How to Recognise and Manage Each of the Phases of Menopause

“What phase am I in?” is the most important question that many women between the ages 45–55 ask themselves.

This is because menopause does not arrive as a single, clear moment.

It begins quietly with disrupted sleep, mood changes, heavier or irregular periods, brain fog, depression, joint pain, old trauma or a sense that “something feels off.”

As these symptoms can appear gradually and overlap with busy lives, trying to make ends meet, stress, anxiety, or burnout, they are often misunderstood or dismissed.

This uncertainty leads many women to ask an important question: “What phases of menopause am I actually in?”

Understanding your menopause stages is important because symptoms, patterns, treatment options, lifestyle, diet, and health priorities change over time. What helps during the early transition may be different from what is most effective later on, and likewise, each woman’s body is unique. Symptoms can feel random and difficult to manage.

In this guide, we will:

• Clearly define the three phases of menopause
• Help you to know what stage of menopause you are in
• Share practical ways to manage symptoms, including lifestyle and medical options

It is also important to know that menopause-related symptoms often begin years before periods stop completely. This is common, normal, and manageable with the right support and information, so you’re not alone.

The 3 Phases of Menopause

Menopause is not a single, prolonged stage. It is a transition made up of three distinct menopause stages, each with its own characteristics, helping you know the category you’re currently in at the moment.

Phase 1: Perimenopause (the menopause transition):
This is often referred to as the years leading up to menopause, when hormone levels begin to fluctuate, and symptoms often begin to show. It can begin 8-10 years before menopause (when your ovaries gradually produce less estrogen. The first telltale signs are changes to your periods. These may become irregular, lighter or heavier, and symptoms can feel unpredictable. In most cases, most women don’t know that menopause is already knocking on their door. As time goes on, you notice more symptoms, such as sleep disturbances, tiredness, hair loss, changes to smell and taste- for a complete list check out the symptom tracker.

Phase 2: Menopause:
This is the single point in time, 12 consecutive months without a menstrual period, not due to pregnancy, contraception changes, or medical conditions. Unlike other stages, menopause is a defined situation, so you don’t stay in this stage. You are in this phase for a maximum of 12 months.

Phase 3: Post-menopause:
This is the stage after menopause. At this stage in life, you’re no longer ovulating or releasing eggs (reproductive years are now behind you). Some uncomfortable symptoms of menopause may improve (e.g. hot flashes or night sweats) while long-term health considerations, such as bone health, heart health, vaginal, and urinary health and others, become more important to be regularly checked and monitored.

Typical Ages and How Long Each Phase Can Last

Most women experience menopause between the ages of 45 and 55, but the timing varies widely. Perimenopause symptoms can begin in the late 30s or early 40s for some women and may last anywhere from a few years to over a decade. While post-menopause occurs on average at age 52, and the moment you enter it, it becomes permanent. Each of these menopause stages can last from several months to several years.

Several factors that influence the timing are:

• Genetics and family history
• Surgical removal of the ovaries
• Medical treatments such as chemotherapy
• Lifestyle, dietary factors and overall health
• Environmental factors

Because of this variation in women, there is no single “normal” menopause timeline.

A Note on Menopause

The word “menopause” is often used to describe the whole process of this hormonal change, since at any given time, there’s often a delay in the menstrual cycle. But for clinical purposes, menopause is used to describe a single point in time, when 12 consecutive months have passed since the last menstrual cycle or period.
This distinction matters due to treatments, symptoms, expectations, and health priorities of individuals, depending on whether someone is in perimenopause, menopause, or post-menopause. Understanding the correct phase allows for more accurate diagnosis and more effective management.

How to Recognise Your Phase: A Practical Self-Check for You

The 3-Part Self-Check

Changes in your menstrual cycle pattern for at least acouple of months are the earliest sign you’ll notice, especially during perimenopause. These may include:

• Periods becoming closer together or further apart
• Heavier or lighter bleeding than usual
• Spotting between periods or skipped cycles
• Missed or skipped cycles
• Hot flushes and night sweats
• Sleep disturbances
• Mood changes, anxiety, or low confidence
• Brain fog or difficulty concentrating
• Vaginal dryness or discomfort
• Changes in libido
• Joint aches and muscle pain

The combination and intensity of symptoms can offer clues about where you are in the transition, whether it’s worsening or stabilising.

Symptoms that come and go over months or years, especially alongside changing cycles, often suggest perimenopause.
Symptoms that persist after periods have stopped may indicate menopause or post-menopause.

