Menopause Explained: Stages, Signs, and Symptoms

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Did you know that menopause is comprised of not one, but three different stages? These stages are called premenopause, perimenopause, and menopause. When talking about menopause, most people are actually referring to the second menopause stage, which occurs in your late 40s.

The fact is, each menopause stage causes different symptoms as well as body changes so to want to prepare yourself, get to know these stages. Let’s take a look at the three stages of menopause in detail:


Your transition to menopause starts at the pre-menopause stage. This occurs when hormone levels in the body become imbalanced. The combination of elevated levels of estrogen and decreased levels of progesterone disrupts regular ovulation or the monthly release of the egg cell. At this point, you still have your regular period and you won’t experience glaring symptoms of menopause but changes are starting to affect your menstrual cycle.

  • Irregular period
  • Heavier flow
  • Breast tenderness
  • Water retention
  • Weight gain
  • Poor concentration
  • Sleep deprivation
  • Reduced sex drive

The pre-menopause stage sets in during the mid-30s to early 40s. The difference between pre-menopause and perimenopause is that the latter occurs two to three years before the final menstrual cycles begin.


The perimenopause stage, which means “around the end of menstruation”, occurs when the level of hormones – including estrogen – starts to dip gradually, leading to missed periods. At this stage, you’ll  start experiencing irregular menstruation along with vaginal dryness, hot flashes, mood swings, and weight gain. Some of these symptoms subside gradually as you reach the second stage of menstruation, but vaginal dryness will continue beyond perimenopause.   Other symptoms include:

  • Lower libido
  • Mood changes
  • Night sweats
  • Racing heart
  • Headaches
  • Vaginal soreness
  • Painful sex
  • Insomnia

Usually, you’ll start feeling the symptoms of perimenopause when you hit 47 but there were cases wherein women in their 30s experience perimenopause symptoms. Do note, as long as you still have your period, it’s possible to get pregnant even if you’re well into the perimenopause stage. This stage lasts about 3 to 5 years before the menopause stage sets in.

Menopause Stage

This is the stage when your period stops completely. True menopause stage usually happens when you have missed your period for 12 consecutive months. Some of the most common symptoms of true menopause include:

  • Irregular periods
  • Hair thinning/Hair loss
  • Vaginal dryness
  • Hot flashes
  • Night sweats
  • Sleep problems
  • Mood changes
  • Slowed metabolism
  • Hair thinning
  • Dry skin

In the US, the average age of menopause is 51 years old. However, so many biological changes occur when you reach this stage that there’s no way to tell when true menopause occurs. Every case is different. It’s quite possible for women in their 40s and late 60s to experience menopause.

Because estrogen level drops significantly as you enter the post-menopause stage, you are susceptible to heart disease, osteoporosis, osteopenia, and stroke. That’s why taking care of your health should be your number 1 priority once you hit the post-menopause stage.

Some of the most common symptoms of post-menopause include:

  • Hot flashes
  • Night sweats
  • Elevated heart rate
  • Insomnia
  • Mood changes
  • Urinary problems
  • Vaginal dryness
  • Painful intercourse

The average post-menopause stage is 55 years old but again, there are cases wherein post-menopause sets in at an earlier or later age.

Most women believe that menopause starts when menstrual period stops but this isn’t the case at all. Menopause is a process that takes years to complete so it occurs before your period stops. The body goes through different changes as it hits post-menopause that we don’t connect some of these symptoms to menopause at all.

During the perimenopause stage, the levels of the two major female hormones – estrogen and progesterone – start spiking and dipping during this time, causing all sorts of body changes and symptoms. Between these changes, you’ll go through different emotions too. Some symptoms taper off; others will stay with you for years to come.

At the start of the perimenopause stage, you’ll experience intermittent occurrences of mood swings, hot flashes, and sleep disturbances. You can get pregnant despite the missed period but your chances of conceiving a child are significantly lower as you reach this stage.

By the time you reach the menopause stage, your ovaries are no longer producing egg cells so you won’t be able to conceive. At this point, menstrual period stops completely. As the estrogen and progesterone levels fall, your vagina tissues start thinning out too, causing vaginal dryness, itching, painful intercourse, and lower sex drive.

At this point, you’re prone to urinary incontinence too. If you’re unsure if you reached the menopausal stage, have yourself checked by a specialist. Your doctor will check your blood for follicle stimulating hormone or FSH, which spikes when the ovaries are starting to shut down.

Once you reach the post-menopause stage, the level of female hormones are depleted hence, symptoms of vaginal dryness and hot flashes may still linger. Because you’re more likely to develop bone or heart disease during the post-menopause stage, sticking to a healthy lifestyle is critical to your health and well-being.

Symptom Management

Do you wake up at the dead of the night drenched in sweat and unable to sleep? Do you experience a sudden feeling of feverish heat at random times of the day or night? If the answer is yes then you may be feeling the first few signs of menopause.

