In the UK, the average age for menopause to begin is 51, although anywhere between 45 and 55 is completely natural. During the menopause, a woman's menstrual cycle will discontinue due to hormonal changes inside the body, most significantly a drop in oestrogen levels.
The hormone oestrogen is predominantly made in the ovaries and affects each of the key process involved in a woman's reproductive and sexual health journey. For example, oestrogen levels rise during puberty, peak in the days preceding ovulation to help facilitate pregnancy, and finally drop to trigger the end of a woman's menstrual cycle. You may see oestrogen spelt like 'estrogen' - this is the same hormone, they're just slightly different ways to spell it.
What are the stages of menopause?
- Pre-menopause is the period when someone is having a regular menstrual cycle and has no noticable symptoms of menopause. Someone is considered pre-menopause until they have entered the perimenopause stage.
- Perimenopause or the "menopause transition" is the first stage of the menopause. Typically beginning 8 to 10 years before the menopause, perimenopause begins when oestrogen production in the ovaries starts to decline and continues until they stop releasing eggs completely. Although symptoms of menopause can begin to appear during the latter few years of perimenopause, monthly cycles (and ability to conceive) do continue. Irregular periods in perimenopausal women are common and should not need medical treatment.
- Menopause is the stage at which a woman will stop releasing eggs for insemination, and therefore will stop having menstrual periods entirely. Menopause begins exactly 12 months after a woman's last period. You should continue to use birth control up until this point.
- Postmenopause is the third and final stage of the menopause and refers to the remainder of a woman's life one year on from her last period. Postmenopausal women are more susceptible to several health conditions, carrying an increased risk of osteoporosis (weakening of the bones) or heart disease due to lower levels of oestrogen. Hormone therapy can help relieve postmenopausal women of symptoms associated with a lack of oestrogen such as hot flushes.
What signals the end of menopause?
Although symptoms of menopause do not tend to stop suddenly, there are certain changes in the body which signify the menopause is coming to an end. Women will generally see disruptive symptoms like difficulty sleeping and low mood begin to ease as they become better adjusted to their new hormonal balance.
As a result, women may experience a rejuvenation of energy and libido as well as an improvement in focus. It is important to note that certain menopausal symptoms, such as hot flushes and mood swings, may occasionally reappear due to changing hormone levels, particularly a decrease in oestrogen.
However, if a menopausal woman feels her symptoms begin to ease alongside a new lease of energy, it is likely the menopause is coming to an end.
What happens after menopause?
Once a woman has gone through the menopausal transition she enters the postmenopausal phase of their life. This period will likely require some level of physical or emotional adjustment. After menopause, some women may experience physical changes such as weight gain, vaginal dryness and urinary incontinence. Although vaginal bleeding after menopause is unlikely to indicate an underlying medical condition, you should still consult a healthcare professional.
More information about postmenopause and hormone therapy can be found on the NHS information page.