When Blood Tests Help (and When They Don’t)

Menopause diagnosis is often symptom-led rather than test-led when hormone levels fluctuate significantly during perimenopause.
This is because a single blood test may not reflect the overall situation. A healthcare professional (HCP) can advise when testing is appropriate. Blood tests may be helpful in certain situations, such as:

• Early menopause
• Premature ovarian insufficiency
• Unclear symptoms
• Medical conditions that require exclusion

Red Flags That Need Medical Review

While many symptoms are part of the menopausal transition, some symptoms should always be checked by a specialist, for in-depth medical review, these include:

• Bleeding after menopause
• Very heavy or prolonged bleeding
• New or severe mood symptoms
• Persistent pelvic, joint pain or unexplained changes in the body.

Phase 1: Perimenopause (the transition years)

Perimenopause Symptoms You Can Actually Recognise. This Is Often the Most Confusing Phase for Most Women Because Symptoms Can Be Inconsistent, Unpredictable, and Sometimes Challenging.

Common Early Signs on How to Recognise Perimenopause. These Are the Early Signs of Perimenopause in Your 40s, You Should Start Looking Out for:

• Changes to menstrual cycle length or flow
• Difficulty falling or staying asleep
• Increased irritability or mood swings

These symptoms may come and go, making them easy to dismiss.

Symptoms That Surprise Most Women

Some symptoms of perimenopause can come unexpectedly even while busy with life, these include:

• Brain fog or reduced concentration
• Heart palpitations
• Headaches or migraines
• Changes in skin texture or hair
• Worsening premenstrual symptoms

What’s Happening Hormonally (A Simple Explanation).

During perimenopause, hormone levels (estrogen and progesterone) fluctuate rather than decline steadily or immediately. These ups and downs explain why symptoms feel unpredictable. For example, improving one month and worsening the next.

How to Manage Perimenopause (Step-by-Step).

Managing perimenopause should be focused on reducing symptom impact and supporting overall well-being as a woman.

First-Line Is Lifestyle Support to Get Good Results. The Simple but Effective Strategies You Need to Include Are:

• Prioritising sleep and temperature regulation
• Regular movement, including strength training and walking
• Balanced nutrition (eat more veggies and fruits than processed foods), hydration, and identifying personal symptom triggers
• Stress reduction and setting realistic workload boundaries

Medical Options to Discuss

Examples of symptom-specific treatment are non-hormonal treatment, such as changing your diet, avoiding triggers to hot flashes, regular exercise routine, etc.
Hormonal options like estrogen or estrogen&progesterone therapy, depending on individual medical history, risk and symptoms. Professional support is appropriate when this stage is bothering you or affecting your daily lifestyle.
Starting hormonal treatment in the perimenopause phase has many benefits, especially on long-term health, such as bone protection, cardiovascular protection and diabetes.

Practical Tracking

Tracking of your period cycle is very helpful, as it supports your medical consultation with a menopause specialist to understand your menstrual history. Track your cycles, what you eat, your sleep patterns, your mood, and any vaginal symptoms (dryness, soreness, pain or bleeding during or after sex, increase in frequency of urinating and Urine infections (UTI).

Phase 2: Menopause (the 12-month marker)

How to Know When You’ve Reached Menopause

Menopause is a point in time when you’ve gone 12 consecutive months without a menstrual period. It happens on average at age 52, however most women will stop having a period around the age of 55.

This stage can be confusing with contraceptives, hormonal IUDs, and light bleeding, because they change bleeding patterns, which can make it harder to know whether periods have stopped because of menopause or because of the contraceptive method. Light bleeding, hot flashes and weight gain are what to expect during menopause transition.

Symptoms Around Menopause (What Often Intensifies)

You may be moving into menopause if you experience some or all of these:

• Hot flushes intensify (vasomotor symptoms- a sudden feeling of warmth that spreads all over your body) and night sweats. Dietary adjustments and lifestyle changes are ways to manage hot flashes naturally. HRT helps
• Sleep disturbance (Insomnia)
• Mood changes and confidence dips
• Vaginal dryness, difficulty having sex and urinary symptoms
• Racing heart, headaches, changes in libido etc.

Managing Menopause Symptoms

The Treatment Menu (So You Feel Informed, Not Overwhelmed)

There are 2 major ways to manage your symptoms because at this period your body goes through a major decrease in hormone production.

Hormone replacement therapy.

