Woman understanding the three stages of menopause and how her body changes

Understanding the Three Stages of Menopause: What Changes and Why

Menopause is a natural stage of a woman's life, but the journey towards it can look different for every woman. Some women experience noticeable changes and symptoms, while others may move through menopause with very few symptoms. Understanding the different stages can help you recognise what may be happening in your body and make sense of the changes you experience.

Dr Marilyn Glenville PhD, in Understanding the Menopause, describes three distinct phases: pre-menopause, peri-menopause and post-menopause. Each stage reflects a different point in the transition, from the time when periods are still regular through to the years after the final period.

What happens during menopause?

The monthly menstrual cycle is governed by several reproductive hormones, including oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH). As a woman approaches menopause, changes in ovarian function affect this hormonal pattern.

As the ovaries decline in their production of oestrogen, the body responds by producing more FSH. The adrenal glands can also produce a form of oestrogen called oestrone, while oestrogen can also be produced from fat cells.

These changes do not happen in exactly the same way for every woman. Menopausal symptoms vary considerably. Some women may experience hot flushes and night sweats, while others may notice changes such as mood swings, declining libido, changes in energy, joint pains, weight gain, headaches or changes in hair quality. Our full guide to menopause symptoms covers the complete list.

It is also important not to assume that every symptom experienced around this time is necessarily caused by menopause. Other health conditions can produce symptoms similar to those associated with menopause, so investigating the cause matters.

The three stages of menopause

Stage one: pre-menopause

Pre-menopause is the first of the three stages. During this stage, periods are still regular, but the first symptoms associated with the transition may begin to appear, such as hot flushes and mood changes. This means a woman may still be having regular periods while beginning to notice changes that suggest her body is moving towards the next stage.

During the years leading up to menopause, ovulation becomes less likely. Declining oestrogen levels can affect the production of progesterone during the second half of the cycle. FSH levels may continue to rise, and a period can still occur even when ovulation has not taken place. This stage can therefore involve changes that are not always immediately obvious from the menstrual cycle alone.

Stage two: peri-menopause

Peri-menopause is the second stage. The function of the ovaries declines during this phase, periods can become irregular and symptoms may become more severe.

For some women, this can be a time when changes become more noticeable. Symptoms include hot flushes, night sweats, vaginal dryness, mood swings, declining libido, lack of energy, joint pains, weight gain, headaches and changes in hair quality.

However, experiencing symptoms does not necessarily mean that every change is caused by menopause. Finding out what's behind symptoms matters more than automatically attributing them to hormones. FSH levels can provide an indication of where a woman may be in the menopausal transition, rising during this phase, although they can vary from month to month.

Stage three: post-menopause

Post-menopause is the third stage and begins from the last period onwards. Medically, the general passage through menopause is termed the "climacteric", while the last menstrual period itself is referred to as "the menopause".

Reaching post-menopause does not necessarily mean every symptom will suddenly disappear. Menopause is a transition in which women experience symptoms differently, and supporting overall wellbeing remains important throughout this stage, including attention to diet, nutritional intake and exercise.

Why every woman's experience can be different

One of the most reassuring points to understand is that there is no single menopausal experience. Some women move through menopause with hardly any symptoms, noticing little more than the eventual stopping of their periods. Others experience much more pronounced physical and emotional changes.

Menopause is also experienced differently across cultures, with lifestyle and diet thought to play a role. It's worth viewing menopause as a natural stage of life rather than automatically treating it as an illness, while still investigating symptoms properly before beginning any medication or natural treatment programme, since symptoms associated with menopause can have other causes.

Supporting yourself through the transition

A general approach to health throughout the menopausal transition includes reducing sugar and refined foods, choosing complex carbohydrates and eating them little and often, ensuring sufficient essential fatty acids from foods such as oily fish, nuts and seeds, and getting plenty of fibre from fresh fruit, vegetables and whole grains.

Phytoestrogen-containing foods are another important part of this approach, including soya, linseeds, whole grains, chickpeas and lentils, as well as garlic, fennel, celery, rhubarb, parsley and hops. Our article on phytoestrogens and menopause covers this in depth.

Nutritional supplements and herbs can also play a role. Meno Support Multi provides a broad nutritional foundation for this life stage, while Meno Herbal Support combines agnus castus, black cohosh and dong quai for symptom-focused support — see our full herbal guide. Herbal approaches require particular care: women taking HRT or another hormonal treatment should not take these herbs unless recommended by a registered, experienced practitioner.

Common questions about the stages of menopause

How long does each stage last? This varies significantly between women. Pre-menopause and peri-menopause together can span several years, while post-menopause is technically permanent from the point of the final period onwards.

Can you skip a stage? No, all three stages reflect the same underlying biological process of declining ovarian function, though how noticeable each stage is varies enormously from woman to woman.

Do symptoms get worse at each stage? Not necessarily in a straight line. Many women notice symptoms peak during peri-menopause specifically, when hormone levels are fluctuating most, then settle somewhat once they reach post-menopause.

How do I know which stage I'm in? Your doctor can measure FSH levels for an indication, though these can vary month to month. Tracking your cycle and symptoms alongside this gives a clearer overall picture.

Understanding where you are can be reassuring

Knowing the three stages of menopause can provide a useful framework for understanding the changes taking place. Pre-menopause describes the stage when periods remain regular but early symptoms may appear. Peri-menopause is marked by declining ovarian function, increasingly irregular periods and potentially more noticeable symptoms. Post-menopause begins from the last period onwards.

Most importantly, every woman's experience can be different. If you are experiencing symptoms, don't automatically assume menopause is the cause. Take the time to investigate what's happening and speak with a qualified health professional when appropriate.

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This article is for information only and is not intended to be a substitute for medical advice. Always consult a qualified doctor or health practitioner before making changes to your diet or supplement routine.

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