When women enter menopause (climacteric), a new phase in life begins, which is often accompanied by symptoms. However, the hormone level does not only change with the menopause, but up to 10 years before.
The course of menopause is therefore divided into different phases, which trigger different hormonal changes in the body depending on age. In this article you will find out what these are, the hormonal changes that occur in each phase and how you can recognise the different phases of menopause.
These are the natural phases of menopause
Menopause is divided into four phases: premenopause, perimenopause, menopause and postmenopause. Sometimes you may also read that there are only 3 phases in menopause. This is because menopause is not necessarily a phase, but rather a specific point in time.
Stage 1: Premenopause
The first phase of menopause is called premenopause and describes the period in which a woman’s menstrual cycle changes very slowly. With the onset of premenopause, periods become more irregular, cycle intervals and the intensity of bleeding changes.
In addition to cycle fluctuations and menstrual cycle problems, women in the premenopause are also accompanied by other symptoms that indicate that menopause is approaching. Other early signs of menopause are premenstrual syndrome (PMS), mood swings, irritability, hot flashes, migraines, headaches, breast tenderness or sleep disorders.
Stage 2: Perimenopause
The second phase of menopause is called perimenopause. It begins on average from the age of 47 and is the most serious phase of hormonal change. When women talk about menopause, most of them mean exactly this phase, because the hormones ride a roller coaster and can mess up a lot in the body.
The consequences are typical menopausal symptoms such as: hot flashes, night sweats, sleep disorders, weight gain, depressive moods or a lack of libido. But how severe the symptoms of the menopause really are in the end also depends on the woman’s circumstances.
Because stress, diet, lifestyle and one’s own emotional state have a major impact on the hormone balance. There are women who hardly suffer from any symptoms during menopause or others who only have isolated symptoms. It doesn’t matter whether you have symptoms or not – it is important that you pay particular attention to your body during this phase and support it so that it can get through the hormonal change as well as possible.
Classification into early and late perimenopause
The second phase of menopause is divided into early and late perimenopause.
In the early phase, the cycle may be shortened, lengthened or the period may not occur at all. It is often difficult to distinguish early perimenopause from premenopause, because the transition is fluid.
In late perimenopause we are moving more and more towards menopause. In this phase, the intervals between menstrual bleeding become significantly longer, until menstruation ultimately stops altogether.
Stage 3: Menopause
Menopause is not so much a phase, but rather the time when the last menstrual bleeding was 12 months ago. The follicles can no longer produce enough estrogen to activate the structure of the lining of the uterus, ovulation and menstrual bleeding are now completely absent. It is said that 50 percent of women have their last menstrual period at the age of 52. Menopause occurs earlier in some women and later in others.
Stage 4: Postmenopause
In the last phase of the menopause, the sex hormones reach their lowest level. Due to the low hormone levels, many women in the postmenopause have symptoms such as hot flashes, vaginal dryness, sleep disorders, depression, weight gain, incontinence or muscle and joint pain.
In this phase of life, the hormone balance first has to level off and stabilise again to a new normal state. The duration of the postmenopause is around 10 years (from the time of the last menstrual period), but it can vary from woman to woman.
Although some women are still struggling with symptoms in the final phase of menopause, most women are feeling much better now that the wild hormonal fluctuations have finally come to an end. The menopause is over.
How do hormones change during the different phases of menopause?
For most women, the first phase of menopause is when they are still menstruating. However, the slowly falling progesterone levels can lead to increased PMS symptoms in the days before the period starts or during the period to mood swings, migraines, sleep disorders or increased menstrual cramps. The intensity and duration of menstrual bleeding can change, as can the length of the menstrual cycle (it usually shortens during the first phase of menopause).
The second phase is the shortest phase of menopause and only lasts about three years on average. In this phase you will feel the most physical changes, because now the estrogen levels are also falling more and more. The brain registers the falling hormone levels and tries with all its might to stimulate the ovaries to produce hormones. This can be clearly seen in the blood from the FSH value (follicle stimulating hormone), which increases significantly towards the end of the second phase. This hormonal tour de force can often cause estrogen levels to rise really high, only to then plummet again in the second half of the cycle. This rollercoaster ride of hormone levels then causes typical menopausal symptoms in many women, which can be unpredictable.
In addition, the effects of testosterone can become more dominant due to the drop in progesterone and estrogen. Although testosterone is a male hormone, it is also present in the female body. Under the influence of testosterone, many women become more assertive during the menopause, can set themselves apart better, no longer have to please everyone at any price and stand up for themselves more.
In the third and last phase, estrogen and progesterone levels are at their lowest and the turbulent years of the hormone roller coaster ride are over. Many women feel better again during this phase. However, if health problems do occur in the postmenopause, then it usually has other causes such as chronic inflammation and the associated increased cortisol and insulin levels, disorders of the intestinal microbiome, lack of nutrients and exercise or pollution.
When is menopause the worst?
Most women perceive late perimenopause as the worst phase of menopause. Because in this phase the most extreme hormonal changes take place in the body, which bring with them many complaints. This is usually exactly the year before the final menopause occurs.
When is the peak of menopause?
The peak of the menopause heralds the last menstrual period. A year after the last menstrual period, it is fairly safe to say that the woman is in menopause and has thus reached the peak of menopause. Women are on average 53 years old when menopause begins.
How long does menopause last?
The entire hormonal change of your menopause takes between 10-15 years. The period from the first phase until women reach menopause (last menstrual period) is between 5-12 years.
Menopause despite hysterectomy?
In most women who have had a hysterectomy, the ovaries remain intact and continue to produce hormones, such as estrogen and progesterone. Therefore, even if your uterus had to be removed, the typical menopausal symptoms can occur. In most cases, however, the age shifts somewhat and women without a uterus often enter menopause earlier.
In the case of a total hysterectomy (including the ovaries), menopause begins immediately after the operation – regardless of age. In this case, women often experience significantly more severe symptoms because the drop in hormones is very extreme.
How can I find out what phase of menopause I am in?
1. Document your period:
While you’re still on your cycle, you should document your monthly period. This will help you recognise when your cycle is shortening or becoming more irregular.
2. Document your symptoms:
Keep a journal of what types of symptoms you are experiencing and how long they last. The documentation allows you to better understand whether your symptoms are changing, staying the same, or getting worse and whether they could be related to external influences such as diet, stress or sleep.
3. Do a hormone test:
Gynecologists often use a blood test to determine the anti-Muellerian hormone, which can provide an indication of the egg cell reserve and thus conclusions about the status of your menopause. Important note: However, the AMH test is not reliable for younger women who may still want to have children.
Of course, one could also have the estrogen, progesterone and testosterone levels determined. But keep in mind that there is quite a hormonal chaos during menopause. Therefore, hormone tests are only a snapshot and are not suitable for determining the specific phase of menopause.
Conclusion on the phases of menopause:
Of course, it is interesting to know what phase of menopause you are in. However, I have found that your lifestyle, your habits, the quality of your sleep, the amount of exercise, your diet and your inner attitude have a major impact on when menopause begins and, above all, how it progresses.
Studies examining the living conditions of women in indigenous peoples have clearly shown that our modern lifestyle has a significant influence on the severity of menopausal symptoms. That means you don’t have to be the victim of your hormones and expose yourself to the hormonal rollercoaster ride.
It is up to you to shape your diet, your stress levels and your lifestyle in such a way that you get through the menopause harmoniously and enjoy this new, powerful phase of life and use it for your personal development.
Take a look at my online group program Hormone Thrive and discover how you can balance your hormones with the help of Ayurveda, building healthy habits and the best support from other women under my guidance.