Ch-Ch-Ch-Changes! What to Expect During Perimenopause and Menopause

Menopause

If you’ve ever seen a movie reference or television commercial about menopause, you may think of it as a years-long journey marking the end of fertility. In reality, menopause is a point in time that’s preceded by a lengthy transitional state known as perimenopause.

“Perimenopause is when things start going haywire but you’re still having periods,” says Kate White, MD, MPH, assistant professor of obstetrics and gynecology at Boston University. They’re irregular and not what you’re used to; it harkens a change is coming.”

Both menopause and perimenopause are natural stages of the reproductive cycle, but that doesn’t mean they’re fun. “When I talk to my patients about menopause, I often say that between the irregular periods, cramps, and skin problems, it can feel like being a teenager again,” says White.

The good news? Knowing what to expect as you move into these life stages can make you better prepared to manage the changes that occur.

What is Menopause?

Menopause is a natural biological process that marks the end of your menstrual cycles. It occurs when the ovaries naturally stop producing estrogen and progesterone, hormones that are central to menstruation.

Because estrogen and progesterone are no longer produced and ovulation stops, menopause is considered the permanent end of menstruation and your body’s ability to become pregnant. Estrogen also plays an important role in protecting your bones and keeping your cholesterol levels in check, so menopause also marks a point at which women are at higher risk for issues like bone loss and heart disease.

Different women may experience menopause at different ages, but it typically occurs when a woman is in her 40s or 50s, and the average age in the United States is 51. You’ve only officially reached menopause when you’ve gone 12 months in a row without getting a period—the transition leading up to this point is referred to as perimenopause, and the period of time after is called postmenopause. But the whole three-part process can be referred to simply as “menopause.”

“Most people use the term ‘menopause’ to refer to when they’ve been diagnosed,” says White. “Some people will say ‘postmenopause’ means that change is over. It’s kind of like the lack of difference between ‘flammable’ and ‘inflammable’; ‘menopause’ and ‘postmenopause’ are sort of the same thing.

The Three Stages of Change: Perimenopause, Menopause, and Postmenopause

“The menopausal experience isn’t like turning off a light switch,” says White. That’s because the term “menopause” refers to a gradual progression that happens in three stages.

  1. Perimenopause can start a lot earlier than many women realize—usually in the mid to late 40s. During this time, the ovaries begin to gradually produce less estrogen, with a more significant drop occurring in the last one to two years. During this transition, many women still have regular menstrual cycles and can become pregnant, but they may start experiencing symptoms (see below). Perimenopause ends when the ovaries completely stop releasing eggs and menopause begins.
  2. Menopause occurs when the ovaries have stopped releasing eggs and producing most of their estrogen and you’ve gone 12 months in a row without a period.
  3. Postmenopause refers to the time after menopause when any symptoms you’ve been experiencing may subside. Because postmenopausal women naturally have low levels of estrogen, which plays a role in bone and heart health, you may be at a higher risk for certain conditions like osteoporosis and cardiovascular disease.

Common Menopause Symptoms

The symptoms associated with menopause may actually start during perimenopause. Every woman is different and may experience different signs and symptoms, but the common cause is usually declining estrogen levels. Estrogen is used by so many parts of the body for various functions, that as levels decrease, different systems are affected. Some of the most common perimenopause/menopause symptoms include:

  • Period changes. For some women, this is the first sign that menopause is approaching. Periods may become longer, shorter, heavier, or lighter. Any kind of change may be normal, but talk to your doctor if you’re concerned about the changes or:
    • You have very heavy bleeding.
    • You have unusual spotting between periods.
    • You have periods that are very close together (i.e. your cycles are shorter).
    • Your period lasts longer than a week.
    • You stop having periods for more than a year and then start again.
  • Hot flashes. Changing estrogen levels can cause sudden feelings of heat in your face and chest or all over your body known as hot flashes. Some women also experience red blotches on their chest, back, and arms, heavy sweating, and/or cold shivering. Hot flashes can last anywhere between 30 seconds to 10 minutes, and may happen frequently (a few times an hour) or more sporadically (once or twice a week). Some women also experience night sweats.
  • Vaginal and bladder control changes. As estrogen levels decline, some women experience vaginal dryness that can make sex uncomfortable. Some women also experience vaginal or bladder infections and/or incontinence (loss of bladder control) that can lead to a sudden urge to urinate, or a urine leak during exercise, sneezing, or laughing.
  • Sexual changes. Some women experience decreased interest in sex during menopause or perimenopause, but some women feel sexier as menopause approaches and occurs. While you won’t be able to become pregnant after menopause, it’s important to remember that you may still be at risk for sexually transmitted infections (STIs). Your risk for contracting an STI increases if you have sex with someone who has sex with other people, so talk to your doctor about how to best protect yourself.
  • Mood changes. Some women feel more irritable or moody as they approach menopause, but not all.
  • Body changes. Some women lose muscle and gain fat as they approach menopause and/or experience pain or stiffness in muscles and joints. Every woman is different, and symptoms vary greatly from person to person.

