Menopause occurs at a single point in time, and is not a phase. It is defined as the day you have gone 12 consecutive months without a menstrual period, and it can only be identified looking backward. Everything leading up to that point is perimenopause, and everything after it is postmenopause. Understanding which stage you are in matters, because the symptoms, the health risks, and the treatment options are different for each.
Stage 1: Perimenopause, the Longest and Least Predictable
Perimenopause is the transition, and it is where most symptoms live. It typically begins in your 40s, though some women notice changes in their mid to late 30s. It commonly lasts about four years, but a span of eight to ten years is well within normal.
The hallmark sign is a change in your cycle. Periods may come closer together at first, then further apart, and flow can swing from unusually light to unusually heavy. Because estrogen fluctuates rather than simply declining, symptoms can come and go from month to month, which is exactly why so many women in this stage are told their labs look normal.
Common perimenopausal changes include:
- Hot flashes and night sweats
- Sleep disruption, often waking at 2 or 3 a.m.
- Mood changes, irritability, and new or worsening anxiety
- Brain fog and word finding difficulty
- Vaginal dryness and pain with sex
- Lower libido, joint aches, and heart palpitations
An important point that catches many patients off guard: pregnancy is still possible during perimenopause. Contraception is still needed until menopause is confirmed.
Stage 2: Menopause, a Single Milestone
Menopause is the 12 month mark of having no period. In the United States, the average age is 51, according to the National Institute on Aging, though anywhere from 45 to 55 is typical.
