Perimenopause vs menopause vs postmenopause: How to navigate this life stage

Menopause marks the end of one period in your life and the beginning of another chapter.

And, for a long time, menopause has largely been misunderstood, underfunded and considered taboo, but with more awareness and education being widely shared, it’s becoming an everyday conversation — as it should.

Because of this, you might find yourself entering menopause without knowing exactly what’s happening and how it may affect you. 

That's where we come in, we’ve gathered everything you need to know about perimenopause, menopause and postmenopause to help you enter this stage of life with as little disruption and confusion as possible.

What is menopause?

Menopause marks the end of a woman’s menstrual cycle — meaning pregnancy is no longer possible — with the average age of natural menopause occurring around 51 in the Western world [1].

Unsurprisingly, there are a bunch of changes happening in your body as you go through menopause. A woman’s ovaries get smaller, shrinking on average 30 per cent and the body makes less oestrogen and your ovaries stop releasing eggs [2].

Whilst menopause is confirmed 12 months after a woman’s last period, symptoms can come much earlier than that — years in some cases.

What is perimenopause?

Perimenopause (sometimes known as menopause transition) refers to the stage before you enter menopause. On average, it lasts for three to four years but it can last only months for some, and others may not even know they’re going through perimenopause at all [3].

People going through perimenopause may find their periods become irregular, before eventually stopping altogether. 

It can be difficult to determine when a woman enters perimenopause because symptoms often vary and the age at which perimenopause begins varies dramatically from person to person.

Typically, it begins during a woman’s 40s but some women experience symptoms as early as their mid-30s [4]. If you're experiencing hot flashes long before you're considered to be in menopause, it could be perimenopausal symptoms.

Once your periods have stopped for a full 12 months, you're considered to be in the menopause phase and as a result, can no longer get pregnant.

What is postmenopause?

Once your periods have stopped for 12 months consecutively, you are officially considered to be postmenopause.

In the postmenopausal stage, women can still experience menopausal symptoms (more on that later) and these can last for several years.

What's the difference between menopause and postmenopause?

The postmenopause stage refers to the time after menopause has occurred and a woman no longer has periods and cannot get pregnant. In this journey, postmenopause is the final stage. 

By the time a woman reaches postmenopause, many bothersome symptoms should begin to subside or have stopped altogether as hormones settle. However, some women can still experience symptoms for years following menopause.

What are the different stages of menopause?

Here's the in-depth breakdown of the menopause timeline.

Perimenopause

Perimenopause is the first stage marking the ending of a woman’s menstrual cycle. The age in which this begins varies drastically from woman to woman, but the average age is the mid to late 40s. However, some women start to experience symptoms in their 30s.

During this stage, you’ll likely experience many common perimenopausal symptoms like hot flashes (also known as hot flushes), irregular periods, mood changes (like mood swings, brain fog, or a decline in your mental health), headaches, vaginal dryness, problems sleeping, fatigue, problems sleeping, night sweats, weight gain, and many other symptoms. 

Menopause  

As previously mentioned, women typically enter menopause in their late 40s and 50s [1].  Entering menopause earlier than your 40s is referred to as premature menopause.

Premature menopause (or early menopause) isn’t incredibly common but perhaps more than previously thought (affecting around one per cent of women under 40) [5]. Little is known about the effects of premature menopause, but low levels of estradiol (a form of the hormone oestrogen) can indicate that a woman’s ovaries aren’t working at full capacity or as they are expected. 

Menopause can also be medically induced before the age of 40 for a variety of health reasons.

Postmenopause

Postmenopause signals the final stage of the menstrual health journey. Symptoms should start to subside during this stage, however, for some women, it can take years to settle.

You can always visit your GP if you’re struggling with symptoms caused by menopause, no matter what stage you’re in.

Menopause and perimenopause symptoms

Perimenopause and menopause symptoms can vary significantly from person to person, some barely noticeable and some completely debilitating to everyday life. In fact, a 2016 study found that 90 per cent of women seek out advice from their healthcare provider on how to cope with their symptoms [4].

Changes to your period

One of the most obvious symptoms you’re entering perimenopause is changes in your period, they might be irregular and eventually stop altogether. 

Hot flashes

Medically known as vasomotor symptoms, hot flashes are sudden changes in body temperature hot or cold predominantly of the face, neck and chest, which can make you feel extremely uncomfortable and even dizzy. It’s estimated that up to a third of women experience hot flashes. [4] It's also suggested that cognitive behavioural therapy (CBT) can help to relieve hot flashes and lessen severe hot flashes.

Insomnia or trouble sleeping

Trouble sleeping can impact life profoundly and can be truly miserable to deal with; not to mention the impact lack of sleep can have on one’s long-term health. Many people going through perimenopause experience difficulty staying asleep through the night and also getting to sleep, which is due to hormone fluctuations [6]. Trouble sleeping might also be due to night sweats.

Depression

Feelings of depression can be common during menopause.

A study from 2016 found that women who had no prior experience with depression were two to four times more likely to experience a depressive episode when going through perimenopause and menopause [7].

It also found that those diagnosed with depression pre-menopause are even more likely to experience it during this transition. 

Decreased libido

Another common symptom is decreased libido due to hormone changes, specifically lower levels of oestrogen and testosterone. 

Vaginal dryness

Also known as vaginal atrophy or atrophic vaginitis, vaginal dryness affects up to one-third of women during perimenopause thanks to the drop in hormones [4].

