Menopause stages: What to expect in your 30s, 40s, 50s, and beyond

A change of career, a different home, a new addition to the family. Life can often bring sudden, abrupt changes, where you’re forced to adapt in the moment as best you can. When it comes to menopause, however, the changes can be much more gradual, causing you to continue adapting year after year after year.

While menopause signals the end of your reproductive years (12 months after your last period), hormone fluctuations start well before this, in a stage called perimenopause, and symptoms continue after, into your post-menopausal years.

This article will help shed some light on what stage of menopause you may be in, from the early signs of menopause at around 40 to post menopause symptoms at around 60. Understanding where you may sit on this journey can be empowering and help you make decisions to get the care you need.

Menopause occurs over three main stages. These are:

• Perimenopause: This typically starts with irregular menstrual cycles and ends one year after your final menstruation. 

• Menopause: The point in time when it’s been 12 months since your last period.

• Postmenopause: The years following menopause.

There is also something known as surgical menopause, which is the sudden onset of menopause after the removal of both ovaries. It causes a sudden drop in estrogen and progesterone, rather than the fluctuation and gradual drop associated with natural menopause.

Perimenopause

The first menopause stage is perimenopause. It lasts for an average of three or four years, but can be as short as a few months or as long as a decade. The symptoms of perimenopause, like hot flashes, night sweats, vaginal dryness, and mood changes, are due to the fluctuations in hormones, especially estrogen.

Menopause

Menopause is the point when you have gone 12 consecutive months without a period. This signals the end of your reproductive years, so it’s advised to continue with a contraception plan until menopause is confirmed.

Postmenopause

The definition of postmenopause is the time after menopause. You will stay in postmenopause for the rest of your life. You may continue to have menopause-like symptoms due to estrogen deficiency, like hot flashes, poor sleep, genitourinary symptoms, and mood changes, but they generally improve the further out you get from menopause.

How clinicians diagnose stages of menopause 

In most cases, a diagnosis for perimenopause or menopause is based on your age and symptoms. There’s no single test to tell if you’ve started perimenopause. Some clinicians may order tests to check your hormone levels like follicle-stimulating hormone (FSH) and estrogen. But these levels fluctuate so much in perimenopause, so the tests aren’t routinely used to diagnose menopause and can be misleading. 

A typical visit to your clinician for a menopause diagnosis may start with an overview of your symptoms and menstrual cycle history, followed by a medical review and recommended treatment plan.

On average, perimenopause begins in your 40s, menopause typically occurs in your early 50s, and post-menopause follows that. While the transition can vary from one person to another, here’s what you may experience as you age from your 30s to 60s:

In your late 30s

During your late 30s, the number and quality of follicles in your ovaries diminish, as does the number of ovulatory cycles. This leads to fluctuations in estrogen and progesterone levels throughout the cycles and from one cycle to another. While this can cause some people to notice menopause-like symptoms in their late 30s, it’s not the norm and you should bring it up to your clinician. And if your periods fully stop before 40, it could be premature menopause and should also be discussed with your healthcare provider.

In your 40s

Early perimenopause symptoms can be defined by occasionally missed periods and cycle irregularity. Later stages are more commonly associated with significant irregularity and long periods of time without a period, decline in ovarian function, and more physiological changes as a result.

Signs of perimenopause in your 40s include erratic periods, flow changes — lighter and heavier bleeding — hot flashes, and night sweats. Genitourinary symptoms like vaginal dryness are also common symptoms of perimenopause. This stage ends when you reach menopause.

In your 50s

The median age of menopause in the United States is 51 years old, but vasomotor symptoms, like hot flashes, can start before menopause and continue for years after you reach this point. You also may notice mental health changes, including:

• Irritability

• Anxiety

• Depression

• Loss of concentration

• Lack of confidence

Menopausal women may struggle with more sleep difficulties than premenopausal women, including night sweats, insomnia, sleep apnea, and restless leg syndrome.

In your 60s and beyond

As you get further and further away from menopause, hot flashes and night sweats can become less prominent. But genitourinary symptoms, like vaginal dryness, tend to be more severe and progressive without treatment. Women in postmenopause may also experience decreased libido and symptoms of sexual dysfunction.

It can feel unsettling to notice changes in your body and mood, but talking about it with your clinician can help put your mind at ease. If you notice any of these signs, you may be in the perimenopausal phase, and should touch base with your clinician.

