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The 3 Stages of Menopause: What to Expect

Stages of Menopause

Women often talk about menopause as if it’s a single event. But menopause typically starts years before your period is gone, and it isn’t complete until you haven’t had a monthly period for 12 full months.

Menopause happens because your body produces less estrogen and other hormones, a process that takes place slowly over time. Most women experience menopause when they are in their late 40s or early 50s, the Cleveland Clinic says. According to the North American Menopause Society, the average age for menopause in the U.S. is 51 years of age. However, you can start your menopause journey as many as 10 years before you reach your destination, and you may have side trips along the way.

What are the stages of menopause?

Doctors generally divide menopause into three stages: perimenopause, menopause and postmenopause. Here’s a look at each stage and what you can expect to happen to you and your body as the years go by.


While premenopause is the time after your periods begin up until menopause starts, perimenopause is specifically the transition period before menopause occurs. Perimenopause is considered to be those years when your hormone levels begin to decrease and ends when you go through menopause and your ovaries no longer release eggs, the Cleveland Clinic says.

If you’re like most women, you will enter perimenopause in your 40s. But it can start as early as your 30s. During this time, the amount of estrogen your body produces starts to decline. The closer you are to menopause, the steeper the decline.

If you’re a smoker, you may experience menopause about two years earlier than your peers, according to the North American Menopause Society.

You will know when you’re in perimenopause because your periods are likely to become irregular. They may come more or less frequently than you’re used to. You may skip a month or two, and then have regular periods again. The flow may be lighter or heavier than usual. (Warning: Your ovaries can still produce eggs and you can get pregnant, so use birth control if you want to avoid that.)

Other common signs and symptoms, according to the Mayo Clinic, include:

  • Night sweats, hot flashes or chills
  • Vaginal dryness and sexual discomfort
  • Difficulty sleeping
  • Mood swings and irritability
  • Weight gain and slowing metabolism
  • Dry skin
  • Thinning hair
  • Breast tenderness

How bothersome are your symptoms of perimenopause? Your answer to this question will affect how you choose to treat them. Some options that might help ease your transition:

Medication. Talk to your doctor about hormone therapy, which is available as pills, skin patches, gels or creams, the Mayo Clinic says. Hormone therapy can relieve hot flashes and night sweats, and help prevent bone loss. Hormone therapy may increase some health risks, so talk to your doctor to discuss whether it’s right for you.

Vaginal lubricants. You can use over-the-counter lubricants to help with dryness and discomfort with intercourse.

Stay active. Regular exercise does wonders: It helps you maintain a healthy weight, improves your ability to sleep well at night and lifts your mood. Weight-bearing exercise also helps strengthen your bones and muscles, which can help prevent falls. As your estrogen level drops, your bones weaken, and when your bones weaken, you’re more prone to falls, notes the National Osteoporosis Foundation.

Adopt good sleep habits. In addition to exercise, you want to go to bed and wake up at the same time on as many days as you can, even weekends. Find what relaxes you and make time for that activity, whether it’s meditation or yoga or something else. Stress reducers are important when you’re transitioning to menopause, the Mayo Clinic notes.

Eat right. During this time in your life, eating right is important. Choose foods that are low in fat, high in fiber and calcium-rich. Plan meals that emphasize fresh fruits and vegetables and whole grains. Limit alcohol and caffeine, or skip them altogether, as they can trigger hot flashes and make it more difficult for you to fall asleep at night, the Mayo Clinic says.


It’s been a year since you had your last menstrual cycle. Congratulations: You’re officially in menopause, according to the Cleveland Clinic. At this point, your ovaries are no longer releasing eggs, and your childbearing years are behind you.

Once you are in menopause, you may experience many of the same symptoms you had in the years leading up to it. You may still get hot flashes and have trouble sleeping. You may have vaginal dryness and a lower libido. Keep doing what works for you to relieve these symptoms — getting quality sleep, exercising, reducing stress, eating healthy, etc. If you're taking hormone therapy, talk to your doctor about whether any adjustments are needed.


Postmenopause is everything after menopause — the rest of your life. You may notice that some of your symptoms of menopause start to subside or aren’t as frequent as when you were going through menopause, the Cleveland Clinic says. Eventually, they may stop.

However, because you have less estrogen, you may be at increased risk for some additional health concerns, including osteoporosis, a weakening of the bones, and heart disease, says the American Heart Association (AHA).

Some women lose a significant amount of bone density — up to 20 percent — five to seven years after they go through menopause, according to the National Osteoporosis Foundation.

To combat bone loss when you are postmenopausal, be sure to eat calcium-rich foods and get vitamin D, which helps your body absorb that calcium. Find time for weight-bearing exercises such as walking because they can help strengthen your bones and muscles, and will help improve balance and prevent falls.

Postmenopausal women are at higher risk for heart disease than younger women, according to the AHA. Women have an increased number of heart attacks about 10 years after they’re menopausal. A couple of reasons: Unhealthy habits you started when you were younger can catch up to you, like a high-fat diet or smoking. Also, estrogen is believed to help your artery walls stay clear and keep your blood vessels flexible so they can fluctuate as needed for optimum blood flow. When you’re postmenopausal, however, you have less estrogen.

Many of the same things you did when you were younger to maintain your health are equally important now, if not more so. Eat a heart-healthy diet, with an emphasis on fresh fruits and vegetables, whole grains, low-fat dairy, nuts and protein. Exercise at least 30 minutes on most days of the week, and more if you’re trying to lose weight, the AHA says.

Talk to your doctor about hormone replacement therapy, if you haven’t already. Every woman is different, and you and your doctor must decide what you can do to reduce your risks, given your age, personal and family healthy history and level of comfort with it, the Mayo Clinic says.

The bottom line

Some women find menopause is a breeze and have only a few bothersome symptoms as they go from perimenopause to menopause to postmenopause. Others can have mild symptoms, and some struggle with severe effects. Knowing what to expect can help, and so can talking to your doctor about how you’re feeling as you progress on your journey.

Remember, you are in charge of your health, and taking care of your body at every stage should be your top priority.

Article references

  1. Menopause, Perimenopause and Postmenopause, The Cleveland Clinic
  2. Menopause 101: A Primer for the Perimenopausal The North American Menopause Society
  3. Navigate with our menopause tour, The North American Menopause Society
  4. Menopause, The Mayo Clinic
  5. Perimenopause, Treatment, The Mayo Clinic
  6. What women need to know, National Osteoporosis Foundation
  7. Hormone therapy, is it right for you?Mayo Clinic
  8. Menopause and Heart Disease, American Heart Association
  9. Exercising with osteoporosis, stay active the safe way, The Mayo Clinic
  10. Osteoporosis: Bone health following menopause, Women’s Health Concern
  11. Menopause: weight gain: stop the middle age spread
  12. The menopause, Women’s Health Concern