Menopause 101 - Signs and Symptoms

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Perimenopause marks the beginning of the female “change of life”, the natural biological process that occurs when women permanently stop menstruating. But what else do you need to know about the menopause transition?

Let’s take a look at the most common questions women have about this time, including signs, symptoms, and tips for preparing for a smoother transition as well as symptom relief. Instead of being unpleasantly surprised by changes to your body and mood, you can get prepared, take control, and celebrate the start of a fabulous new chapter in your life.

What are the phases of menopause?

The three phases of the menopause journey are premenopause, perimenopause, and postmenopause.

  • Premenopause is the time from puberty when you started menstrual periods through your 20s and 30s. Most women still have regular periods. You may have hormonal fluctuations, but for the most part, they are not noticeable.

  • Perimenopause starts in your 40s, or possibly earlier. You start to experience menstrual cycle changes and symptoms like hot flashes, sleep disturbances or mood swings.

  • Postmenopause is the stage after reaching menopause. Once you reach menopause, you are officially considered post-menopausal. You may continue to experience symptoms for up to 10 years.

Many people make reference to the entire process as “menopause.” Menopause is actually a milestone rather than a phase. Technically speaking, you are not “in” menopause. You are in one of the three phases!

When does the menopause transition start?

Perimenopause, or the start of the menopause transition, usually begins about four to eight years before reaching menopause for most women. Perimenopause is when your body is not ovulating as predictably or precisely, this results in less consistent progesterone production and, in turn, there is less of the hormone estrogen, the primary female sex hormone made by your ovaries. About eighty percent of women will experience symptoms of varying intensity.

One of the best ways to predict when the menopause transition may naturally begin for you is to look into your family history. Find out when your mother, sister, or other biological female relatives reached menopause. This may help you prepare and be able to better identify some of the first signs of changing hormones in your own body. But like starting periods, while there can be some similarity in families, there can also be significant differences too.

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When will I reach menopause?

Most women will reach menopause naturally after 12 consecutive months without a period, which is confirmed by your doctor. The average age of reaching menopause naturally in the United States is 51 years, with most women achieving this milestone between the ages of 45-55. About six percent of women reach menopause earlier due to cancer treatment, surgical removal of the ovaries, and other health and lifestyle factors. About five percent of women reach menopause after age 55.

What is premature and early menopause?

Women who stop having a period before the age of 40 that is not due to cancer treatment or surgical removal of the ovaries are typically experiencing premature menopause, also referred to as primary ovarian insufficiency. Women who stop having a period between the ages of 40-44 experience what’s called early natural menopause.

Approximately six percent of women experience premature or early menopause. Some factors that can increase the likelihood of premature or early menopause include smoking, chemotherapy, family history, oophorectomy (removal of the ovaries), certain autoimmune conditions, and being underweight at any point in your life.

The first signs of premature or early menopause will almost always be a change in periods, including heavy bleeding or spotting, periods that last longer than one week, or periods that return after being absent for several months. Basically, menstruation that is even more of a roller coaster. You should consult your healthcare practitioner if you experience any irregularities with your period.

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What can women expect with starting perimenopause?

Common symptoms include hot flashes, interrupted sleep, vaginal dryness, and mood swings, which are caused by estrogen fluctuations in your body. Many women attribute perimenopausal symptoms to things like stress or a busy lifestyle and don’t realize that they have started the menopause transition. As you progress to the later stage of perimenopause, you can expect to start having irregularity in your periods. They may become closer or farther apart, heavier, lighter, or just spotting. You might have a period, then skip a period for a few months, and then return to a monthly cycle for a while before your period completely subsides.

What are the symptoms of menopause?

There are plenty of symptoms that can sneak up during perimenopause and continue into postmenopause.

Many women report hot flashes, night sweats, chills, changes in mood, including depression, anxiety, and sadness, weight gain, sleep problems, headaches, dry skin, and thinning hair as a result of changing hormones.

