4 min|Integrative

The Three Stages of Menopause

Wellness, Education
Many people use the term “menopause” to refer to the entire menopause experience, however menopause is far more complex. Menopause is a continuum that includes three important stages that will last between one-third to one-half of an average women’s life: perimenopause, menopause, and post menopause.

Why do women go through a menopause transition?

There aren’t solid answers but the ideas from anthropology, genetics and evolution give some interesting hypotheses. Here are two of them:

The Grandmother Hypothesis

Overwhelmingly, women of past generations had children at a younger age than now, typically starting in their teens and early 20’s. After children are born to a young woman and her family, her genetic contribution to future generations is complete. Since childhood disease and trauma impact human mortality so strongly, children’s survival becomes evolutionarily paramount. When women have children that survive long enough to bear them grandchildren, the continuation of the woman’s genes becomes more probable. Also, grandmothers may improve the likelihood of their grandchildren’s survival by sharing their resources, help and knowledge, creating more insurance for the survival of her genes. This hypothesis is called “Kin Selection” and it proposes that there are strong natural selection factors supporting longer lifespans (for both women and men).

Why do women outlive their fertility?

Twenty-first century women (and people in general) are living 40- 50 years longer than women did before 1900. At that time, most women died around age 40 (across different cultures), before even reaching the menopausal transition. Living through the menopausal transition and beyond is relatively recent.

There may be no evolutionary “purpose”, or survival advantage, to either individual women or to their descendants. The length of the reproductive life span in human females is comparable to other great apes, however great apes die soon after their reproductive systems age and stop functioning. The hypothesis is that menopause might not be the key trait. Perhaps the ability to extend life post-menopause is the critical trait that needs more attention.

The Stages of Menopause


This is the transitional stage leading up to menopause. It usually begins several years before menopause when the ovaries gradually start to produce less estrogen. Perimenopause can last anywhere from a few months to several years. During this stage, women may experience irregular menstrual cycles, hot flashes, night sweats, mood swings, and other symptoms as hormone levels fluctuate.

Premature Menopause

Some women may experience early menopause due to illness, genetics, or medical procedures. Symptoms tend to mirror those of perimenopause.


Menopause is officially reached when a woman has gone 12 consecutive months without a menstrual period. It also marks the end of the reproductive years of a woman’s life. On average, menopause occurs around age 51, but it can happen earlier or later for some women. Symptoms such as hot flashes, vaginal dryness, mood changes, and difficulty sleeping may continue during menopause, although they often lessen over time.

Post Menopause

Postmenopause begins after menopause and lasts for the rest of a woman's life. During this stage, hormone levels stabilize at lower levels than during perimenopause and menopause. Symptoms such as hot flashes and mood swings typically diminish, although some women may still experience them.

Postmenopausal women are at increased risk for certain health conditions, such as osteoporosis and heart disease, due to the decline in estrogen levels. This means that participating in regular women’s health monitoring is important even if you do not have any new symptoms or concerns.

Stages of Menopause

These three stages form a continuum of the menopause experience because they represent different phases of the same biological process. Perimenopause gradually leads to menopause, and postmenopause follows. The symptoms and experiences may vary from woman to woman and can range from mild to severe. Understanding these stages can help women navigate this natural transition and manage any associated symptoms effectively.

The known long-term benefits of hormone replacement therapy (HRT) during this phase are critical and point to a decreased risk of osteoporosis, Alzheimer’s dementia, and colon cancer. While improving sleep and quality of life (by reducing daily symptoms). The exact type of hormones or dosages need to be evaluated by a doctor to ensure this is the best fit for you needs.

If you are struggling with any symptoms related to menstrual health or would like support optimizing your wellness during any of the three menopause phases, a Naturopathic Doctor at Integrative could be the support you need.

Book a consultation to get started on your menopause journey with Integrative.

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