The three stages of menopause

1. Perimenopause. Perimenopause, which means ‘around the end of menstruation’, is generally what we think of as the menopause experience. During this time, a woman’s ovaries start producing less of the sex hormones oestrogen, progesterone and testosterone. The decline isn’t necessarily steady — sometimes hormone levels fluctuate and cause irregular periods. (If you suddenly experience heavy periods, let your doctor know so other causes, such as fibroid tumours and endometrial cancer, can be ruled out.)

Symptoms such as hot flushes, insomnia and forgetfulness are at their peak. The tissues of the vagina and urinary tract may become dry and atrophied, possibly making sex uncomfortable and making urinary-tract infections more common. It is still possible for a woman to become pregnant.

If you’re not sure whether you’re in perimenopause, your doctor can order blood tests to measure your hormone levels. Consistently high levels of follicle stimulating hormone (FSH) and low levels of estradiol (the most common form of oestrogen), combined with some of the symptoms above, provide compelling evidence.

Women may benefit from beginning hormone replacement therapy (HRT) at this stage. Alternatively, your doctor may prescribe low-dose birth control pills as a form of HRT. The advantage of this is better control of the menstrual cycle. It’s important to remember that taking either birth control pills or HRT can make it more difficult to determine exactly when menopause has occurred.

While women can enter natural menopause at any time during their forties or fifties, the average age of menopause in the Western world is 51. Perimenopause begins on average at the age of 47 and lasts anywhere from two to 10 years. Contrary to popular belief, there is no relationship between the age at which a woman started menstruating and the age at which she enters menopause.

Chances are, you’ll go through menopause at about the same age as your mother and grandmother did. Women who smoke typically enter menopause two to three years earlier than those who don’t.

Find more information about menopause