The way menopause is used in media is often as an umbrella term for the 3 stages that make up the unique experience of a womans reproductive system essentially going into retirement.

Breaking Down The Stages Of Menopause

The short answer: Menopause is when a womans reproductive system naturally slows then stops altogether. She could spend a significant portion of her life liberated from monthly cycles, PMS symptoms, and, yes, the possibility of pregnancy. But did you know there are 3 significant stages to the menopause experience?

The first stage: Perimenopause

This stage may begin in your mid-30s or 40s. This is the time your bodys hormones will begin to fluctuate, and youll be navigating the bulk of the symptoms youve likely heard about and attributed to the change. You may not experience all of the indicators on the list, but in order to understand how perimenopause may be showing up, heres the lineup of main symptoms:

Periods become irregular

This is often the first sign that youve entered into perimenopause. And it can be baffling. Periods are lighter, shorter, farther between. Or, they are heavier, longer, and more frequent, or any and all of these at different times. Because your body may be producing less progesterone, the uterine lining (which is regulated by progesterone) might get thicker, meaning heavier periods. (Help for wonky periods.)

Hot flashes

Though commonly associated with the 2nd stage of menopause, hot flashes are actually the most common symptom reported by women in perimenopause. (P.S. HRT helps with hot flashes.)

Interrupted sleep

Sleep gets more challenging during this time. Some women find it harder to fall asleep, others to stay asleep. And the onset of hot flashes and night sweats can make a good nights sleep even harder to come by. (Get better sleep.)


As estrogen ebbs and flows, mood can change with it. Anxiety, depression, and rage are all fairly common. Its important to be aware and attentive to emotional issues, as depression during perimenopause can reach dangerous levels. (More information on anxiety, perimenopause depression, and angry hormones .)

Decreased fertility

Conceiving is generally much more difficult once perimenopause has begun. (Considering IVF?) But dont throw out your birth control just yet! Because during perimenopause is the time of highest accidental pregnancy, outside the teen years. PMS levels up in intensity. Yeah, sorry. Breast tenderness, perimenopause headaches, mood, cramps, all can get worse... or not. Think of it as natures way of helping you truly appreciate the end of periods when it finally happens. (Killer menopause cramps?)

Brain fog and memory issues

Estrogen is a master regulator of the brain, so as levels decrease, you may experience brain fog, confusion, inability to concentrate, or memory loss. These are generally temporary as your brain adjusts to your new level of hormones. (Increase concentration focus.) Some of the more alarming symptoms can include: hormonal heart palpitations, surprisingly increased anxiety and/or menopause depression, even non-period vaginal bleeding or spotting. Make your doctor your ally and keep them in the loop about whats going on in your body.

If you have questions or concerns about what's going on with your body, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Many women find low-dose birth control pills or a hormonal IUD like the Mirena can help control many perimenopausal symptoms.

In terms of whats happening in your reproductive system, basically, your ovaries are figuring out how to go into retirement. Declining numbers of eggs means hormone and cycle fluctuations and ultimately, declining levels of estrogen and progesterone.

And since we have estrogen receptors throughout our bodies, changes in estrogen levels mean systemic changes to pretty much everything from our hair to our foot pain in menopause.

While its a natural process, the shifting of hormones can be... ahem, really challenging and sometimes temporarily miserable. Take heart, it will end.

The second stage: Menopause

Menopause (proper) specifies that youve gone 12 months without a period. A year, period-free? Fantastic! Youve arrived! Youre IN. Technically, menopause lasts just one day that anniversary of your last period.

Menopause, by our definition, is an invitation: to take extremely good care of yourself, to try out new things, to indulge your wants and desires, to embrace your sexuality and beauty, and to give a whole lot less importance to others opinions of you.

Feelings of grief or sadness (if you have them) may linger, and they can pass if a woman is willing to let them. Mindset and choice are yours in how you perceive this time of life. Women are living between 20 years to a third of their lives after menopause. Theres plenty to experience, revel in, and do in your life including taking extra good care of yourself, body and mind.

The third stage: Post-menopause

Living out the rest of your best life in post-menopause may take a little more effort to protect your health, but you are not fragile, by any stretch. Especially after the transformation and challenge of perimenopausal symptoms. Consider yourself as a powerful, fairly badass, brand new butterfly at this stage.

Actually, the way you navigate your perimenopausal symptoms may set you up for ease, comfort, and better overall health for post-menopause, especially when it comes to:


Diagnosed with osteoporosis or osteopenia? Consider talking with your doc (or ours) about how to incorporate regular, gentle strength training and weight-bearing exercise. This alone promotes improved bone density, develops a stronger core, which can help you avoid falling and potentially breaking a bone. HRT (hormone replacement therapy) can also help battle bone loss. (More on osteoporosis exercise and osteoporosis medications.)

Heart disease

The #1 killer of women: about 10 years past menopause, a womans risk of dying is higher than a male of similar age, in part because were less able to recognize the symptoms of heart attack in a woman. Eat well, hydrate, exercise, know your risk. (Discover how to have a healthier heart with Dr. Sarah Speck from POTENTRx.) A proactive stance is within your power, and heart disease can be held back with simple, if not always easy, practices and choices.

Alzheimers and dementia.

Women suffer from Alzheimers at a higher rate than men. Nutrition may help protect your brain, as may HRT if used correctly, so talk with your doctor or ours about how to minimize your risk of developing Alzheimers. (A delicious option: how to eat for retirement with Lisa Mosconi.)

Eating well, getting regular exercise, frequent hydration, minimizing or heck, eliminating, stress, quitting smoking, and getting good rest and sleep will make you feel fantastic at every stage, no matter your age. Youre on the path of adventure and exploration, and you are welcome here.

Your path during all 3 stages of menopause may be completely unique, but you are not alone. Curious about where you may be in menopause? Take our menopause assessment.

Want to connect with other women and menopause practitioners about your symptoms? Join the conversation in the Gennev community forums!


Shannon Perry

October 15, 2019
Director of Programming & Media

Medically Reviewed By

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