4 Stages of menopause every woman should know

Most of us were never told what menopause looks like. One day your cycle changes or you wake up hot at 3 a.m., and it's hard to know where you are.

Menopause comes in four stages that differ in symptoms and length. If the heat is what brought you here, our hot flash relief page is a good place to start.

The menopause timeline, stage by stage

1. Premenopause

Premenopause is the stretch from your first period until the first changes. Your cycles are regular and your hormones follow a steady monthly rhythm.

There are no menopause symptoms yet. It's the best time to build the habits that pay off later: strength training, good sleep and enough calcium and vitamin D.

It's also worth asking your mother when her periods stopped, because the timing often runs in families. You're likely in premenopause if:

• Your period comes every month, on a schedule you can predict.
• Your cycle length barely changes from one month to the next.
• You haven't had hot flashes, night sweats or new trouble sleeping.
• You're in your 30s or early 40s.

2. Perimenopause

Perimenopause is the transition, and the stage most women feel. In a study of 2,570 women, it started at a median age of 47.5 and lasted nearly four years.¹

Estrogen rises and falls unevenly, so cycles get shorter, longer or skip, and hot flashes, broken sleep, mood swings and stronger PMS can show up.

It starts with small changes in your cycle and ends with long gaps between periods. Knowing what age perimenopause starts helps you spot the first signs.

A perimenopause supplement is made for the heat and mood swings of this stage. You may be in perimenopause if:

• Your cycle length now varies by a week or more.
• You've skipped a period, or gone 60 days or more between periods.
• You get hot flashes or night sweats but still have periods.
• Your sleep, mood or PMS feels different than it used to.
• You're in your mid to late 40s.

3. Menopause

Menopause is a single point in time, not a phase: the day you reach 12 months without a period. In the US, that happens at 51 on average.

Hot flashes and night sweats often peak in the year or two around it, the time a menopause supplement is made for.

You only know it in hindsight. Menopause before 40 is called premature, and between 40 and 45, early. You've reached menopause if:

• You've gone 12 months in a row without a period.
• Nothing else explains it, like pregnancy, breastfeeding or a medication.
• You're somewhere between 45 and 55, the usual range.

4. Postmenopause

Postmenopause is every year after that day. Your periods are done, and estrogen settles at a lower, steady level.

Many symptoms ease, but some take their time, and protecting your bones and heart matters more from here on.

Post menopause supplements focus on the symptoms that linger in these years. You're in postmenopause if:

• More than a year has passed since your last period.
• Your periods haven't come back since.
• Some symptoms are easing, though hot flashes, dryness or achy joints may linger.

Perimenopause vs menopause

The two words get mixed up all the time. Perimenopause is the years of change; menopause is the finish line that marks their end.

So when people say they're "going through menopause" with irregular periods and hot flashes, they're usually in perimenopause.

"This is a really important distinction. We talk so much about hot flashes, sleep and mood,

but far less about the changes women may begin noticing in their skin and appearance during this transition."

Michele Feinstein

Stages of perimenopause

Perimenopause has two parts. In early perimenopause, your cycle length starts to vary by a week or more from month to month, and PMS can feel stronger.

In late perimenopause, you start skipping periods, with gaps of 60 days or more. This is when hot flashes and broken sleep usually hit hardest.

You can still get pregnant in either part, because you still ovulate some months. Most symptoms start here, so support for this stage helps most early.

How long does menopause last?

Longer than most women expect. In a long-running US study of over 1,400 women, hot flashes and night sweats lasted a median of 7.4 years.²

4.5 of those years came after the last period, so the heat often outlasts your periods.² Perimenopause alone usually lasts around four years.

It can be as short as a few months or as long as ten. Women whose hot flashes start early in perimenopause tend to have them longest.²

What signals the end of menopause

The clearest sign is simple: a full year without a period. From that day on, you're in postmenopause.

Before that, the gaps between periods keep getting longer, and hot flashes may come less often. Any bleeding after that year needs a check with your doctor.

Your next step at each stage

Blood tests help little in perimenopause, because hormones swing week to week. Your cycle is a better guide.

Premenopause: build your base

Strength train two or three times a week, and get enough calcium and vitamin D while estrogen still protects your bones.

Perimenopause: track and protect

Track your cycle and symptoms for your doctor. Keep using birth control until your doctor says you can stop.

Menopause: plan for the peak

Hot flashes often peak now, so keep layers and a fan close. If they disrupt your sleep or work, see your doctor.

Postmenopause: protect bones and heart

Ask your doctor about bone density checks, keep lifting and watch your blood pressure.

Post menopause symptoms to know

Postmenopause isn't symptom-free for everyone. These are the ones that most often linger or appear:

• Hot flashes and night sweats, which fade slowly for many women. Our guide to hot flashes after menopause covers why.
• Vaginal dryness, which tends to grow over time rather than fade.
• Lighter sleep, often tied to the heat at night. More on menopause and sleep.
• Stiff joints and aches, common in the years after the last period.
• Faster bone loss, which has no symptoms but is worth checking.

What helps at every stage

The basics don't change from one stage to the next. Strength training, a cool bedroom, less alcohol and steady sleep help at all four.

When hot flashes start, keep a fan close and dress in layers you can peel off. Our night sweat relief page has more ideas for cooler nights.

And when you want daily support, Pausive is made for the heat, the broken nights and the mood swings that come with perimenopause and menopause.

Stages of menopause FAQs

Is premenopause the same as perimenopause?

No, though the words get swapped. Premenopause is the years of regular cycles; perimenopause is when cycles and symptoms start to shift.

Does menopause ever end?

Yes. The transition ends once you reach postmenopause, and most symptoms ease in the years after. Some, like vaginal dryness, can stay.

How do you know when menopause is over?

When you've gone 12 months in a row without a period, you've reached menopause, and the transition is over.

What is the average age of menopause?

51 in the US. Most women reach it between 45 and 55, and genes play a big part in the timing.

Can you skip perimenopause?

Only if your ovaries are removed or stop working suddenly, for example after surgery or some cancer treatments. That's called surgical or induced menopause.

What is the hardest stage of menopause?

For most women it's late perimenopause and the first year after the last period, when hormones swing most and hot flashes peak.

Do symptoms change from stage to stage?

Yes. Cycle changes and PMS lead in early perimenopause, hot flashes and sleep problems peak around menopause, and dryness and joint aches come later.

Sources

1. McKinlay SM et al., Maturitas, 1992: in 2,570 women, perimenopause started at a median age of 47.5 and lasted nearly four years.
2. Avis NE et al., JAMA Internal Medicine, 2015: in the Study of Women's Health Across the Nation, hot flashes and night sweats lasted a median of 7.4 years in total, and 4.5 years after the last period.