• Menopause
• Vaginal Changes

A Comprehensive Guide to the Stages of Menopause

Medically reviewed and edited by Lauren Cramer, PA- C

Published: August 01, 2023
Updated: November 11, 2025
5 mins

Menopause is a significant and transformative phase in a woman's life that marks the natural end of her reproductive years. 

As women go through menopause, they will experience three distinct stages. Each one is characterized by unique experiences and challenges.

Understanding these stages is important for navigating menopause with confidence and knowing what you can do to lessen its impact. 

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The Different Stages of Menopause

There are three distinct stages of menopause that develop in different periods of a woman’s life.

Perimenopause is defined as the transitional phase leading up to menopause. 

This period typically takes place seven to 10 years before menopause, and symptoms can start as early as the mid-30s (more commonly 40s).

During perimenopause, ovulation becomes less consistent. That means lower and less reliable progesterone, while estradiol (estrogen) swings high and low instead of staying predictable. 

Over time, the brain compensates by turning up FSH, trying to coax the ovaries into producing more estradiol. During this time, hormone imbalances become evident and responsible more many symptoms during this time such as irregular menstrual periods 

The symptoms of menopause can vary from person to person. Common signs of perimenopause include:

• Cycle changes: Periods may become shorter or longer, with heavier or clottier bleeding and occasional spotting between cycles.

• Vasomotor symptoms: Hot flashes, night sweats, and chills are common as hormones fluctuate.

• Sleep and cognition: You may notice two to four a.m. wake-ups, brain fog, trouble finding words, or shifts in mood and anxiety.

• Metabolic and body composition: Weight may shift more easily to the midsection, with increased carb cravings and more difficulty losing fat.

• Musculoskeletal: Joint stiffness, new post-exercise soreness, and hormone-related headaches or migraines can appear around hormonal swings.

• Skin, hair, and urogenital health: Skin may feel drier, hair shedding can increase, and vaginal dryness, discomfort with sex, or urinary urgency and infections may develop.

• Sexual health: A noticeable decrease in libido or desire is also common during this transition.

These symptoms can be mild or severe and may last for anywhere from a few months to several years. 

Managing your symptoms with lifestyle changes

During this phase, it’s essential for women to manage their health proactively to alleviate some symptomatic discomfort. Helpful strategies you can implement include:

Staying physically active: Focus on movement that builds strength and supports insulin sensitivity. Aim for strength training two to four times per week using progressive weights that target major muscle groups like the legs, hips, back, and chest. Incorporate moderate “zone 2” cardio and short bursts of high-intensity exercise as tolerated, and try to keep your daily step count consistent.

Prioritizing recovery: Make time for rest and restoration between workouts. Support recovery with regular mobility work, a protein-rich meal or snack after training, and consistent, high-quality sleep.

Maintaining a healthy diet: Eating a balanced diet rich in different nutrients and food groups to improve overall well-being. You should also minimize processed foods, caffeine, and alcohol because they may worsen symptoms. Try to build each meal around protein (about 25–35 grams per meal) and include plenty of fiber (25–35 grams per day), colorful fruits and vegetables, and omega-3-rich foods. Limit ultra-processed foods and added sugars as much as possible.

Managing stress: Stress and anxiety can aggravate symptoms and increase discomfort. Practicing relaxation techniques – such as meditation and deep breathing exercises – can help reduce these feelings.

Getting enough sleep: Prioritize getting proper sleep by establishing a regular bedtime schedule, morning light, and a cool, dark bedroom for your wind-down routine. You can also improve your sleep hygiene to promote a better night’s rest.

Staying hydrated: Drinking enough water can help prevent dehydration which can worsen symptoms like hot flashes. 

Menopause

When you enter the natural menopause phase, you are at the end of your fertility cycle.

Most women will enter this stage of menopause around the average age of 51, but it may occur earlier or later for certain individuals. 

This phase concludes when a woman has gone without a period for 12 consecutive months.

During menopause, the ovaries start producing even less hormones, which causes a rapid decline in estrogen, progesterone and testosterone.

This decrease leads to permanent loss of the menstrual cycle. Estrone becomes primary estrogen, a much weaker estrogen coming from adipose tissue.

Menopause can cause physical and emotional symptoms, including:

• Experiencing hot flashes and night sweats

• Noticing vaginal and urinary changes

• Feeling increased irritability

• Experiencing anxiety and depression

• Having a lower libido

• Losing bone density

These symptoms can range from mild to severe, with varying duration for each woman.

If these symptoms significantly impact your daily life, seek medical advice from your healthcare provider.

You should also create a supportive environment of close friends and family.

They can offer help and guidance during this challenging time, especially if some have already gone through menopause. 

Managing your vasomotor symptoms and osteoporosis risk

In addition to implementing the same strategies that are used during perimenopause, you can also do the following to alleviate menopausal symptoms:

• Dress in layers: Wear lightweight, breathable clothing that can be removed easily. This helps to control fluctuating body temperatures that contribute to hot flashes. 

• Use cooling techniques: Keep a fan nearby, use cooling cloths, or take a cold shower to alleviate symptoms like hot flashes and night sweats.

• Avoid triggers: Identify and avoid triggers that may worsen your symptoms, such as spicy foods, alcohol, or caffeine. 

• Maintain bone health: Eat foods rich in calcium and vitamin D or consider taking a supplement to ensure healthy bones. You can also incorporate weight-bearing exercises into your routine to prevent bone density loss. 

These strategies can help reduce the severity of your symptoms and provide some relief from discomfort. 

You can also speak to your doctor about hormone replacement therapy (HRT).

