Stages & Symptoms

Menopause is a transition that unfolds over time, with three phases: perimenopause, menopause, and postmenopause.¹ Each woman’s experience is unique, and the timing and symptoms can vary.

Perimenopause is the stage leading up to menopause, often beginning in the 40s and lasting several years. Hormone levels, especially estrogen, rise and fall unpredictably, which can lead to symptoms such as hot flashes, night sweats, mood changes, or sleep difficulties, as well as menstrual cycle changes causing irregular or heavy menstrual periods. Of note, that menopause symptoms can start even before menstrual cycle changes begin.²

Menopause is confirmed once 12 consecutive months have passed without a period. It signals the end of egg production by the ovaries and a significant drop in hormone levels.¹

Postmenopause is the time after menopause. While some symptoms fade with time, other symptoms such as vaginal dryness or painful intercourse (called genitourinary syndrome of menopause or GSM) may persist or even worsen. This is also a time of greater bone loss due to low estrogen levels.

Menopause is associated with a range of symptoms that can affect physical, emotional, cognitive, and sexual health. The experience varies widely, but some symptoms are very common and can significantly impact daily life. Hot flashes and night sweats are among the most well-known, affecting up to 80% of women, and for some they are severe enough to disrupt daily activities. These symptoms on average last about 7 – 8 years and may interfere with sleep, concentration, and overall quality of life.³

Changes in sleep are also common, including frequent waking, difficulty staying asleep, or early morning awakenings. While night sweats play a role, hormonal changes also can affect the quality of rest, often leading to fatigue, poor focus, and reduced productivity. Hormone fluctuations can also contribute to mood changes, such as irritability, anxiety, or depression, and existing mental health concerns may be more pronounced during this stage.⁴

Many women describe challenges with memory, attention, or concentration, often called “brain fog.”  These are more prominent in perimenopause and often resolve after menopause. Fatigue is widely experienced during menopause but is sometimes underappreciated as a symptom.⁵

Declining estrogen levels can affect the vulva, vagina, and bladder, causing dryness, discomfort with intercourse, itching, lower sexual desire, and a greater risk of urinary tract infections. These changes, known as genitourinary syndrome of menopause (GSM), are common and may persist into postmenopause if not treated. ⁶

In addition, joint and muscle aches, stiffness, and other musculoskeletal concerns are frequently reported.⁷ Lower estrogen contributes to bone loss, raising the risk of osteoporosis, particularly in women who reach menopause early or premature.⁸

Other symptoms can include headaches, migraines, bloating, skin and hair changes, dry eyes, tingling sensations in the hands or feet, and ongoing fatigue. While not every woman will experience all of these issues, menopause often brings a combination of symptoms that can influence health and quality of life in many ways.