Have you ever wondered exactly where “Perimenopause” ends and “Menopause” begins? Or what “Postmenopause” even looks like for your future health?

While these terms are often used interchangeably, they actually represent distinct phases of a significant natural life transition. Understanding the specific stage you are in is the first step towards managing your symptoms and protecting your long-term health. Let’s break down the journey through menopause into three key stages.

Stage 1: Perimenopause (The Transition)

The journey begins with perimenopause, the phase leading up to the end of menstruation (the last menstrual period). This stage typically lasts 4 to 8 years.¹ During this time, hormone levels (especially estrogen and progesterone) begin to fluctuate, perimenopausal menstrual cycles become irregular, and new symptoms in other areas of the body arise. You can fall pregnant during perimenopause, but it may be increasingly more difficult to as ovulation becomes less predictable.

Common experiences during perimenopause include:

• Physical changes: hot flashes, night sweats, breast tenderness, weight changes / difficulty losing weight
• Sleep issues: troubles falling asleep or staying asleep, and daytime fatigue
• Emotional and cognitive shifts: mood swings, irritability, brain fog and difficulty concentrating

Stage 2: Menopause (The Milestone)

Menopause itself is officially diagnosed as a single point in time after you have gone 12 consecutive months without a period.^2,3 This means menopause occurs in retrospect; you may not actually know you are in menopause until you look back in time and calculate that it has been 12 or more months since your last period! Entering menopause marks the permanent end of menstrual cycles and you can no longer become pregnant because the ovaries stop working to release hormones and eggs. In Canada, the average age for a woman to reach menopause naturally is about 51 years old, but can range between the ages of 45 to 55 years old.^1,4

While most will reach this stage naturally as they age, some women experience premature or induced menopause:

• Premature Ovarian Insufficiency (POI): This occurs when menopause happens before age 40, often due to genetic factors or autoimmune conditions.
• Induced Menopause: This is a sudden loss of ovarian function caused by medical treatments like surgery, chemotherapy, or radiation.

Stage 3: Postmenopause (The New Normal)

Once you have passed the 12-month mark without a period, you enter the postmenopausal stage for the rest of your life. Many of the symptoms described in perimenopause occur in postmenopause as well. However, because estrogen levels remain low and no longer fluctuate, some women find the symptoms they had during perimenopause improve such as mood swings or brain fog. However, keep in mind some symptoms may persist and being in postmenopause brings new considerations for long-term health.

The decline in estrogen affects many organ systems; it impacts the bones, heart, brain, bladder, and metabolism. In addition to all the symptoms mentioned it can also lead to:

• Reduced bone density (which may lead to risk of osteoporosis), increased cardiovascular risk, and changes in body fat distribution.^5,6
• Genitourinary Syndrome of Menopause (GSM): Lower estrogen can make vaginal and bladder tissues thinner and drier, leading to vaginal and urinary symptoms. This can feel like discomfort or more frequent urinary tract infections. These symptoms remain longterm and may get worse with time.⁷

It is important to note that any postmenopausal vaginal bleeding or having postmenopause periods are not normal and should be investigated by a physician or healthcare practitioner.

Managing the Journey

To figure out what stage you may be at you can ask yourself these 3 questions:

• Are your menstrual cycles changing?
• Are you experiencing any new or worsening symptoms?
• Have you gone 12 months without a period?

Going through these stages of menopause may cause you to feel symptoms or changes in your body that are new or bothersome. You do not have to navigate these stages without support. Our first goal is for you to understand what is happening in your body. The next goal will be to develop a personalized, evidence-based care plan designed for your body and your stage of life.