HRT is a medical treatment that involves replacing hormones – such as estrogen, progesterone and testosterone – to reduce menopause-related symptoms in women.

This treatment method aims to balance hormone levels and manage acute symptoms such as, hot flashes, night sweats, mood swings, and vaginal dryness. It can also protect against bone loss, cardiovascular and metabolic health decline, improve skin and hair and improve women’s vitality and quality of life.

Each woman should be evaluated on an individual basis by a qualified healthcare provider to discuss medical history and needs.

Regular check-ups and consultations with your provider are essential for safe and optimal HRT management.

Postmenopause

Postmenopause is a stage of a woman’s life that begins after she has reached menopause. It marks the end of the transition and typically occurs during a woman’s 50s. 

During postmenopause, hormones stabilize at undetectable levels, and most menopausal vasomotor symptoms start to resolve.

It’s important to note that some women may still experience some menopause-related changes and need to take specific considerations during this phase. These include:

• Health considerations: Focus on implementing strategies that can improve your bone health (to prevent osteoporosis), cardiovascular health (to lower the risk of heart disease), and breast health (to monitor potential breast cancer developments).

• Hormonal changes: Estrogen and progesterone levels remain undetectable during postmenopause, which can affect various aspects of your health – such as the metabolism. It’s important to take steps to manage the effect of these changes.

• Vaginal changes: Vaginal dryness can persist during postmenopause, which can cause discomfort during intercourse and increase the risk of urinary tract infections (UTIs). Using products like lubricants and vaginal moisturizers can help alleviate this.

• Emotional well-being: While mood swings and emotional instability are less common during this phase, keeping your mental health in mind and implementing strategies to ensure you stay healthy is vital. 

• Continued self-care: Maintaining a healthy lifestyle — including regular exercise, a balanced diet, stress management, and adequate sleep — remains essential during postmenopause. This helps to promote overall well-being and prevent age-related health issues.

• Regular health check-ups: Women in postmenopause should continue to have regular check-ups to monitor their overall health and address any emerging concerns.

Remember that postmenopause will be different for everyone. If you have any questions or concerns during this stage, discuss them with your healthcare provider. 

What can you expect after this stage?

Postmenopausal women can expect to be in this stage for around a third of their lives.

In this phase, it’s important to keep taking care of your health and continue with any productive habits you’ve implemented during menopause.

These healthy habits will help you avoid any age-related complications that may become more common during postmenopause.

How Do You Know Which Stage of Menopause You’re in?

Identifying which menopausal state you're in involves understanding the different stages of menopause and recognizing the associated signs and symptoms. 

• Perimenopause: During perimenopause, irregular menstrual cycles and symptoms like hot flashes, mood swings, weight redistribution and sleep disturbances may occur. This phase typically starts seven to 10 years before menopause.

• Menopause: Menopause is over when a woman has gone 12 consecutive months without a menstrual period

• Postmenopause: Postmenopause begins one year after you’ve had your last period.

Recognizing the signs of each stage can help you determine where you are in the change of life.

A healthcare provider can also assess your hormone levels with a lab test to help you find out which stage you are in.

They can also assess your medical history to provide a more accurate understanding of your menopausal state.

Individual Variations and Experiences

Menopause is an individual experience, and its impact can vary significantly among women. 

While menopause may have a minimal impact on some individuals, others may find this period of time very challenging. 

There are various factors that influence the duration and severity of menopause symptoms, making each woman’s journey unique.  

Genetics play a significant role in determining how a woman experiences menopause.

If a person’s mother or sisters had a relatively smooth transition, the individual will likely have the same experience.

Other factors – like lifestyle choices, diet, exercise, and stress management – can also influence individual experiences and especially the severity of the symptoms.

Women with good overall health tend to have an easier menopause transition.

It’s important to acknowledge these factors when trying to seek help for your menopause symptoms – remember that what works for one person will not necessarily be effective for everyone.

Your medical provider can help you navigate this transitional phase by assessing your hormone levels and providing a tailored treatment that suits your specific needs.

Whether it's HRT, lifestyle adjustments, or complementary therapies, a customized approach can improve a woman's quality of life during perimenopause, menopause and post-menopause.

Supportive and compassionate communication among women is equally important.

Sharing your experiences and talking to others can provide you with valuable insights and reassurance. This also helps to foster a sense of community during this phase of life.

Where Can I Learn More About the Different Stages of Menopause?

If you’re noticing changes in your body or want to understand more about menopause, the LifeMD Women’s Health Program is here to support you. Qualifying patients receive personalized guidance tailored to their experience, whether they’re navigating menopause or beginning to notice perimenopausal changes.

Schedule an appointment with LifeMD and get expert support for every stage of menopause – all from the privacy and comfort of your home.

Lauren Cramer, PA- C

Lauren is a passionate and dedicated board-certified physician assistant. She received her Bachelor’s degree in Kinesiology and Exercise Science from SUNY Cortland — graduating magna cum laude while competing as a three-sport collegiate athlete in indoor and outdoor track and cross country. She went on to complete her Master’s degree in Biological Sciences and earn her Physician Assistant degree from Daemen College in Buffalo, New York. Lauren has years of focused experience in perimenopause, menopause, and postmenopause care, specializing in hormone replacement therapy (HRT), bone health optimization, and a functional medicine approach to women’s wellness. She integrates evidence-based hormone therapy with lifestyle, nutrition, and metabolic strategies to support long-term vitality, cognitive health, and bone density. In addition to her women’s health expertise, Lauren has a well-rounded background in allergy, asthma, otology, laryngology, and rhinology. Functional medicine has always been a passion of hers, and she continues to pursue advanced certification to deepen her ability to deliver personalized, root-cause care to her patients.

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