Menopause: Is It Starting?

Know the three stages and what to look for

Menopause: Is It Starting?

The 3 Stages of Menopause

Every woman’s experience with menopause is different. One may breeze through “the change,” barely realizing it’s happening. Another may suffer debilitating symptoms, such as depression, anxiety, sleep loss, hot flashes or night sweats. One woman may feel the effects of fluctuating hormones at age 40. Another may still be having monthly periods at 55.

How can you be sure when the change is happening to you? And more importantly for some, how do you know when the change is over?

Fortunately, there are some telltale signs. What most people call “menopause” is actually a three-stage process:

1. Perimenopause: getting ready. Since your early reproductive years, your ovaries have produced a steady mix of estrogen, progesterone and testosterone.

“Each hormone has played a role in your reproductive system, but estrogen has always been the ‘leading lady,’” says Holly Thacker, MD, Director of Cleveland Clinic’s Center for Specialized Women’s Health. “She has regulated your monthly menstrual cycle. She has affected your psychological well-being, including your mood, sleep and sex drive. She has helped the function of your urinary tract, your skin and vaginal tissues, your bones and heart, your brain and more.”

During perimenopause, estrogen begins to withdraw, and your steady mix of hormones gets disrupted. That’s when things can start to get wacky. Your periods may become unpredictable. Your bleeding may become quite heavy. Strange symptoms can crop up:

  • Hot flashes — sudden sensations of heat that spread from your chest to your head, often followed by sweating or cold shivering. They may come with hot flushes, when your neck and face turn red.
  • Night sweats — hot flashes that occur during sleep and cause perspiration.
  • Difficulty sleeping — often related to hot flashes and night sweats.
  • Vaginal changes — including dryness and increased vulnerability to bladder infections.
  • Mood changes — such as irritability, anxiety and mood swings.
  • Sex drive — a reduced interest in sex that can be related to mood changes or vaginal dryness, which can make sex uncomfortable.
  • Skin changes — including dryness, itching and loss of elasticity.
  • Headaches/migraines — which can be aggravated by fluctuating hormones.
  • Heart palpitations — manifestations of symptoms (e.g., hot flashes) in the autonomic system (e.g., the nerves and muscles that cause blood vessels to expand or contract).
  • More hair on your face; thinning hair on your head.
  • Forgetfulness/poor concentration — which can be linked to various conditions, including yo-yoing hormones, lack of sleep and increased stress.

“Perimenopause usually begins in a woman’s 40s, sometimes lasting as long as eight to 10 years,” says Dr. Thacker.

You won’t necessarily have symptoms that whole time — if you have them at all. For some women, symptoms begin their last few years of perimenopause, when estrogen plummets.

2. Menopause: the transition. Actual menopause is your first 12 consecutive months without a period. It’s when your ovaries stop releasing eggs and drop almost all estrogen production.

Menopause usually occurs between the ages of 45 and 55. It’s timing is partly genetic.

“If women in your family tend to reach menopause in their early 40s, chances are you will too,” says Dr. Thacker. “Your lifestyle and medical history also are factors. For example, smokers and women with a chronic illness are more likely to reach menopause earlier.”

3. Postmenopause: a new beginning. Postmenopause begins your “second adulthood,” once your reproductive years are complete.

The first five years of postmenopause — which begin on that 13th consecutive month without a period — are most critical in terms of menopausal symptoms and bone loss. During this time, women generally start hormone therapy, if they need it.

Should you Consider Hormone Therapy?

If you’re struggling with symptoms of “the change,” or if you’re just not feeling like your old self, see your doctor.

“Millions of women have found relief with hormone therapy, the only FDA-approved treatment for menopausal symptoms,” says Dr. Thacker. “And they’ve done it without increasing other health risks.”

Hormone therapy supplements your body with estrogen and progestogen that it’s no longer getting from your ovaries. It can be just enough to regulate certain body functions and relieve hot flashes, vaginal dryness and other symptoms. Hormone therapy comes in a variety of forms:

  • Pills
  • Creams
  • Gels
  • Vaginal rings
  • Patches

Whether or not you need hormone therapy, menopause is a natural part of aging. It’s not a disease or something to resist. In fact, many women welcome it — giving new meaning to the phrase “Change is good.”


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