Some women don’t find the symptoms uncomfortable and these symptoms usually go away on their own. But if say, you’re having problems dealing with menopause symptoms, here are ways to help you cope:

Hot Flashes

A hot flash is one of the most common symptoms of menopause. It occurs when a surge of adrenaline rouses the brain from sleep, causing blood vessels near the skin surface starts to dilate. As the blood vessels dilate, there’s a sudden feeling of heat coupled by a red, flushed face and sweating. It’s worth noting that not all pre-menopausal or menopausal women experience hot flashes but if you’re one of the unlucky ones then it’s time to start learning what triggers a hot flash. Caffeinated drinks, stress, and spicy foods are possible hot flash triggers, so reduce your intake or avoid these foods/drinks completely.

If attacks happen frequently, try dressing in layers so when you experience a hot flash, you can simply peel off your clothes layer by layer. As soon as the attack starts, take slow, deep breaths while fanning yourself to cool off. If you’re overweight, losing weight could reduce hot flashes.

Vaginal Dryness

As estrogen production winds down, the clear fluid that lubricates the vaginal walls, start to decrease. The thick, elastic tissues of the vaginal walls start to get thinner and less elastic too, causing a condition called vaginal atrophy. All these changes lead to vaginal dryness, an extremely uncomfortable menopause symptom that affects your sex life. Vaginal dryness causes a burning, itching sensation in the nether region as well as painful intercourse.

If you’re suffering from vaginal dryness, use a water-based lubricant and vaginal moisturizer to relieve the symptoms.  Avoid bubble baths and scented soaps because these beauty products will aggravate dryness. Prolonging foreplay is also effective in terms of preventing painful intercourse. Taking supplements could also ease vaginal dryness and its related symptoms.


The combination of body changes, emotional distress, and imbalanced hormones causes a variety of menopause symptoms and some of them can disrupt sleep. Estrogen is considered as a sleep hormone and when your estrogen level is low, you’ll end up tossing and turning in bed. Worse, sleep deprivation aggravates perimenopause symptoms, leaving you irritable, anxious, and tired the next day.

Apart from having yourself checked by a specialist, you can overcome menopause-induced insomnia by making a few lifestyle changes. Start by working out regularly. You don’t have to stick to a grueling regimen to keep fit. Performing light exercises for 30 minutes every day should be enough to achieve a healthy body. Never work out too close to bedtime if you have trouble sleeping!

Avoid taking long naps in the afternoons and drink something warm, soothing, and caffeine free before bedtime. Avoid caffeinated drinks during the afternoons and never drink alcohol close to bedtime. Finally, keep your room dark, cool, and quiet at night to lull yourself to sleep. If hot flashes are causing sleepless nights, find your trigger.

Mood Swings

Some days you’re all happy and sunshiny and the next, you’re depressed and you’re telling people off. About 20% of women experience depression while going through menopause. Studies show that about 50% of women going through menopause experience emotional distress (depression, anxiety, irritability, aggression, melancholy, sadness, etc.) or mood swings due to the fluctuations of estrogen and serotonin in the body. These hormones regulate mood and emotions and the changes will affect your temperament.

Of course, hormonal imbalance is just one of the many reasons why menopausal women experience these changes. Stress is a significant factor that causes moderate to severe mood swings.

To manage stress and feel your best, stay physically active by working out at least 30 minutes every day. If you can, try to reduce your chores and free up your schedule for a soothing massage, breathing exercises, meditation, or other relaxing activities.

Avoid greasy, unhealthy foods and eat fresh, organic whole foods o you’ll always have a steady supply of vitamins to improve mood. Finally, try to get as much sleep as you can at night so you wake up well-rested and cheerful in the morning.

Weight Gain

As you go through menopause, the body’s metabolic rate slows down and this causes steady weight gain. Gradually, your thighs and belly are less slim, you feel bloated all the time and maintaining your normal weight becomes a Herculean effort as you age. All these are normal changes caused by hormonal imbalance, genetics, unhealthy food choices, sleep deprivation, and lack of exercise.

Being selective in terms of the food you eat on the daily will do wonders for the waistline. Prepare your own meals using fresh, whole ingredients. Avoid greasy snacks and refined carbs to maintain your weight. Switch to zero to low-calorie food items whenever possible. Limit your alcohol intake and pare down your consumption of overly sweet beverages.

Working out regularly allows you to burn off excess calories from the food you eat. Walking for at least 30 minutes every day is a fantastic way to keep fit. Aerobics, yoga, Pilates, and Zumba are just a few of the fun yet light exercises you can do to maintain a leaner frame.


Your menopause journey includes going through a roller coaster of emotions and body changes and that’s okay. As long as you’re taking care of yourself and you’re getting all the love and support from your family, you can overcome the physical, mental, and emotional changes that menopause brings, stage after stage.

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Tina Lee-Almazar | Tinaciouslee

Tina Lee-Almazar is a writer and editor based in the Philippines. She holds a Bachelor’s degree in Broadcasting from Centro Escolar University in Manila. She started out as a production associate at ABS-CBN Broadcasting Network in 2004 before transitioning to creative writing in 2006. Her years of experience as a writer resulted in having considerable knowledge in a variety of writing fields. When she’s not surrounding herself with pretty things or discussing herself in the third person, Tina watches funny cat videos all day.

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