Every woman’s experience with menopause is different. One may breeze through “the change,” barely realizing it’s happening. Another may suffer debilitating symptoms, such as depression, anxiety, sleep loss, hot flashes or night sweats. One woman may feel the effects of fluctuating hormones at age 40. Another may still be having monthly periods at 55.

How can you be sure when the change is happening to you? And more importantly for some, how do you know when the change is over?

The 3 stages of menopause

What most people call menopause is actually a three-stage process:


Since your early reproductive years, your ovaries have produced a steady mix of estrogen, progesterone and testosterone.

Each hormone has played a role in your reproductive system, but estrogen has always been the leading lady. She has regulated your monthly menstrual cycle. She has affected your psychological well-being, including your mood, sleep and sex drive. She has helped the function of your urinary tract, your skin and vaginal tissues, your bones and heart, your brain and more.

During perimenopause, estrogen begins to withdraw and your steady mix of hormones gets disrupted. That’s when things can start to get wacky. Your periods may become unpredictable. Your bleeding may become quite heavy. Strange symptoms can crop up, including:

  • Hot Flashes: sudden sensations of heat that spread from your chest to your head, often followed by sweating or cold shivering. They may come with hot flushes, when your neck and face turn red.
  • Night sweats: hot flashes that occur during sleep and cause perspiration.
  • Difficulty sleeping: often related to hot flashes and night sweats.
  • Vaginal changes: including dryness and increased vulnerability to bladder infections.
  • Mood changes: such as irritability, anxiety and mood swings.
  • Sex drive: a reduced interest in sex that can be related to mood changes or vaginal dryness, which can make sex uncomfortable.
  • Skin changes: including dryness, itching and loss of elasticity.
  • Headaches/migraines: which can be aggravated by fluctuating hormones.
  • Heart palpitations: the sensation of your heart skipping beats or having extra beats. May also experience the heart racing or going fast.
  • Hair changes: more hair on your face and thinning hair on your head.
  • Forgetfulness/poor concentration: linked to hormone changes, lack of sleep and increased stress.

Perimenopause usually begins in a woman’s 40s, sometimes lasting as long as eight to 10 years. You won’t necessarily have symptoms that whole time — if you have them at all. For some women, symptoms begin their last few years of perimenopause, when estrogen plummets.


Actual menopause is your first 12 consecutive months without a period. It’s when your ovaries stop releasing eggs and drop almost all estrogen production.

Menopause usually occurs between the ages of 45 and 55. Its timing is partly genetic.

If women in your family tend to reach menopause in their early 40s, chances are you will too. Your lifestyle and medical history also are factors. For example, smokers and women with a chronic illness are more likely to reach menopause earlier.


Postmenopause begins your “second adulthood,” once your reproductive years are complete.

The first five years of postmenopause — which begin on that 13th consecutive month without a period — are most critical in terms of menopausal symptoms and bone loss. During this time, women generally start hormone therapy, if they need it.

Treating your menopause symptoms


  • Identify and avoid your hot flash triggers like stress, caffeine, alcohol, spicy foods, tight clothing, heat and cigarette smoke.
  • Keep the bedroom cool. Use fans during the day. Wear light layers of clothing.
  • Try deep, slow abdominal breathing (6 to 8 breaths per minute).


  • Avoid using sleeping pills.
  • Eating cereal and milk products at bedtime or during the night may boost serotonin levels. (Avoid products that contain caffeine.)
  • Take a relaxing warm bath or shower at bedtime.


  • Find a self-calming skill to practice, such as yoga, meditation or slow, deep breathing.
  • Avoid sedatives, if possible.
  • Engage in a creative outlet that fosters a sense of achievement.


  • Eat foods low in sodium and limit caffeine consumption as well.
  • Calcium can slow bone loss and may decrease fractures. Consume 1,200 milligrams of calcium a day.
  • Vitamin D aids in the absorption of calcium and stimulates bone formation. Consume at least 800 IU of vitamin D a day, but do not exceed 2,000 IU.


  • Eat a variety of vegetables, fruits and whole grains, including foods with soy. Limit salt, cholesterol and fat.
  • Don’t smoke.
  • Maintain a healthy weight.
  • Take a vitamin supplement. Choose one that contains antioxidants, including vitamins C and E.

Holly L. Thacker, MD, is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is the Executive Director of Speaking of Women’s Health and directs the digital platform speakingofwomenshealth.com. She is the author of Women’s Health: Your Body, Your Hormones, Your Choices and The Cleveland Clinic Guide to Menopause.