Ever wondered about the different stages of menopause and how they’ll affect you? A top doctor answers your qs

The menopause is something that almost every woman will go through – sometimes earlier than we think. In the UK, the average age of menopause is 51, with anything between the ages of 45 and 55 considered "normal". That said, around one in 100 women experience the menopause before 40 years of age, and in a few exceptional cases, women may go through early menopause in their 30s or even younger.

Maybe you are in the middle of menopause and looking for advice on how to tackle persistent symptoms? Or perhaps you haven’t got any symptoms yet, and you just want to understand how to prepare yourself for the perimenopause (that's the stage before menopause, FYI). 

Either way, it’s never too early (or too late) to understand the different stages of the menopause and how they’ll affect you. Keep scrolling to find out.

Different stages of the menopause: 4 to know about

Largely speaking, there are four different stages of menopause that most women will experience.

Pre menopause

The time in your life before any menopausal symptoms. 

Perimenopause

When you experience menopausal symptoms but you still have your period.

Menopause

When you do not have your period for 12 consecutive months.

Post menopause

The time in your life after you have not had a period for 12 consecutive months.

When do perimenopause and menopause happen?

Perimenopause

Wondering, what is perimenopause? Good question. It's “the time prior to menopause and can start up to a decade before menopause,” explains GP, menopause specialist and founder of the UK’s first online menopause clinic, the Online Menopause Centre, Dr Laila Kaikavoosi. 

Symptoms will probably begin with a small change in your period. “Perimenopause is the start of change,” adds Dr Alice Duffy, GP and founder of Health in Menopause. “Changes in the female hormones can begin many years in advance of menopause leading to physical, psychological and local vaginal symptoms.”

The first hormone to decline is progesterone. “This can lead to a change in menstrual cycle with periods becoming closer together or further apart, shorter or longer in duration, lighter or heavier in flow,” explains Dr Duffy. “While progesterone starts to fall, the ovary continues to produce oestrogen but in an inconsistent way, leading to peaks and troughs and leaving women feeling great some days and awful on others.”

At this stage, any of the menopausal symptoms can be experienced, including but not limited to:

• Feeling flushed and hot at night
• Poor quality of sleep and waking up multiple times in the night 
• Mood swings
• Irritability
• Anxiety
• Loss of confidence
• Joint and muscle pain
• Weight changes
• Palpitations
• Headaches
• Fatigue
• Dryness
• Reduced focus and concentration 
• Brain fog
• Recurrent cystitis (urine infection)
• Reduced libido
• Visible signs of ageing 
• Changes in frequency and intensity of menstrual cycles
• Heavy bleeding and missing cycles

The symptoms of perimenopause are similar to menopause, “but the difference is that they come and go instead of being present all the time,” says Dr Kaikavoosi. “The reason for this is that the ovaries are still functioning and producing different quantities of hormones. Whereas at menopause, ovaries permanently stop producing hormones, so symptoms tend to be present all the time.”

Still not sure if you're going through it? Davina's open discussion of her perimenopause might help.

Menopause

So when does the menopause actually start? A bit like when you start having your periods, everyone’s experience is different.

Medically speaking, "menopause" is classified after “there has been no bleeding (menstrual cycle phases) for 12 months,” explains Dr Kaikavoosi. “At menopause, the ovaries have stopped producing the main hormones; estrogen, progesterone and testosterone. This will result in the emergence of a whole host of symptoms from physical to mental and sexual. The severity and number of symptoms experienced varies between individuals and so it’s important to get individual advice as each person’s menopause is different.”

Dr Duff agrees; “The listed symptoms are common to perimenopause and menopause alike, there is no fixed picture, each woman will have her own journey.”

The most common symptoms, according to the 2022 Online Menopause Centre study, are brain fog/poor memory or focus (48%), followed by weight gain (45%), sleep difficulties (44%), change in mood (43%), hot flushes/night sweats (40%), fatigue (40%) and loss of libido (30%).

Post menopause

Post-menopause is the time after menopause – once it has been twelve months since you’ve had a period, you are post-menopausal.

In post-menopause, symptoms of menopause may ease or completely stop, but some women will continue to have symptoms for longer. “Symptoms of menopause can be experienced throughout life by some and they can therefore choose to continue with treatment for many years post-menopause,” says Dr Kaikavoosi.

There can be an increased risk of some health conditions post menopause, adds Dr Kaikavoosi, “such as dementia, diabetes, heart disease and osteoporosis.” So it is important to have a healthy diet and lifestyle and to continue with any regular cancer screenings, including those for things like gynaecological cancers and so on.

How to cope with each stage of the menopause: your guide

Let the experts help.

1. Start to chart your menstrual cycle 

“If you notice a change in cycle length, in the duration of a period or the volume of blood loss, think about perimenopause,” says Dr Duffy. “Once identified, be alert for changes in mood – increased anxiety, panic symptoms, tearfulness, irritability, poor sleep, forgetfulness. Watch out for worsening of Premenstrual Syndrome (PMS) symptoms or worsening migraine.”

2. Get advice

“Get professional help early from a healthcare professional who specialises in menopausal care and educate yourself about different options,” says Dr Kaikavoosi.

“Talk to your partner, family and friends, explain what is happening,” adds Dr Duffy. “If you are struggling to cope, if your quality of life is reduced, speak to a healthcare professional about medication that will help. NICE guidelines from 2015 state that for the majority of women, the benefits of HRT outweigh the risks. HRT remains the most effective treatment for the relief of symptoms associated with the perimenopause and menopause.”

3. Make lifestyle adjustments to minimise the impact of your symptoms

And finally, take a look at how your living, as you may be exacerbating some symptoms. “This is the best time in life to reassess and optimise lifestyle and improve your general fitness, nutrition and reduce the occurrence of diseases in the future,” says Dr Kaikavoosi. “Remember hormone replacement (HRT) is an option but will not improve all symptoms alone. Lifestyle modifications and stress management play a huge role in our health and symptom management at this transitional stage.”

If you have hot flushes, night sweats or palpitations – caffeine and alcohol are not your friends, Dr Duffy goes on. Instead, try to drink decaffeinated drinks and avoid caffeine after 12 midday, as well as limiting alcohol and maintaining your intake to less than 14 units per week."

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