Period and bleeding changes

The first signs of perimenopause are usually a change to your menstrual cycle. You may find that your cycles become shorter or longer, and the flow may vary. If you do start to experience very heavy bleeding in perimenopause, speak to your medical professional to rule out any other causes. Try to track your cycle so you can discuss changes and concerns with your clinician.

Hot flashes, sleep issues, mood changes, and brain fog

Hot flashes are a common side effect of perimenopause — some women experience a feeling of warmth, while others feel it very intensely. Vasomotor symptoms can have a large impact on your sleep and mood. In fact, studies show 40% of perimenopausal women have issues with their sleep. Sometimes this may be impacted by perimenopause night sweats, but insomnia is also a common age-related concern. The unpredictability of perimenopause may also contribute to irritability, and according to research there is a link between brain fog and perimenopause, as estrogen and progesterone are involved in maintaining brain function.

Vaginal and urinary changes

Decreasing estrogen levels in late perimenopause can affect your vaginal tissue and cause it to become drier and thinner. Vaginal dryness in perimenopause may lead to irritation, itching, pain during intercourse, and a decrease in libido. The menopause transition is also associated with increased urinary complaints, including waking up to pee throughout the night and urinary incontinence.

If you reach menopause between 40 and 45, this is considered early. About 5% of women go through early menopause naturally (as opposed to it being caused by surgical removal of the ovaries). 

Premature menopause affects 1% of women under 40 years old. Known as Premature Ovarian Insufficiency (POI), it is when your ovaries stop functioning before 40 and it can be spontaneous or induced. Many cases have no clear cause, but sometimes it can be a result of medical interventions including chemotherapy or removal of the ovaries. In other cases, premature menopause could be caused by autoimmune disorders, genetic factors, infections, or metabolic syndromes.

When to get evaluated if symptoms start earlier than expected

POI is a possible cause of infertility in women due to the absence of ovulation and menstruation. This can have both psychological and health implications, and because of the association of POI with autoimmune diseases, close follow-ups with a clinician are recommended.

If you start to experience early menopause signs, it’s important to get checked by a medical professional to rule out other conditions and discuss your options. 

Your clinician will ask about your symptoms and may suggest a blood test to measure your estrogen and related hormone levels. You could also speak to them about fertility, but you should continue to use contraception until menopause is confirmed if you don’t wish to get pregnant.

You may spend up to one-third of your life in the postmenopause stage, and menopause symptoms can linger well into it. In rare cases, vasomotor symptoms can last up to 20 years post menopause, but they should improve with time.

Lifestyle strategies can help with mild symptoms of hot flashes. You can try:

• Lowering the room temperature and using fans

• Wearing thinner layers of clothing

• Avoiding potential triggers like spicy food and stress

For more severe symptoms, hormone replacement therapy may be an option for those under 60 years old or within 10 years of menopause.

Postmenopausal symptoms may continue or change over time. If you experience any bleeding at all 12 months after your last period, you should visit your clinician. They’ll also be able to help with any remaining postmenopause symptoms and health worries.

You should always speak to your clinician if any symptoms of menopause are bothering you or impacting your quality of life. It’s best to seek medical advice if you experience menopause symptoms in your 30s, including very heavy bleeding, or if you have any bleeding after menopause, as it can be a sign of health issues.

When seeking menopause support from your clinician, it’s helpful to arm yourself with all the information you can. This helps you walk into the medical office confidently and ready to advocate for yourself. Keep a simple log to track your cycles, symptoms, and any potential triggers.

In the meantime, you could practice menopause self-care techniques to help with menopause symptoms. But bear in mind that while these are often recommended, there’s limited evidence as to whether they actually work. These include things like exercising more, eating a balanced diet, and practicing deep breathing or relaxation techniques. Women who have overweight tend to report more discomfort from hot flashes, and some studies suggest that losing weight may lower the intensity of them.

When it comes to menopause, there’s no universal experience. While the median age of reaching menopause is in your early fifties, everyone’s journey is different. If you experience menopause symptoms early or you find that they impact your quality of life, it’s best to speak to your clinician for personalized advice. They should be able to help you find strategies to minimise symptoms across the different menopause stages and provide perimenopause and menopause support.