This is a symptom that, unlike many of the others, doesn’t tend to get better over time without treatment. Menopausal Hormone Therapy (MHT), previously referred to as Hormone Replacement Therapy (HRT), can help with vaginal dryness thanks to the replenishment of oestrogen.

Alternatively, vaginal lubricants can be incredibly helpful. NORMAL's Water-Based Lube is a gentle and paraben-free formula that can help make sex after menopause easier.

Joint pain

While research is limited when it comes to the other less common (but still extremely difficult) symptoms of menopause such as joint pain, it's thought that the hormone oestrogen plays a role in this and impacts connective tissue to cause discomfort.

Fatigue

With all of the hormone changes and disturbed sleep, it’s no wonder that a lot of women experience fatigue during menopause.

Urinary difficulties

Urinary difficulties are extremely common during menopause, with around 50 per cent of women experiencing issues [8]. This is due to the fact that the urinary tract contains oestrogen receptors in the urethra and bladder, and this drop in hormone levels means women can experience incontinence and other issues like infections [7].

Anxiety

Anxiety is another common symptom, with a study from 2021 finding that 58% of its participants experienced anxiety during menopause [9]. Anxiety and stress can produce consequent symptoms such as bloating due to the connection between your mind and gut.

How do you know if you're in menopause or postmenopause?

It’s difficult to determine what stage of menopause you’re in because there’s no singular test that diagnoses it. But, you're considered to have reached menopause once you've been without a period for 12 consecutive months and the postmenopause stage begins.

Typically, the symptoms you experienced during perimenopause should begin to subside, but many women can experience these symptoms for a few years during postmenopause. 

It’s important to know when you have reached the menopause and postmenopause stage (this is easily done by using a tracking app or noting your cycle and its irregularity in a calendar) because there are certain health conditions women are more prone to as they enter the postmenopausal stage. 

Is postmenopause worse than perimenopause?

There’s no clear-cut answer to whether one stage of menopause is better because every woman responds to these changes in hormones differently. Plus, there still isn’t enough research on menopause to determine how many of these symptoms are impacting different groups of women. 

It’s no secret that menopause has a huge impact on a woman's life, though. It can impact their personal life, work life and relationships with many studies acknowledging this [10].

Not all women report symptoms brought on by menopause, but those who do often note that it can be a significant burden to the quality of everyday life. 

Having said that, help is out there for those who need it. With the right treatment plan and guidance from a medical professional or service, hormones can be rebalanced through MHT to help alleviate those unwanted symptoms.

Complications of being in menopause

Going through menopause and entering the postmenopausal stage in your life can also come with increased health risks (such as cardiovascular disease), which is why it’s super important to be in tune with your body and track any symptoms you’re having.

Complications can include:

Bleeding

Once you’ve reached 12 consecutive months of no menstrual cycle, you aren’t expected to experience bleeding after this.

If you do experience bleeding, you should contact your GP to report your symptoms and pay them a visit — even if the bleeding is a one-off. It’s not typically something to worry about but it can, in some cases, be a sign of something more serious like cancer so it’s definitely worth getting checked out.

Cardiovascular disease

After menopause, women can be at higher risk of cardiovascular disease (conditions affecting the heart and blood vessels), due to the drop in oestrogen levels [7].

Osteoporosis

Another health complication of menopause can be osteoporosis, a condition that weakens the bones. This may require medical intervention to rebalance your hormone levels [5].

Urinary incontinence/UTIs

Suffering from urinary incontinence and urinary tract infections (UTIs) is another fairly common health issue that can occur due to the plummeting of oestrogen, which is needed for the receptors in the urethra and bladder [7].

Preparing for the perimenopause and menopause stage

Knowledge is key when it comes to menopause. Due to the taboo in discussing symptoms and issues relating to menopause, many women may feel like they can't talk about their symptoms and struggles. You absolutely should seek help if and when you need it because for many women it can be life-changing. 

Symptoms relating to menopause can be debilitating and last for years, affecting a woman's mental health. The transition and changes in a woman's body can also put them at higher risk for other conditions and diseases making it important to know what signs to look out for. 

No matter what stage you are in life, it’s always helpful to track your periods as this can help you plan ahead, spot any patterns that may seem off and record when your periods start to become more irregular and eventually stop altogether. 

How to alleviate perimenopause and menopause symptoms

While MHT is the most effective way to treat menopausal symptoms, there are a few other things you can do that can help. But, it does depend on the individual and what works for one, may not work for the other.

Lifestyle choices can play a big role in menopausal symptoms, so try your best to nail down these things.

Healthy diet

Making sure you're eating a varied diet is important for your overall health but especially important if your hormones are all over the place. It's even more vital if you have a family history of certain conditions like heart disease.

You may experience hormonal weight gain during menopause so eating healthily and moving your body can help mitigate some of this.

Physical activity

Staying on top of movement is also something that is going to positively impact your overall health, in particular, it can help with your cardiovascular health.

Experts often recommend relaxing exercises and practices such as yoga and tai chi.

Sleep hygiene

Maintaining a good sleep routine can help to get your body into a cycle of restful sleep. This includes sticking to a regular time schedule, limiting screen time before bed and setting up a relaxing nighttime routine.

Reduce alcohol intake

It's recommended to reduce or limit your alcohol intake as it can exacerbate existing symptoms like night sweats, mood swings, mental health issues and hot flashes.