Medically Reviewed by Samantha M. Dunham, MD on July 21, 2024 | Written by Progyny Editorial Team
At Progyny, you have a Menopause Patient Care Advocate to answer any questions you may have. We wanted to give you this handy guide that walks you through the different transitions of menopause and their corresponding symptoms.
The journey through menopause is split into three transitions: perimenopause, menopause, and postmenopause. Understanding the transitions, and what you may experience during each may give you peace of mind.
Here are a few statistics that highlight how common symptoms and behaviors are:
- 100% of people see changes in their menstrual cycles
- Up to 80% of people in perimenopause experience vasomotor symptoms like hot flashes
- Up to 90% of individuals who go through menopause consult their healthcare provider on how to cope with menopausal symptoms
Perimenopause
Perimenopause is the transitional time that leads up to menopause. This progression towards your final menstrual period begins with the onset of menstrual irregularities and persists until menopause begins. The median age of onset is 47 but can vary.
Much in the same way it can take years in puberty to establish regular ovulation and have regular predictable menses, it can take years for the ovulation signals to shut down and for menses to stop.
The term “perimenopause” is tricky because it includes the time leading up to menopause, with the change in period predictability, all the way through the first year after menopause. During this time, your hormones fluctuate, so you may experience some of these symptoms:
- Hot flashes and night sweats are caused by changes in the ovaries leading to less estrogen in the body estrogen withdrawal. These symptoms can last seven-10 years after their initial onset.
- Irregular bleeding and menstrual cycles — you’ll notice changes in your cycle, with its interval becoming shorter or longer. As ovulation becomes less frequent, you’ll then skip some cycles.
- Vaginal dryness and pain during intercourse are due to decreased estrogen, which can cause changes in the delicate tissues of the vagina, vulva, bladder, and urethra.
- Sleep disturbances, like troubling falling asleep or waking up more at 2 a.m. and 3 a.m., are associated with hormonal changes.
- Depression, anxiety, irritability and other mood disturbances are also caused by hormonal shifts.
- Brain fog encompasses cognitive symptoms, frequently manifested in memory and attention difficulties.
- Bone loss starts to accelerate during this time due to lower estrogen levels.
- Joint aches and pains are common and thought to be related to hormonal changes. They also may reflect changes in life habits.
Menopause
Menopause is a normal, natural, and distinct moment in time. It’s official 12 months after your final menstrual period – this can seem elusive since the time leading up to menopause is frequently marked by irregular/less predictable menstrual cycles.
After years of regular monthly ovulation, unless you have a history of absent or irregular periods, the cycles start to become less regular and predictable as ovarian function decreases. We suggest that you keep a record of your bleeding patterns. If it’s been less than 12 months since your last period or if you don’t experience periods, and you’re experiencing other symptoms of menopause, consider connecting with your provider.
This is a good time to schedule a health assessment. Cardiovascular risk accelerates here with changes in lipids, bone loss increases which can be mitigated by exercise, and changes in genitourinary (genital + urinary) systems are easily reversed with treatment.
After that day, when 12 months have passed since the last menses, postmenopause starts. The ovaries are finally finished with ovulation and estrogen production. If bleeding occurs after menopause, it’s best to see your healthcare provider.
Postmenopause
This is the time of life after menopause. You will no longer have a menstrual cycle and previous symptoms associated with perimenopause and menopause may decrease, although some may remain.
Common symptoms of postmenopause:
- Changes in physical appearance such as decreased muscle mass, change in skin tone, thinning hair, and increased weight, especially in the abdominal area.
- Decreased libido, pain with penetrative vaginal sex, and decreased ability to reach orgasm may result in less frequent satisfying sexual encounters.
Potential health risks:
- Increased risk for osteoporosis due to low estrogen can result in the following:
- Back pain
- Loss of height
- Stooped posture
- Brittle bones
- Increased risk for cardiovascular disease
- Heart disease
- High blood pressure
- High cholesterol – increased “bad” cholesterol and decreased “good” cholesterol” can lead to plaque buildup in your arteries
- Stroke
- Increased risk for strokes
- Increased risk for diabetes
Coping With Menopause
It’s a natural part of life but has its struggles. Everyone born with ovaries who lives long enough will undergo menopause at some point in their lives. Each transition presents its own set of challenges and considerations.
Recognizing these symptoms can help you seek appropriate medical advice and find ways to promote your overall well-being. We suggest that you talk to your healthcare provider to determine which transition you are in and explore options to manage your symptoms.