There are two main types:

• Estrogen hormone therapy: Your provider gives you estrogen in low doses in the form of gel, patch or spray. This can’t be used alone without progesterone if you still have your uterus. Estrogen is provided as a transdermal, applied to the skin to reduce risks and increase absorption. The main product used is known as Bio-Identical, which means it has the same chemical composition as the Estrogen you produce in your body.
• Progesterone hormone therapy: This comes in many forms, oral capsule (bioidentical), Mirena coil or as a combined patch (Estrogen). During the consultation, we determine the ideal product based on your lifestyle and risk factors.

All medications carry risk, HRT(hormonal therapy) is no different. During the consultation, the Menopause Specialist will discuss the Benefits and Risks as well as other factors.

Non-hormonal options for symptom relief

Some Non-Hormonal Treatments Recommended Are Dietary (Eat Lots of Protein, Vegetables, Flaxseed, Lentils, Fruits) And Lifestyle Changes, Non-Hormonal Medications Are Available, Avoiding Triggers For Hot Flashes (Keeping Your Bedroom Cool At Night, Quit Smoking), Vaginal Treatments For Dryness During Menopause And Urinary Symptoms.

“What should I ask my doctor?”

Every woman’s menopause phase is different. Talk to your doctor about your symptoms. Ask questions to lead you through shared decision-making so that you feel informed, involved, and reassured, not confused. For example:

• Which stage of menopause am I in right now?
• What treatment options are most suitable for my symptoms?
• How long might it take before I notice improvement?
• Is hormonal therapy an option for me?
• How long do menopause symptoms last?
• Are there lifestyle or diet changes that could help my symptoms?
• How will we monitor progress and adjust treatment if needed?

Phase 3: Post-menopause (life after the transition)

What Changes in Post-Menopause

The post-menopause stage begins after 12 consecutive months without a period. Hormone levels stabilise at lower point, some symptoms improve (like hot flushes), others may continue. However, this is the time to focus on your long-term health because once you’re in this stage, you’re in it for life.

Managing Post-Menopause

Hormone therapy (HRT), vaginal cream, and antidepressant medication, can be used to manage symptoms suchas menopause anxiety, menopause brain fog, menopause sleep problems (insomnia), vaginal dryness during menopause, and menopause joint pain.

Bone Health Basics

Women in menopause have a high risk of osteoporosis and bone fracture due to low bone density caused by low estrogen production during the perimenopause and menopausal phase. Therefore, strength training and mobility are vital during the transition, as well as eating nutritious foods (foods rich in calcium-yoghurt, spinach, fortified cereals), vitamin D and calcium supplements are highly recommended and screening conversations with your healthcare provider.

Heart and Metabolic Health

Before menopause, estrogen helps protect your veins and your heart, reducing the risks of heart disease or heart attacks/strokes. The cardiovascular risk increases after menopause. So get enough sleep, eat healthy foods, increase water intake, practise regular exercise and avoid smoking or vaping, reduce alcohol intake to reduce the riskof high blood pressure and cardiovascular disease, and many more.

Vaginal and Urinary Health

Decreased estrogen levels cause the vaginal tissues to get thin and dry, leading to vaginal dryness, itching and increased infections, mainly UTI or Thrush. Using vaginal estrogen, lubricants and moisturisers will help reduce these symptoms. Don’t ignore the symptoms that you notice because, as long as vaginal dryness occurs, you will be extremely uncomfortable until your vaginal health is restored.

Menopause Scenarios

Early Menopause and Premature Ovarian Insufficiency (POI).

Early menopause happens when a woman stops having periods before the age of 45, while premature ovarian insufficiency (POI) occurs earlier, before the age of 40. Both situations require tailored care because the long-term health implications can differ from the regular menopause occurring at the average age.

Women experiencing early menopause or POI may benefit from:

• Checking bone and heart health more often
• Creating and implementing a personal treatment plan
• Ongoing clinical support from health professionals

Surgical or Medical Menopause

Menopause that is caused by surgery or other medical treatment (e.g. chemotherapy, pelvic radiation therapy) that has already occurred, leads to a rapid decline in hormone levels of a woman. Symptoms may come on abruptly and feel more intense compared to natural menopause in other women.

Personalised treatment and early support from your health care providers are especially important in these situations to help manage symptoms and protect long-term health.

Menopause at Work

Menopause can affect your mental health, concentration levels, focus, belief in yourself, energy and sleep. These can make it difficult for you to perform well at work. Simple adjustments include flexible working hours, room temperature control, or workload support. Honest, open conversations and practical support from friends, colleagues, and family can enable you to continue to be engaged and productive during this transition.