Understanding Menopause Stages: Premenopause, Perimenopause, Menopause, and Post-Menopause Explained

Menopause is defined as going through 12 consecutive months without having a menstrual cycle in a woman’s life ^{(1, 3)}. It is the official end of the female reproductive cycle. Perimenopause is a transitional period leading to menopause which occurs when the actual menopause starts ⁽²⁾. Premenopause is a stage where the patient does not have symptoms of either and occurs before the menopause stage. Perimenopause occurs around the time of menopause and is loaded with many changes.

Menopause is a fairly well known term, but not many women are well versed with the different stages occurring with menopause, which are equally important to identify and understand. Menopause officially occurs when a woman stops menstruating. Perimenopause means “around the time of menopause” and is a transitional phase before menopause. Post-menopause is the stage, which occurs a few years after menopause.

In this article, we will discuss the different stages within the menopause and their meaning, symptoms and management.

Premenopause vs. Perimenopause

Premenopause and perimenopause are often interchangeably used; however, they have different meanings. Premenopause occurs before well before menopause and when a woman does not experience any symptoms of perimenopause or menopause.

She still continues to have periods and they can be regular or irregular, but still are considered reproductive years. There are some hormonal changes occurring, however, no obvious changes seen.

Perimenopause on the other hand occurs around the time of menopause and is filled with a gamut of symptoms of menopause and include: hot flashes, changes in menses, mood swings and sleep disturbances.

When Does Perimenopause Occur?

Perimenopause occurs around the time the official menopause begins. According to the Cleveland Clinic, a woman can go through Perimenopause and experience hormonal changes about 8 to 10 years before the actual menopause ⁽⁴⁾. These changes can occur during the 30s or 40s of a woman’s age.

The characteristic feature of Perimenopause is declining estrogen levels, which is the primary female hormone that the ovaries produce. There can also be fluctuation in estrogen levels, which can cause irregular periods along with other symptoms ⁽⁵⁾.

Final stages of perimenopause are when the body starts to produce less and less of estrogen. However, it is important to remember that the possibility to get pregnant still exists. The duration of perimenopause can be few months to a few years.

When Does Menopause Occur?

Menopause is officially said to occur when the ovaries stop producing estrogen altogether or produce so less estrogen that the eggs are no longer released causing the periods to completely stop altogether ⁽³⁾. The diagnosis of menopause is made once the woman has not had a period for a complete year.

When can a Woman Experience Early Menopause?

A woman can enter early menopause if ^{(6, 8)}:

• There is a family history of early menopause.
• If she has undergone oophorectomy or hysterectomy.
• If she is a smoker.
• If she has had cancer treatments.

What are the Symptoms of Perimenopause and Menopause?

Some of the common and most talked about symptoms of menopause are hot flashes, weight gain amongst others.

Symptoms of perimenopause consist of ⁽⁷⁾: Irregular periods, which can be lighter heavier or than usual; worsening of premenstrual syndrome; weight gain; breast tenderness; changes in skin and hair; headaches; palpitations;  decreased libido; difficulty in concentration; muscle aches; forgetfulness; urinary tract infections (UTIs) and fertility issues.

Symptoms of Menopause are: As there is reduction in the estrogen levels, the woman starts to have symptoms of menopause some of which can occur while she is still in the perimenopause stage. Menopause symptoms consist of: hot flashes, night sweats, depression, irritability or anxiety, insomnia, mood swings, skin and vaginal dryness; fatigue, and frequent urination.

Increased Cholesterol levels in Menopause: A woman going through perimenopause and menopause will also have elevated cholesterol levels, which in turn increases the risk of heart disease in menopausal women.

What is Post-Menopause?

This stage occurs after menopause and can be present for about 3 to 6 years after the menopause ⁽⁸⁾. Some of the symptoms of post-menopause include hot flashes, which can persist for many years after the menopause has occurred. In this stage, the woman will not have periods whatsoever and she cannot get pregnant ⁽³⁾. The symptoms of menopause will subside with time; however, there can be some long-lasting changes. The decreased production of estrogen and progesterone increases the risk of ⁽³⁾:

Heart disease, osteoporosis, decreased muscle mass, weight gain, vaginal dryness and decrease in the size of the urinary tract and vagina which is known as uro-genital atrophy.

When Should A Doctor Be Consulted?

A doctor should be immediately consulted when there is:

• Spotting after the period is over.
• If there is bleeding after sex.
• If blood clots are passed during the period.
• If the duration of periods is longer or shorter than usual.

Some of the potential causes other than menopause for the above symptoms are fibroids or hormonal imbalances, which are both treatable. The possibility of cancer should be excluded by consulting a doctor.

It is also important to seek medical attention if the symptoms of perimenopause or menopause are severe and are disrupting your daily life.

How to Manage or Treat Perimenopause and Menopause?

There are over-the-counter (OTC) and prescription treatments for dealing with the symptoms of perimenopause and menopause such as:

Estrogen Therapy ⁽⁹⁾: Hormone (Estrogen) therapy is given for normalizing the levels of estrogen, so the patient does not experience uncomfortable symptoms with abrupt drops and spikes of this hormone. Some estrogen forms can also help in reducing the risk of osteoporosis.

Estrogen is often used in combination with progestin and is available in different forms such as: oral pills, gels, skin patches and creams.

Other Medications: Other medications for treating the symptoms of menopause are more targeted such as:

Prescription vaginal creams can be used to relieve the dryness and pain during intercourse.

Gabapentin is a seizure medication, which can be given for managing hot flashes.

Antidepressants can be given to treat depression, mood swings, irritability and anxiety.

Home Remedies and Lifestyle Changes for Perimenopause and Menopause

Some of the ways to relieve the symptoms of perimenopause and menopause at home are:

Exercising regularly has lot of benefits, such as better mood, dealing with weight and even hot flashes. Avoid exercising just before bedtime, as it can worsen insomnia.

For tackling insomnia one indulge in relaxing activity before sleeping such as soaking in a warm bath, journaling or yoga. Daytime naps should be strictly avoided as it can interfere sleeping at night.

Some of the other steps which should be undertaken to relieve symptoms of menopause are avoiding large meals, limiting alcohol and caffeine intake; quitting smoking; all these will help with managing the insomnia, hot flashes and other menopause symptoms.

Conclusion

Perimenopause and menopause are both important transitional stages in a woman’s life which signify the end of her reproductive years.

A woman goes through a lot during her life and has to make considerable adjustments to feel better. She should not hesitate to seek a doctor’s opinion if any of the symptoms is proving to be too much and is bothering her a lot, so much so she cannot perform her daily tasks. There are different types of treatment and management available, so a woman can go through this phase much easily and manage her symptoms in a better way.

References:

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