Menopause is not a sudden change but a gradual process that often spans over ten years. During this time, the ovaries progressively reduce the production of estrogen and progesterone. These hormones impact not only fertility but also various bodily functions, including cardiovascular health, bone density, and overall well-being. The effects are both physical and emotional, influencing different areas of life—from partnerships and sexual health to social interactions and work activities.
The transition through the stages of menopause is often difficult to define clearly. Some women experience symptoms early on in the premenopause, while others notice changes later. This process is highly individual, making it essential to understand each phase and pay attention to your body’s signals.
Am I in menopause already? Challenges in diagnosis
Diagnosing menopause is typically based on the symptoms reported. Common signs like irregular cycles, hot flushes, and sleep disturbances offer clear indicators. Only in exceptional cases is a blood test performed to measure hormone levels and rule out other causes. Menopause is not always considered as a diagnosis, especially when lesser-known symptoms like muscle and joint pain or “brain fog” take center stage.
Enhancing your understanding of menopause will help you recognize early changes and discuss them with your menopause specialist or physician.
The four phases of menopause
1) Premenopause
Premenopause often begins in the late 30s. During this phase, periods are generally regular, but progesterone levels start to decline slowly. Many women notice early symptoms such as mood swings, mild sleep disturbances, or changes in their menstrual cycles. This phase can last up to ten years. You may have already felt it: sleepless nights or emotional imbalance, even when everything seems “normal” at work and home.
2) Perimenopause
Perimenopause is the phase with the most significant hormonal fluctuations, lasting up to seven years, and marked by decreasing estrogen and progesterone levels. These hormonal shifts can be intense, leading to irregular cycles and more pronounced symptoms. Unexpected hot flushes, night sweats, or sudden waking in the middle of the night are common. Many women also report concentration difficulties and “brain fog,” affecting both their personal and professional lives.
Perimenopause can also present challenges in partnerships, particularly if issues like vaginal dryness or pain during intercourse arise, straining intimacy. It's essential to communicate openly with your partner, as these changes are often misunderstood or overlooked as menopause symptoms.
3) Menopause
Menopause is defined as the point of the last menstrual period, confirmed only retrospectively after twelve months without menstruation. In Germany, the average age of menopause is about 51. At this stage, hormone levels stabilize at a lower level, and some symptoms usually subside. However, symptoms of the urogenital syndrome, such as vaginal dryness and atrophy, can become more prevalent, impacting sexual health and comfort.
4) Postmenopause
Postmenopause begins one year after the last period and continues for the rest of life. While many menopausal symptoms lessen, the risk for certain conditions, such as bone density loss (osteoporosis) and cardiovascular diseases, increases. Preventive measures like bone density tests, cardiovascular check-ups, and screenings, such as colonoscopies and mammograms, become essential and are covered by health insurance. Don’t wait for symptoms to appear – preventive
The four phases of menopause: The figure illustrates the gradual decline of estrogen and progesterone levels across the four phases of menopause. Premenopause, lasting until approximately age 39, is characterized by stable hormone levels and regular menstrual cycles, with no menopause-related symptoms. Perimenopause, beginning around age 40, is marked by significant hormonal fluctuations, leading to symptoms such as hot flushes, insomnia, mood swings, brain fog, and weight gain. This phase can last up to seven years. Early postmenopause, typically between ages 51 and 60, starts one year after the last menstrual period. Hormone levels stabilize at a low baseline, with some symptoms subsiding, although vaginal dryness and an increased risk of chronic diseases, such as osteoporosis, often emerge. Late postmenopause, from age 60 onwards, is associated with prolonged estrogen deficiency, raising the risk of chronic conditions like cardiovascular disease, osteoporosis, and dementia. The timing of transition into these phases varies individually, and the chart provides only an exemplary representation.
Cultural perspectives on menopause
Menopause perceptions and approaches vary significantly across cultures. In Western countries like Germany and the USA, hot flushes and sleep disturbances are the most commonly reported symptoms, while in Asian cultures, such as Japan, hot flushes are less frequently mentioned. This may be due to dietary habits and cultural attitudes toward menopause. In some cultures, menopause is seen as a “liberating phase,” where societal expectations around motherhood and fertility are lifted. In others, however, there remains pressure to appear “youthful and fertile,” or menopause is stigmatized and often remains a taboo topic. Fortunately, awareness of menopause is growing, and society is beginning to approach the subject more openly. It’s long overdue – after all, menopause affects half of all women. Every individual who engages with and speaks about menopause helps make the topic more visible, fostering societal acceptance and equality.
Menopause and its impact on social life
Menopause not only affects the body but also influences the social lives and relationships of many women. During this phase, many women feel insecure or withdraw, especially when symptoms are severe. This can strain friendships and make professional life more challenging. Partnerships are often impacted as well, with physical and emotional changes posing new difficulties – for instance, sexual issues such as vaginal dryness, which can make intercourse uncomfortable. This is why increasing knowledge about menopause and its effects is so important. Health literacy enables women to better understand these changes and approach them proactively. Open conversations with partners, friends, and experts provide support and help navigate this life stage with understanding and solidarity. Menopause affects half of all women – let’s talk about it and support each other.
Treatment options and lifestyle adjustments
There are many ways to alleviate menopause symptoms. Regular exercise, a balanced diet, adequate sleep, and stress management are essential for supporting the body during this time. It’s also important to consider and discuss hormone therapies, as they can be highly effective for a range of symptoms. Non-hormonal treatments, such as herbal supplements (e.g., black cohosh for hot flushes and related discomforts), may offer relief, though they are generally less potent.
Sources
Monteleone P et al. Symptoms of menopause — global prevalence, physiology, and implications.Nat Rev Endocrinol 14, 199–215 (2018). DOI: 10.1038/nrendo.2017.180