The Menopause Stages

The menopause stages can be confusing. Premenopause. Perimenopause. Menopause. Postmenopause. What do all these words mean and why is it important to use them properly when describing where you are in the continuum of menopause?

Here are some reasons why it is important to know where you are in this journey:

• to know what to expect
• to get the most effective and safe symptom management since, for example, hormone therapy will differ if you take it in perimenopause versus in postmenopause.

Premenopause/Reproductive Years

Between puberty—when ovulation (and accompanying production of estrogen and progesterone), periods, and fertility start—and perimenopause are the reproductive years, whether or not a woman gets pregnant.

Perimenopause/Menopause transition

Female sexual hormones—estrogen (the predominant female hormone) and progesterone—start fluctuating in perimenopause, indicating the start of changes in ovarian function. Women who previously had regular menstrual periods may start noticing changes, such as shorter intervals between periods, lighter or heavier bleeding, shorter or longer bleeds, spotting between periods, and in some months even no bleeding at all. This is usually the first change women notice in perimenopause, but many women also report hot flashes, fatigue, aches and pains, difficulty sleeping, headaches, dry itchy skin, mood swings, anxiety, depressive feelings, low sexual desire, hair loss, weight changes, body shape changes, palpitations, irritability, foggy brain, bladder problems, dizziness, and others. Perimenopause can start in a woman’s late 30s or early 40s and last 2-6 years.
Perimenopause is a journey. The unpredictability of not knowing when the next period is going to come, when or if ovulation is going to occur, and experiencing spotting can be upsetting and frustrating for many women.
Women who are sexually active and don’t wish to get pregnant must use birth control until at least 12 months after the last period because ovulation is unpredictable in perimenopause but may still occur. Perimenopause can start in a woman’s late 30s or early 40s and last 3-6 years.

Menopause

Menopause is the end of ovarian function, the end of ovulation and fertility, and consequently periods stop as well.
How do you know when you are in menopause? Menopause is confirmed when you haven’t had a period for 12 consecutive months. The next day you are in postmenopause! Congratulations! Celebrate this milestone!
All women go through menopause if they live long enough, and for most women it is a normal and natural event.
Menopause usually happens between 45 and 55 years of age, and the average age of menopause in North America is 51. Some women may experience early menopause, before 40 years old.

Induced menopause/surgical menopause

Induced menopause occurs when a woman undergoes removal of both ovaries and/or chemotherapy and radiation treatments (which damage the ovaries) for certain types of cancer. Women who experience induced menopause at a younger age experience more severe symptoms due to the very sudden drop in estrogen levels and are at higher risk for diseases related to low estrogen levels, like osteoporosis, dementia, and heart disease.

Postmenopause

These are the years after menopause is confirmed and postmenopause lasts for the rest of the woman’s life. Many women will live past their 80s and will spend one-third of their lives in postmenopause. It’s important to understand the protective effect of estrogen against diseases like stroke and heart attack, osteoporosis, and diabetes to help you make healthy lifestyle choices to ensure healthy aging and prevent disease.