How to Manage Menopause Symptoms

If perimenopause or menopause symptoms interrupt your daily life, your doctor may suggest prescription medications to help steady your hormonal levels and/or treat your hot flashes. But some women find they’re able to manage their symptoms with lifestyle adjustments. Here are a few to try:

  • Dress in layers that you can remove as you start to feel a hot flash coming on.
  • Adopt a mindfulness meditation, deep breathing, or yoga practice.
  • Avoid alcohol, caffeine, and spicy foods, which can all make symptoms worse.
  • Invest in a small portable fan to carry with you in case you feel a hot flash start.
  • Practice good sleep awareness and follow a regular sleep schedule so that you go to sleep and wake up at approximately the same time each day, especially if you experience night sweats or other symptoms that disrupt your sleep. If you need some help staying accountable, your Fitbit app has all the features you need to set a sleep goal, sleep schedule, and bedtime reminders.
  • Don’t smoke. Research shows that it can make hot flashes worse in some women.
  • Exercise. Incorporating physical activity is a good idea at any age, but for menopausal or postmenopausal women, finding safe ways to increase mobility and strength training (like brisk walking and yoga) can help minimize the risk of falls and may help improve mood and sleep quality.

If these lifestyle changes don’t make a positive impact on your menopause symptoms and you’re experiencing mood changes, sexual problems, issues with bladder control, or other troublesome symptoms, talk to your doctor.

17 Comments   Join the Conversation

17 CommentsLeave a comment

  • I took the pill for 25 years and immediately after I stopped taking them, my period stopped. It’s now been 7 months since I’ve had a period. At first I was extremely moody, I still have hot flashes, my joints ache a lot and my sex drive, well I don’t have one. My poor husband hasn’t had none for a while. It doesn’t help that I am very dry and seems like I’ve closed some..in other words it’s to painful so I rather not..is there anything I can do for that without taking hormones?

    • I suffered from the same, nothing helped. Then my doctor told me that extended periods of foreplay will lengthen the vagina and help with elasticity and dryness (add lubricant for sure). And it works! Luckily my wonderful husband is game! Sex has become less frequent for certain, but absolutely amazing! Good luck.

      • I’ve been told that having sexual stimulation helps…. either with or without a partner if you know what I mean! It’s a very logical and natural solution to dryness and discomfort. Seemed like a better alternative to vaginal pesseries with all sorts of side effects.

  • How can the new female health tracking help those of us experiencing peri menopause when the maximum period length is 10 days? Three of my periods in the last year have been over 2 weeks…with over 3 months in between?

  • This is not the best article. It’s rather repetitive with little information. I use a cold wash cloth all over for hot flashes. You can keep one in a zip bag in your purse.

  • I believe ive started perimenopause..very irregular periods. Some heavy for a few days others lighter but last longer. Hot flashes have begun snd ive got joint pain also need a wee alot more often..
    Im 51.

  • What about all the ladies like me that had a complete hysterectomy due to endremetreouses. In my twenties! Hit flashes, sweating like a leaking faucet and male doc who just don’t understand!! Never any information for us!!

    • I’ve found that the standard trained MD doesn’t have answers for women beyond “Your hormones are within the acceptable range.” Find a “functional” medicine doctor. I have, starting at 48, and am taking progesterone and testosterone to help with my perimenopause symptoms. I am now 50. It has been life changing!

  • Several years ago I was having excessive bleeding (filling a pad in an hour) with large clumps/clots and periods lasting over 2 weeks. I had to have endometrial ablation done. I only had a couple of periods afterwards and have not had one in 2 or 3 years now. I turn 47 in August. I’m going to assume that I am in the postmenopausal stage. I continue to take birth control because I was told that you can still get pregnant after having ablation, however my Neurologist that I see for migraines wanted me to take one that doesn’t contain estrogen due to the fact that I have migraine with aura. I’ve had the hot flashes which seem to be diminishing, I continue to have dryness and decreased sex drive. Will that change?

  • I’m so glad I clicked onto this link, people experiencing the same things as you and sharing is great. Not had hot flushes but suffered from terrible bouts of “flooding” in my early forties – solved by an IUD which now needs changing. Just started to have multi week periods which are NOTHING LIKE the horrors of five years ago. They just start, seem to peter out and then start again, just stopped after 2 weeks – irritating but it could be worse.

    I’m 47 and work with a load of men so very little opportunity to share.

  • This article is great, but my issue came from a total hysterectomy two years ago due endometriosis. I’ve started seeing a nurse practitioner who specializes in hormone replacement. I wish the new female health tracking was more than just tracking your periods.

  • Thank you for this! I just started this process and it’s nice to have a place to share. I went off the pill on 6/2/18 at age 53 and it is 8/3 and no period yet. My eczema is flaring now and has not in 4 years and when I exercise and get up in the morning, my joints hurt. My emotions are revving high and I’m trying to keep it together for my 16 year old daughter. And this too shall pass?

  • Nice to see this article, but disappointed that in the Women’s Health settings they are all about cycles and birth control.

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