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Understand the stages of menopause and you can better understand the symptoms, determine where you are in the process, and prepare for what is coming next. The four stages of menopause include pre-menopause, peri-menopause, menopause, and postmenopause.

  1. Pre-menopause begins with your very first period, continues through your reproductive years, and ends with your last menstrual cycle.
  2. Peri-menopause includes the years immediately before you begin menopause. For most women, peri-menopause usually begins in your 40s, and lasts for about four years, although many women experience peri-menopausal symptoms for as many as 10 years. During this time you may experience irregular periods, as well as some of the symptoms routinely associated with menopause.
  3. Menopause is actually determined after your final period. Once you have gone for one year without a menstrual period, you have technically been through menopause. The average age for menopause is 51, but it can occur earlier or later, and still be considered normal.
  4. Post-menopause begins after your last period, and lasts for the remaining years of your life. Menopausal symptoms can linger for one to two years in most women, but they eventually taper off.
  5. The post-menopausal years are associated with increased risk for health problems related to lower levels of estrogen and progesterone. Two primary areas of focus include osteoporosis and heart disease. Your doctor will help monitor for changes related to these conditions.


The common symptoms that occur during menopause include hot flashes and night sweats, vaginal dryness, pain with intercourse, problems sleeping, headache, weight gain and slowed metabolism, mood changes, problems with memory, thinning hair, dry skin, decreased sex drive, urinary changes, and loss of breast fullness.

Let your doctor know the most troublesome symptoms you are experiencing, and ask about medications that can help you manage those symptoms during this difficult time. Many women do not find the symptoms severe enough to warrant taking medications. Yet sometimes the symptoms can be extreme, interfere with your ability to function at work and at home, and cause both physical and mental distress.

Menopausal hormone therapy is a new name for hormone replacement therapy. This type of treatment involves taking both estrogen and progesterone. If you no longer have a uterus (due to hysterectomy), then you would just take estrogen. Do not take menopausal hormone therapy if you have vaginal bleeding with an unclear cause, a history of breast cancer, a history of uterine or ovarian cancer, a history of thromboembolic problems including DVT, pulmonary embolism, stroke, or heart attack, liver problems, or if you have a genetic condition that increases your risk of blood clots. Your doctor will know if it is safe for you to proceed with menopausal hormone therapy.

Change your diet. Soy contains phytoestrogens, which are substances that can act like natural estrogen in your body. Natural sources of soy include tofu, tempeh, soymilk, and soy nuts. Some products claim to reduce menopausal symptoms by using natural ingredients, like soy. Since the manufacture of these products is not regulated in any manner, natural products may not always be reliable or even safe

Take herbs with phytoestrogens. Some herbs contain varying amounts of phytoestrogens. Some examples include black cohosh, wild yam, dong quai, and valerian root. Many of these herbs can be made into different forms of administration, like oral tablets or topical creams. Use caution with natural or herbal sources of phytoestrogens. Many herbs claim to provide benefit with hot flashes. Talk to your doctor if you decide to use herbs to treat your symptoms. The safety and reliability of these products is unknown.


Change your lifestyle:

  1. Quit smoking. If you are a smoker, try to quit. Smoking can trigger hot flashes, weaken your bones, and irritate your bladder which may already be more sensitive.[26] Smokers also tend to go through menopause two to three years earlier than non-smokers.
  2. Eat a healthy diet. Limit alcohol and caffeine, and maintain a good balance of foods in your daily food choices. Eating a well-balanced diet can help to provide you with the energy you need and avoid gaining weight during this time as your metabolism begins to slow down. You may want to include some of the natural soy products in your diet.
  3. Regular exercise can help to control your weight, improve your sleep, provide strength for your bones, and help with mood changes.
  4. Include stress-reducing and relaxation activities to help you cope with the symptoms you experience. Meditation, mindfulness exercises, and yoga, are a few ways to help control your stress.

Other steps that can help with sleep problems include avoiding large evening meals, caffeine after noon, and alcohol near bedtime. Try drinking something warm and caffeine-free, just before bed. Keep your bedroom dark, quiet, cool, and use your bed just for sleep or sex. Avoid watching television or playing video games just before trying to sleep. Avoid napping during the day, and try to go to bed and get up at the same times every day. Consider asking your doctor for a medication that can help. Short-term use of agents used for insomnia may help you get the sleep you need during this transition. Zolpidem and eszopiclone are controlled prescriptions and come with risks such as abnormal behavior and risk of dependence and abuse. Safer medications for sleep such 1mg of melatonin, 25mg of Trazodone, or 10mg of Doxepin may be suggested. The treatment for insomnia that has the most evidence for long term effectiveness is CBT-I, cognitive behavioral therapy for insomnia. Low dose progesterone is also helpful for sleep in menopausal women.

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