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.
- 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.
- 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.
- 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.
This article is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or condition. Always check with your doctor before changing your diet, altering your sleep habits, taking supplements, or starting a new fitness routine.