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Preparing for Menopause: Understanding the Signs and Symptoms in all Three Stages

Posted April 03, 2023 by Edward Ferris, M.D., FACOG

Woman with grass behind her

For people with ovaries, having a period is a fact of life, but so too is losing it. Menopause is a normal part of aging and natural transition all females experience. It occurs when the ovaries stop producing eggs and the reproductive hormones decline — marking the end of menstruation and fertility.

For most females, menopause begins between the ages of 40 and 55. However, it can start earlier for individuals who experience premature ovarian failure or have surgical removal of both ovaries at a young age.

But while menopause is a natural process, the changes to your body and mood may feel anything but normal. The experience of menopause varies greatly amongst individuals. Some may barely notice any symptoms, while others may experience all of them.

Common menopause symptoms include:

  • Hot flashes
  • Insomnia or sleep disturbances
  • Night sweats
  • Elevated heart rate
  • Mood changes, such as irritability, depression or anxiety
  • Vaginal dryness or discomfort during intercourse
  • Urinary incontinence or frequent urination
  • Decreased libido

Menopause is divided into three basic stages: perimenopause, menopause, and postmenopause. During this time, the ovaries begin to atrophy which causes a decline in the production of the hormones that stimulate the menstrual cycle; estrogen and progesterone. Additionally, as females age there is a natural decline in the number of eggs in the ovaries.  As a result, fertility declines. The transition from perimenopause to menopause to post-menopause usually lasts seven years or longer.

Understanding the stages will help you know what to expect, how to better manage your symptoms, and know when it’s time to talk to your healthcare provider.


The perimenopause or pre-menopause stage occurs about three to five years before menopause. The age at which females experience this stage can vary greatly. Most females begin to experience symptoms in their mid to late forties. It is rare to notice symptoms prior to age 40.

During this stage, your estrogen and progesterone levels begin to fluctuate. You may begin to experience mood changes, irregular menstrual cycles and other menopausal symptoms.

During this stage, it’s still possible to get pregnant, so continuing a form of birth control is important.


Menopause is defined as the absence of menses for 12 straight months without other causes, such as illness, medication or pregnancy. Once you reach menopause, you can no longer achieve pregnancy.

The average age of menopause is 51, but the age can vary greatly. Some enter this stage in their mid-forties and others not until mid-fifties.


The post-menopause stage signals the end of your reproductive years. While your ovaries produce low levels of estrogen and progesterone, you no longer will ovulate or menstruate.

Once you enter the post-menopause stage, you’re in it for the rest of your life. You may continue to have the same symptoms you experienced during the perimenopause and menopause stages for many years after your final menstrual cycle. Fortunately, these symptoms tend to dissipate over time. However, females in this stage are at an increased risk of heart disease and osteoporosis due to the decrease in estrogen.

The good news is no matter which stage you find yourself in, menopause symptoms often can be managed by a healthy diet, regular exercise and lifestyle modifications.

However, if your symptoms are intense enough to disrupt your quality of life, then it’s time to talk to your gynecologist or healthcare provider. Together, you can develop a personalized care plan, which may include hormone replacement therapy or other medications that will control your symptoms and improve daily function. Menopause is manageable. In fact, many report it as a positive step into a new stage in life.

About the Author

Edward Ferris, M.D., FACOG

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