Some women also report changes in sexuality, specifically sexual desire, the frequency of sexual activity, vaginal dryness, and painful intercourse. Unfortunately, more than fifty percent of women don’t report vaginal dryness to their healthcare providers, and less than four percent of affected women are actively using any of the many therapies available. It’s important to know that these changes are not inevitable or irreversible and may affect women differently. Sexual health-related changes may occur months or years in postmenopause.

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How long do symptoms of menopause last?

Menopause symptoms and their severity can vary among women and depend on a number of individual factors.

This also means that some women find symptom relief sooner or in different ways than other women.

Perimenopausal symptoms may last for months or years and some menopausal symptoms can persist for up to 10 years after your final period. Studies suggest that on average, hot flashes can last for 10 years and that African American women often experience hot flashes for longer than white women.

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How is natural menopause diagnosed?

Natural menopause is diagnosed when you haven’t had your period for 12 consecutive months and you are not pregnant, breastfeeding, or using a birth control product that suppresses your period.

Many women self-diagnose when menopause is reached, but to be sure, it’s a good idea to speak with your doctor, especially before age 45. If there is any question, certain tests can be done to help confirm that signs and symptoms are indicative of reaching menopause and not another condition.

Your doctor may check your levels of estradiol (a type of estrogen). Additionally, they may test your follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), or thyroid-stimulating hormone (TSH) to rule out other conditions that have similar symptoms to menopause.

Can you delay menopause?

Although research has shown that earlier menopause can increase a woman’s risk for osteoporosis, cardiovascular disease, anxiety, and depression, it may also reduce her risk of breast, ovarian, and endometrial cancer.

Rather than intervening with biology, you can best support the optimal timeline of your body’s natural transition process by making healthy dietary and lifestyle choices as often as possible.

Women who smoke or tend to eat more refined carbohydrates, like packaged snack foods, white bread, and white pasta, often start menopause earlier than women who eat more complex carbohydrates, like legumes (beans, peas, and lentils). A diet based on fiber-rich whole plant foods, which limits processed foods and unhealthy fats, may also help prevent menopause from starting too early.

Research has also shown that consuming oily fish, like trout and herring, can delay menopause by an average of three years. Additionally, vitamin B6 (found in whole grains, eggs, soy, and poultry) and zinc (found in seafood, eggs, legumes, soy, nuts, and seeds) have also been shown to support a slightly later menopausal onset.

How can you have a better menopause experience?

One of the most effective ways to improve your menopausal experience and help with symptom relief is to choose healthful lifestyle behaviors as early as possible. Many women think menopause is far off in the future and not something to be concerned about in your 20’s and 30’s. However, the sooner you incorporate healthy lifestyle behaviors into your life the higher your chances that your menopause transition will be easier and occur naturally.

Diets that incorporate whole soy foods, which are rich in isoflavones, have been shown to offer relief for certain symptoms, like hot flashes, for some women. Eating more plant foods and fewer animal products have been associated with fewer uncomfortable menopausal symptoms.

Although research is mixed when it comes to whether exercise improves certain menopausal symptoms for women, regular physical activity has also been linked to better mental health, sleep patterns, the overall quality of midlife, and healthy aging.

Having a positive attitude about the changes in your body and life as well as taking charge of your symptoms will go a long way to improving your journey and help manage the impact of menopause. Embrace your menopause transition and celebrate the start of something great!

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Whether you’re just starting to dip your toes into perimenopause, continuing to experience symptoms into postmenopause, or simply looking for some guidance on what to expect in the coming years of life, we’re here for you! For more information and support around your menopause journey, as well as ideas for symptom relief, join us over at Lisa Health.


Dr. DePree is the Director of Women’s Midlife Services at Holland Hospital in Holland, Michigan, and has practiced as a board-certified gynecologist and women’s health provider for 30 years. She is a certified menopause specialist and in 2013 was named Certified Menopause Practitioner of the Year by the North American Menopause Society for “exceptional contributions” to menopause care. Dr. DePree also founded the groundbreaking website middlesexmd.com, a site focused on educating women about sexual well-being, particularly during the menopause transition, and offering curated products that support vaginal health and sexual wellness.