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Deconstructing the Stages of Menopause

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Words by Mona de Crinis. Photo by Adobe Stock.

Knowledge can help us navigate the change of life.


Night sweats, hot flashes, mood swings, weight gain and chin whiskers as thick as coaxial cables are common punchlines associated with menopause, but these and other symptoms are no laughing matter for women experiencing this inevitable life change.

In its simplest terms, menopause signals the cessation of female reproduction. The actual process, however, occurs in three stages—perimenopause, menopause and post-menopause—that can be lengthy and layered with discomfort and drama.

“Perimenopause basically means ‘around menopause’ and refers to the time when menstrual periods become irregular or other menopause-related symptoms begin, to one year after the final menstrual period,” explains Rachel W. Heinle, M.D., an obstetrics and gynecology specialist at ChristianaCare in Newark. “Menopause is defined by the natural end of monthly menstrual periods for a woman. Post-menopause refers to a woman’s time of life after menopause.”

The majority of women go through these stages somewhere between ages 40 and 59. But “the exact timing is unique to each woman and difficult to predict,” Heinle acknowledges. “However, on average, perimenopause begins in the early 40s. Menopause occurs at 51 and the post-menopausal years start at 52.”

According to Heinle, perimenopause symptoms are generally the most intense and bothersome. Menstruation cycles become irregular, and bleeding is heavier and more prolonged than usual, she explains. Moods mirror the body’s unpredictability, swinging from high to low in an instant, coupled with an unwelcome uptick in anxiety and irritability for many women.

“Other common symptoms include a lack of focus or ‘brain fog,’ as many women call it; a decrease in sexual desire; breast tenderness; bloating and weight gain; and hot flashes and night sweats,” Heinle notes.

As perimenopause evolves into menopause followed by the post-menopausal years, women may experience continued hot flashes and night sweats, changes in hair and skin, insomnia, joint aches and vaginal dryness that can result in painful intercourse.

Heinle advises the following first-line DIY treatments in helping alleviate symptoms that can present in all stages: attention to a healthy diet and adequate hydration; engaging in regular aerobic exercise; avoiding smoking and excessive alcohol consumption; and implementing mindfulness practices, such as meditation and paced breathing.

“Some women also find it helpful to avoid caffeine and spicy foods,” she continues. “It is also beneficial to establish a regular sleep-wake routine, consider dressing in layers and use cooling mechanisms like fans and air-conditioning.”

While over-the-counter menopausal supplements offer relief for some, medical data to support the effectiveness of these supplements are lacking, she says. For vaginal dryness, Heinle recommends first trying OTC lubricants and moisturizers. If those are ineffective and symptoms become severe, prescription therapy is the next indicated step. Fortunately, safe and effective hormonal and nonhormonal options exist for women who require them.

Going through menopause is not all doom and gloom, however, Heinle adds encouragingly.

“Many women suffer from menstrual problems such as painful, heavy or irregular periods. The lack of periods in menopause can bring great relief to these women,” she informs. And don’t forget the added perk of permanently shelving birth control, as post-menopausal women no longer need to prevent unwanted pregnancies.

If you’re struggling with the stages of menopause, find the silver lining that works for you and embrace the beauty of aging gracefully.


Published as “Deconstructing Menopause” in the Fall/Winter 2020 issue of 302Health.

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