It can be challenging to distinguish between stages of menopause due to their many shared symptoms. However, the internal process your body undergoes varies significantly in each of these stages. Therefore, learning about their differences and the measures you can take to feel better becomes your greatest tool (1). 

In total, there are 3 stages of menopause: perimenopause, menopause and postmenopause. Thus, we will explain each of them and how you can feel better when faced with their manifestations (2). 

Perimenopause: understanding the initial stage

If you have never heard the term before, you may be wondering what is perimenopause? It is usually less recognised than menopause or spoken of interchangeably. This stage marks the beginning of the process, as the ovaries begin to gradually decrease their function. As a result, the production of progesterone and oestrogen is altered, causing a loss of hormonal balance (1,2). 

Although it is a natural process, it can present physical and emotional manifestations like those expected during menopause. However, unlike menopause, in perimenopause, your menstrual cycle has not completely ceased (1,2). Specifically, this stage is characterized by irregular egg production. And as hormone levels fluctuate, you may experience symptoms similar to those of premenstrual syndrome when you encounter higher oestrogen levels. The low levels are those that can generate manifestations of menopause (1,2).  

Now, the main manifestations of perimenopause are (1,2): 

• Hormonal changes. 

• Alterations in sexual desire. 

• Concentration problems. 

• Headaches. 

• Night sweats. 

• Hot flushes. 

• Vaginal dryness. 

• Sleeping difficulties. 

• Muscle and joint pain 

• Intense sweating. 

• Need to urinate continuously. 

• Change in breast size. 

These symptoms may persist for months or years. In addition, they vary in intensity in the different stages of menopause (3). 

Menopause itself 

This is the most popular stage of menopause. It is characterized by the permanent cessation of menstruation and is officially established when at least 12 months have elapsed since the last menstrual period. It typically occurs between the ages of 45 and 55. However, it may occur earlier, known as early menopause, or later, in cases of late menopause (3,4).  

The symptoms of menopause are, for the most part, the same as those of perimenopause. They differ in the cycle changes. The reason is that menstruation ceases completely, there is no ovulation and female infertility begins naturally (4). 

It is difficult to determine exactly when you are experiencing menopause itself, as the absence of your menstrual period may last for several months. Then, you may start menstruating again just before you reach 12 consecutive months without menstruation (4). 

Postmenopause, the last of stages of menopause

This refers to the period that follows after going through menopause. At this stage, more than a year has passed without menstruation. The childbearing years are behind us, and ovulation is no longer occurring. This is when symptoms may decrease in intensity or disappear. However, some women may continue to experience them for about 10 years or even longer (5). 

At this stage, the risk of cardiovascular disease and osteoporosis increases, because oestrogen intervention, which provides some protection against these diseases (5), is no longer the same. In addition, it is the last stage of hormonal changes in a woman's reproductive life, with ovaries gradually becoming smaller. Thus, mood swings, hair loss, dry skin, slow metabolism, urinary incontinence, and variations in body weight are common (5). 

It is recommended that you consult your gynaecologist if you experience any vaginal bleeding at this stage. Ultimately, it is not considered that there can be a return of menstruation after menopause (5). 

Useful tips for all stages of menopause 

To address the manifestations of all stages of menopause, several recommendations are suggested (4): 

• Make lifestyle changes. A healthy diet and regular exercise are the perfect combination to keep your body in optimal condition. 

• Avoid caffeine, spicy foods, and bad habits, such as smoking or alcohol consumption. This will help reduce symptoms such as hot flashes and night sweats. 

• Consider hormone replacement therapy. Remember to discuss this option with your doctor, as it can help alleviate several symptoms and reduce the risk of osteoporosis. 

• Evaluate the use of topical oestrogen to improve vaginal dryness. To do so, consult your gynaecologist beforehand. In case it is not recommended for you, you can opt for water-based lubricants. 

• Explore non-traditional and alternative options as a complement. For example, meditation, yoga, acupuncture and relaxation techniques. 

Now, with a better understanding of the stages of menopause, you can recognise what stage you are in. This way, you will know how to cope with the changes in your body. It is time to take care of yourself and take time for yourself because knowing yourself and understanding the process you are going through will make it easier to embrace this stage as a natural change in your life. 

Bibliographic references 

1. NHS Choices. Overview - Menopause [Internet]. 2024 [cited 2024 Mar 6]. Available from: https://www.nhs.uk/conditions/menopause/ 

1. Hopkins medicine. Perimenopause [Internet].  N.d. [cited 2024 Mar 6]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause#:~:text=Perimenopause%20is%20the%20time%20around,%2C%20antidepressants%2C%20and%20lifestyle%20changes. 

1. NHS Choices. Symptoms - Menopause [Internet]. 2024 [cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/menopause/symptoms/ 

1. WebMD. Your Guide to Menopause [Internet]. 2022 [cited 2024 Mar 7]. Available from: https://www.webmd.com/menopause/menopause-information 

1. Cleveland Clinic. Postmenopause: Signs, Symptoms & What to Expect [Internet]. 2021 [cited 2024 Mar 7]. Available from: https://my.clevelandclinic.org/health/diseases/21837-postmenopause