to Expect in Postmenopause?
Since ovaries no longer contain eggs, their estrogen and progesterone production is halted. Although these hormones are still produced in small amounts in other parts of the body, their levels remain consistency low in postmenopause.
These persistent hormonal lows bring about a set of new health challenges, most important of which being osteoporosis and postmenopausal heart disease. It is also common for women to still experience some lingering symptoms, like painful sex, vaginal dryness, incontinence, and weight gain, for a few years into postmenopause.
For women, aging is not merely about dealing with newly spotted gray hair, achy joints, and slower metabolism. From the first period, through their childbearing years, and until the time following their last menstruation, women endure substantial hormonal changes. These natural, but oftentimes intense shifts, bring about an array of physical and emotional symptoms as well as new health challenges. As such, experts agree that it is essential for women to know how to recognize each of those menopause stages in order to ensure optimal well-being, catch potential abnormalities early on, and seek adequate treatment when necessary.
- American College of Obstetricians and Gynecologists. (2014). Female Age-Related Fertility Decline. Retrieved February 11, 2021 from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Female-Age-Related-Fertility-Decline
- Fertility and Sterility. (2014). Female age-related fertility decline. Retrieved February 11, 2021 from https://www.fertstert.org/article/S0015-0282(13)03464-X/pdf
- American College of Obstetricians and Gynecologists. (2015). The Menopause Years. Retrieved February 11, 2021 from https://www.acog.org/Patients/FAQs/The-Menopause-Years
- Minerva Ginecologica. (2009). Hormone changes associated with the menopausal transition. Retrieved February 11, 2021 from https://www.minervamedica.it/en/journals/minerva-ginecologica/article.php?cod=R09Y2009N06A0483
- North American Menopause Society. (n.d.). Menopause FAQs: Understanding the Symptoms. Retrieved February 11, 2021 from https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms
- Office on Women's Health. (2018). Menopause. Retrieved February 11, 2021 from https://www.womenshealth.gov/menopause/
- Penn Medicine. (2016). The Change Before the Change: 9 Questions About Perimenopause. Retrieved February 11, 2021 from https://www.pennmedicine.org/updates/blogs/womens-health/2016/december/the-change-before-the-change
- US Food & Drug Administration. (2018). Menopause. Retrieved February 11, 2021 from https://www.fda.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117978.htm
- Women's Health Research Institute. (n.d.). How Hormones Depletion Affects You. Retrieved February 11, 2021 from http://menopause.northwestern.edu/content/how-hormone-depletion-affects-you
- Mayo Clinic. (2019). Menstrual cycle: What's normal, what's not. Retrieved February 11, 2021 from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186
- Office on Women's Health. (2018). Your menstrual cycle and your health. Retrieved February 11, 2021 from https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle-and-your-health
- The North American Menopause Society. (n.d.). Are We There Yet? Navigate Now with Our Guided Menopause Tour. Retrieved February 11, 2021 from https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/are-we-there-yet-navigate-now-with-our-guided-menopause-tour
- University of Utah. (n.d.). Postmenopause. Retrieved February 11, 2021 from https://healthcare.utah.edu/womenshealth/gynecology/menopause/postmenopause.php
- Mayo Clinic. (n.d.). Perimenopause. Retrieved February 11, 2021 from https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
- Harvard Health Publishing. (2020). Perimenopause: Rocky road to menopause. Retrieved February 11, 2021 from https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause
- Cleveland Clinic. (2019). Menopause, Perimenopause and Postmenopause. Retrieved February 11, 2021 from https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause
- Mayo Clinic. (2020). Menopause. Retrieved February 11, 2021 from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
- Menopause. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Retrieved February 11, 2021 from http://www.menopause.org/docs/default-source/2014/nams-recomm-for-clinical-care.pdf