Three Stages of Menopause: Signs and Symptoms

Bonny Osterhage

Written by Bonny Osterhage

Bonny Osterhage

Written by Bonny Osterhage

The term menopause is commonly used as a sweeping generalization to encompass all the changes a woman goes through as her body prepares to, and finally stops menstruating.

But that's not entirely accurate.

Bookended by perimenopause and postmenopause, it is the second of three stages that a woman experiences during her menopausal years. All three stages have distinct symptoms leading up to and following the end of menstruation. Knowing what changes and symptoms to look for, when to look for them, and how to treat them, can help make each of the stages more manageable.


The first, and often most confusing stage of menopause, perimenopause occurs when estrogen and progesterone levels begin to shift significantly. These hormonal changes can start to happen 4-8, or even 10 years before a woman stops having a period.1 What makes perimenopause so difficult to detect is that there is no specific age when symptoms start to occur. Furthermore, the symptoms can be vague and easily written off as the result of stress, fatigue, or lifestyle. Most often, women experience hormonal changes associated with perimenopause between the ages of 40 – 44, but this can vary a few years in either direction; for some women shifts can even begin in their 30s.2

The signs of perimenopause into menopause also vary from woman to woman and may include at least 34 different disruptive symptoms.  Some of the more obvious and common symptoms can include:

Other, less obvious signs can coincide with:

A woman who is experiencing these symptoms with regularity and is in her early 40s or older, can request that her healthcare provider perform bloodwork to check her hormone levels.3  This may be able to help support whether she is in this first stage of menopause and provide guidance on how best to address or treat the symptoms she’s experiencing. It’s important to note, however, that these blood tests may not provide definitive results for everyone.


While many perimenopausal symptoms tend to get lumped under the heading of “menopause”, that’s just not the case. In fact, menopause is actually only one 24-hour period in time. It is the day that marks one year from a woman’s last period.4

When a woman says she’s “going through menopause,” she’s typically referring to the years leading up to it or after it, whether she realizes it or not. The actual day of menopause typically occurs around the age of 515, but like perimenopause, it can vary by a few years in either direction. The symptoms are very similar, but may increase in frequency or intensity as a woman nears actual menopause and postmenopause.


Once a woman has reached her one-year-without-a-period milestone, she’s in the third stage of menopause and considered to be postmenopausal. During this time, some of the previously experienced symptoms during perimenopause may have lessened or even disappeared completely. However, this stage brings its own list of things to consider.  The postmenopausal years can bring with it an increase in risk of cardiovascular disease, including stroke, as well as osteoporosis,  urinary tract infections (including bladder habit changes), and some cancers.6 That’s why it’s important to maintain a good relationship with your gynecologist or to check-in with your healthcare provider to determine your risk factors for these and other diseases or health conditions that could be related to postmenopause.

Don't Just “Deal” with Perimenopause and Menopause Symptoms

Transitioning through the three stages of menopause doesn’t have to be something you struggle through. There are plenty of ways to address the symptoms and keep them from disrupting your daily life.

If prescriptions solutions, such as hormone replacement therapy, aren’t your ideal treatment approach, there are naturally derived alternatives available that are designed to provide relief from some of the more disruptive perimenopause and menopause symptoms such as hot flashes and vaginal dryness, as well as those that can help to increase sexual satisfaction, ease mood swings, and more.

Diet can also play an important role in both symptom management and severity. Studies have shown that a diet high in fat and sugar can exacerbate night sweats and hot flashes.7 Some healthcare providers recommend the heart-healthy Mediterranean Diet to their menopausal patients for its myriad of health benefits, which can include a reduction in inflammation, enhanced immune function, optimized cardiovascular health and improved energy levels.8

As always, be sure to consult with your healthcare provider before trying any new supplements or incorporating drastic dietary changes. It’s also important to speak with your provider to determine whether or not additional treatments, such as certain prescriptions or hormone replacement therapy, may be necessary to further address your symptoms.

Knowledge is everything when it comes to managing the three stages of menopause. Understanding the symptoms and how to manage them empowers women to better help themselves.  In today's world, there is no reason for a woman to struggle with treatable symptoms. Life is too short to feel uncomfortable.


  7. Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013;97(5):1092-1099.

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