Menopause: Understanding the stages, ages, signs, and symptoms

Published October 12, 2023

Menopause is a natural part of life, but it can be an incredibly challenging time for women. Over 1 million women in the United States experience menopause each year.¹ They are mothers, partners, sisters, daughters, and friends. And menopause can come at a time when they're at the peak of their careers— while balancing the demands of work and family. It's also a time when their risk of heart disease, stroke, and bone loss increases.²

But menopause is a new chapter—not the end of the book. It can be a time of renewal and empowerment. It’s a time to reflect on all the experiences you’ve gone through and the milestones you’ve achieved. Embrace it as a time of new beginnings and celebrate your second act. Because menopause is a time to celebrate all parts of your life—including your health.

What’s menopause?

Menopause is the natural end of a woman's menstrual cycle. It happens when the ovaries stop producing eggs and the levels of hormones (estrogen and progesterone) decline.

When does menopause start?

Natural menopause usually happens between the ages of 40 and 58, but the average age for menopause is 51.³ It can also happen earlier (30s) or later (60s) for some women. 

How do you know if you’re going through menopause?

Menopause is often referred to as a catch-all term for the entire menopause transition, but it does involve several stages. Knowing what to look for during each stage can help you better understand your body and seek the right support.

The menopause transition has 3 different stages, each with its own set of possible signs and symptoms:

1. Perimenopause is when your body starts preparing for menopause. Your ovaries start to produce less estrogen and progesterone. This drop in hormones can cause symptoms like skipped periods, hot flashes, or night sweats. But even during these changes, you could still get pregnant. Perimenopause can last for a few months to a decade, but the average length is 3 to 4 years.
2. Menopause follows perimenopause and usually happens around age 51. During this time, your ovaries will no longer release eggs, hormone levels will become very low, and your period will stop completely. Once you’ve been period-free for 12 months in a row, you’ll have transitioned to menopause. But there’s a catch: if you haven’t had a period in a few months and then it returns, the clock starts over, and you’re back in perimenopause. 
3. Post menopause follows menopause and is the time when your body adjusts to the changes that have happened. Hot flashes and other symptoms can continue for a few years, but eventually, they fade away. It’s important to know that bleeding isn’t a symptom of post menopause. Bleeding during this time is not normal, you should speak with a healthcare provider if it happens.³

What’s early menopause?

Early menopause is when menopause happens before age 45. This is much earlier than natural menopause, which usually happens around age 51. Early menopause affects about 5% of women in the United States.⁴ Smoking, medical procedures, and genetics can lead to early menopause. Women who experience early menopause are at a higher risk for certain health conditions, such as bone loss (osteoporosis), heart disease, and depression.⁴

What’s premature menopause?

Premature menopause is when menopause happens before age 40. This condition affects about 1% of women in the United States.⁵ The exact cause of premature menopause (when not caused by medical treatments) is unknown, but it could be due to genetics, autoimmune diseases, or other factors we don’t fully understand. 

The difference between premature menopause and early menopause is the age of when menopause happens:

• Premature menopause is when menopause happens before age 40
• Early menopause is when menopause happens before age 45

Premature menopause should be evaluated thoroughly by a healthcare provider.⁵ Women who experience premature menopause are at a higher risk of developing osteoporosis, heart disease, and other health issues associated with menopause. Because of this, it’s crucial to receive proper medical care and support.⁵

What’s induced menopause?

Induced menopause is when a woman goes through menopause due to the surgical removal of the ovaries, medical treatments, or medication usage. Induced menopause can happen suddenly, unlike natural menopause, which happens gradually over time. Women experiencing induced menopause might have symptoms that come on suddenly and intensely, unlike the gradual onset of symptoms that is typical of natural menopause.⁵

Signs and symptoms of menopause

Menopause is a unique experience for every woman. Your symptoms, timeline, and needs may be different from those of your mother or sister. And that's okay. Your family tree might not predict how or when you will experience menopause.

Menopause is usually known for hot flashes and night sweats. And for good reason—over 80% of women will experience hot flashes and night sweats during the menopause transition.⁶ But they are far from the only uncomfortable symptoms of menopause. Menopausal symptoms can be extremely different for each woman. Some women might have mild symptoms, while others could have severe symptoms that significantly impact their quality of life (both personally and professionally). Menopause might be a natural part of life, but it can come with a host of uncomfortable symptoms, including:

• Anxiety
• Bloating
• Brain fog
• Breast tenderness
• Depression
• Difficulty concentrating
• Dry skin
• Fatigue
• Forgetfulness
• Hot flashes
• Irritability
• Joint pain
• Loss of interest in sex
• Migraines
• Mood changes
• Muscle pain
• Night sweats (hot flashes that happen when you’re sleeping)
• Period changes (missed, skipped, heavier, or lighter periods)
• Sleep problems
• Thinning hair
• Tingling in the arms, hands, legs, or feet
• Urinary issues (going more often, leaking urine)
• Vaginal dryness
• Weight gain

Is there a test to check for menopause?

Yes, there are tests for menopause. But there is no single test that can definitively diagnose menopause. Instead, doctors typically use a combination of tests and medical history to make a diagnosis. The most common tests to check for menopause include:

• Estradiol (pronounced eh-struh-dial) is the main (and most potent) form of the hormone estrogen. It’s first produced at puberty and changes throughout your menstrual cycle until the menopause transition, when it starts to decrease.
• Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland that stimulates the ovaries to produce eggs. It also controls your menstrual cycle. As you age, estrogen levels decrease and FSH levels increase.
• Luteinizing hormone (LH) is a sex hormone produced by the pituitary gland that helps control your menstrual cycle and triggers ovulation. As estrogen levels decrease with age, LH levels increase.

No doctor visit is required to buy your own lab test at questhealth.com. PWNHealth and its affiliates review your purchase to ensure it is medically appropriate before submitting the test order for processing. PWNHealth also reviews your test results and will contact you directly if they require prompt attention. Included in each purchase is the option to discuss your test results with an independent physician; however, you are also encouraged to speak with your primary healthcare provider.

References

1. National Institute on Aging. Research explores the impact of menopause on women’s health and aging. Accessed September 8, 2023. https://www.nia.nih.gov/news/research-explores-impact-menopause-womens-health-and-aging. 
2. Office on Women’s Health. Menopause and your health. Accessed September 8, 2023. https://www.womenshealth.gov/menopause/menopause-and-your-health. 
3. Mayo Clinic. Mayo Clinic Q and A: Spotting, perimenopause, and menopause. Accessed September 8, 2023. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-spotting-perimenopause-and-menopause. 
4. Cleveland Clinic. Premature and early menopause. Accessed September 8, 2023. https://my.clevelandclinic.org/health/diseases/21138-premature-and-early-menopause. 
5. The North American Menopause Society. Menopause FAQs: Premature, early, and induced menopause. Accessed September 8, 2023. https://www.menopause.org/for-women/menopause-faqs-premature-early-and-induced-menopause. 
6. Bansal R, Aggarwal N. Menopausal Hot Flashes: A Concise Review. J Midlife Health. 2019;10(1):6-13. doi:10.4103/jmh.JMH_7_19

Sources

1. National Institute on Aging. What is menopause? Accessed September 8, 2023. https://www.nia.nih.gov/health/what-menopause. 
2. Harvard Health Publishing. Perimenopause: Rocky road to menopause. Accessed September 8, 2023. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause.