Menopause is the point at which a woman has gone 12 consecutive months without a menstrual period. Technically, it is a single day. Harder to pinpoint are the symptoms that come with menopause’s three phases: perimenopause, menopause, and postmenopause.
But women can prepare themselves, says Kimberley J. Sampson-Paine, MD, MSc, an obstetrician and gynecologist at Southwestern Vermont Medical Center, a member of Dartmouth Health.
“We don’t have to wait until we’re in menopause to talk about lifestyle changes, transitions, and appropriateness of different medications. Just because we have a term of menopause doesn’t mean that we actually need to only address things at that stage. We should be having those conversations much earlier,” says Sampson-Paine.
To help start those conversations, Sampson-Paine sat down with Dartmouth Health to answer common questions about the three stages of this transitional stage of a woman’s life.
When can you expect menopause?
The average age of menopause is 51 to 52, but there is no set age when menopause occurs. Studies show that genetics play a big role, with heritable components largely determining your natural age of menopause
But many other factors influence the age at which you hit menopause. Among those that affect timing may include:
- Time of menarche (the start of your period)
- Your reproductive history
- Irregular menstrual cycles
- Smoking
- Use of oral contraceptives
What we do know is that menopause is generally considered early before age 40, and that when it occurs early, studies show a possible increased risk of cardiovascular disease, bone loss, cognitive changes, and other long-term health concerns, though some of these risks may be reduced with treatment.
Surgery involving removing the ovaries, chemotherapy, and pelvic radiation can also lead to earlier menopause. So, too, can environmental exposures, social and health factors, and even trauma.
When is perimenopause?
The transition leading up to menopause is called perimenopause. During this time, ovarian hormone production becomes more variable and eventually declines. The start and length of this phase differ by person, but symptoms can begin years before the final menstrual period.
Some people may begin to notice symptoms in their late 30s. More common is for perimenopause to begin in one’s 40s, and symptoms can be difficult to manage, no matter when they start. That’s, in part, because of their unpredictability.
“It is a time of fluctuation. It can bring ups and downs, night sweats, mood swings, sleep disturbance, joint pain, and hot flashes,” says Sampson-Paine. Hair and skin health can also be affected. So, too, can mental health.
“For many people, perimenopause is actually more disruptive than menopause itself,” she says. “Later, when hormones settle, many people describe finding a new baseline.”
This article by the American College of Obstetricians and Gynecologists (ACOG) notes that during this time, four in 10 women have mood symptoms similar to premenstrual syndrome (PMS), and these mood variations may be unrelated to the timing of your menstrual cycle. The likelihood of depression can also increase during this time. So, too, can anxiety levels.
In addition, changes in sexual desire are common, given that estrogen and testosterone production are decreasing.
“When you add in other symptoms that can occur, such as vaginal dryness, pain, and difficulty with sexual stimulation during intercourse, your overall interest in sex may decrease,” adds Sampson-Paine.
What is postmenopause?
“Postmenopause is the rest of our lives,” explains Sampson-Paine.
Many of these symptoms carry over from perimenopause and can include:
- Hot flashes
- Irritability, mood swings, or depression
- Sleeplessness
- Vaginal and urinary symptoms such as dryness, irritation, recurrent UTIs, and discomfort
- Difficulty concentrating or brain fog
- Urinary incontinence
- Digestive issues such as nausea or constipation
- Joint pain
- Deceased sexual desire
For some women, says Sampson-Paine, these symptoms can continue long into the postmenopausal stage.
For example, while some women’s hot flashes may resolve within a seven-to-10-year window after the perimenopausal years start, “other people are going to continue to have these symptoms ongoing,” she says.
Joint pain is also common. “Really, the drops and changes in our hormones could really impact our whole system. Our bones are no different. Our joints, all of our musculoskeletal system, are hormone-receptive areas. It can impact how we sleep, it can impact how we’re moving, how we exercise,” says Sampson-Paine.
You also may experience these conditions:
- Urogenital atrophy
- Osteoporosis
- Cardiovascular disease
- Cancer
- Cognitive decline
Grouped together, these physiological changes and symptoms may be referred to as postmenopausal syndrome, and they can negatively affect your quality of life, according to this study. Socio-environmental stresses of midlife, as well as aging in general, are contributing factors as well.
What is the best menopause treatment for you?
Because each person is different, Sampson-Paine stresses that it is important to talk to your healthcare provider about what you are experiencing, concerns you have, what might await, and what treatment is available, if needed.
“Being aware, I think, is the first piece. Partner with your provider and say, ‘Hey, I’m experiencing these symptoms. Could this be part of the perimenopause or menopause journey?’ Ask what symptoms you will have postmenopause,” she says.
