Key stages of the Menopause

Technically speaking, the menopause is the stage at which women completely stop having periods, which happens at an average age of 51 in the UK. However, generally the term menopause is also used to describe the whole time period within which someone is experiencing symptoms of the menopause – which happens up to several years before they stop menstruating and can persist for several years after.

There is no one-size-fits-all timeline of the menopause symptoms, as most will experience them at different times and stages, and with different levels of severity.

We’ve outlined the 4 key stages of the menopause below, and the typical symptoms associated with each one. This should help you understand more about what happens to your body during the menopause process, and what to expect when you (or a loved one) go through this ageing process.

1. Premenopause

Premenopause is the time between hitting puberty (usually in someone's teens) and experiencing the first indication of ‘perimenopause’. During this time, the majority will have regular periods naturally guided by their reproductive hormones, and are able to fall pregnant. During the menstrual cycle, hormones fluctuate and this can very often cause premenstrual syndrome (PMS) symptoms – commonly causing abdominal cramps, irritability, low mood, headaches and breast tenderness.

Of course, there are exceptions to this, not everyone will experience regular periods and some may experience fertility difficulties, with some going through early menopause (our blog ‘what is the menopause?’ explains more).

2. Perimenopause

The perimenopause tends to begin in the early to mid-forties, lasting for around 3-5 years – until menstruating stops completely. Although in some cases the perimenopause will last just a few months, or even up to 10 years. The perimenopause is when the ovaries begin ageing and produce less reproductive hormones than they did before (for example oestrogen, progesterone and testosterone). Because these hormones naturally guide the menstrual cycle, as their levels decline it can be common to experience less frequent and more irregular periods.

Declining oestrogen levels in the body typically causes a range of physical symptoms including hot flushes, elevated heart rate, urinary issues, and vaginal dryness. It can also impact mood, and it's not uncommon to experience low mood or mood swings. Loss of libido (the desire to be physically intimate) is another common, yet challenging, symptom – affecting between 20-40% of women during the menopause process. Read our blog ’managing the symptoms of the menopause’to find out more about ways to treat and manage the key symptoms.

Because menstruating is still occurring during the perimenopause, although often less frequently or irregularly, they can still fall pregnant. You will need to continue to use contraception until two years after your last period if you are under 50, or a year after your last period if you are over 50. It's not always obvious that the symptoms they’re experiencing are caused by the menopause – there is a blood test available to those under 45 years of age but healthy women over 45 years of age should be diagnosed based on symptoms.

3. Menopause

The menopause is the stage at which menstruating stops completely, and you must have had 12 consecutive months without a period, as there are several other factors and conditions that may cause periods to temporarily stop or become infrequent.

The symptoms caused by the perimenopause will very often persist during the menopause stage. The main change to the body here is that pregnancy can no longer naturally occur.

4. Postmenopause

The stage beyond 12 months after menstruation has stopped is the ‘postmenopause’. For some, their perimenopause symptoms will linger for some time during this stage too. But for everyone at the postmenopausal stage, hormone levels permanently remain low after declining during the perimenopause. This increases the risk of developing more serious health conditions – particularly if symptoms aren’t addressed and treated early enough.

For example, a lack of oestrogen can lead to osteoporosis, which is a disease that weakens the bones – increasing the risk of sudden fractures. Oestrogen also helps control cholesterol levels, so once this drops, it increases the risk of heart disease.

The good news, however, is that there are several simple ways to help manage and prevent symptoms before they escalate into health risks. Read our blog ’managing the symptoms of the menopause’ to find out more.

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Medically reviewed by Llinos Connolly in March 2024.