Natural menopause, which happens without any medical intervention, happens in three stages: perimenopause, menopause, and postmenopause.
Perimenopause, also called the menopausal transition, is the stage when a woman begins to transition into menopause.
During this time, ovulation becomes less regular, causing menstrual irregularities (e.g., prolonged and heavy periods, shorter periods, skipped periods, etc.) and decreased fertility.
This stage often begins in a woman’s 40s, but some women enter perimenopause in their 30s. Perimenopause can start up to 10 years before a woman enters menopause, though the average length of this stage is 4 years.
Many women experience bothersome symptoms during this time of life, including:
- Vasomotor symptoms (VMS; hot flashes and night sweats)
- Sleep disturbances-insomnia
- Elevated heart rate
- Mood changes—irritability, depression, anxiety
- Vaginal dryness or discomfort during sexual intercourse
- Urinary symptoms (e.g., frequent urination, urinary urgency)
Despite the decline in fertility associated with this stage of menopause, women can still become pregnant. Those who do not wish to become pregnant should continue using some form of birth control until they have reached menopause.
Menopause is the point at which a woman stops ovulating and having menstrual periods without other causes such as illness, medication, pregnancy, or breastfeeding. The average age of menopause is 51, though women can experience it anytime in their 40s and 50s. Since periods often become irregular at the end of the reproductive years, menopause is not diagnosed until a woman has not had a period for 12 consecutive months.
Factors that are toxic to the ovary often result in an earlier age of menopause. Women who have had surgery on their ovaries, or have had a hysterectomy, despite retention of their ovaries, may experience early menopause. Smokers are also more likely to experience early menopause.
Postmenopause is the duration of a woman’s life after her final menstrual period. In postmenopause, hormone levels remain at a constant low level and women are unable to become pregnant.
Once in postmenopause, the symptoms experienced in perimenopause may continue for an average of 4-5 years, though some women report their symptoms last longer. Every woman experiences these stages of menopause differently. Some women may have mild symptoms that last a couple of years, while others will have severe symptoms lasting a decade or more. Still others may never experience menopausal symptoms. Most symptoms due to perimenopause and menopause tend to decrease in intensity and frequency as a woman goes through postmenopause.
Lower hormone levels also increase a woman’s risk for related diseases like heart disease and osteoporosis.