The menopause timeline: What to expect from each stage

Despite being one of the major life events in the biology of being a woman, the menopause is still considered a taboo topic.

As a result many women are going into menopause feeling fearful of how it will impact their lives.

New research by menopause expert Maryon Stewart, has revealed that 96% of the 1,100 women surveyed felt unprepared for the menopause, while 29% feel overwhelmed or confused.

As well as feeling unprepared, the survey also highlighted that women are suffering in silence, with 71% finding it difficult to discuss their menopause, 58% struggling to speak to their partner and 35% even finding it hard to talk to their friends.

Further research has revealed that there has been a 37% spike in online searching for the menopause in the last three years, with some of the biggest ranking searches last year relating to symptoms, age to expect it and treatment.

It seems that women are being left woefully underprepared for a process that can begin as early as their 40s and take-up up to twenty years to resolve.

“For taboos around the subject to fall away, we need to provide support and information to these women and all women, starting with the fundamentals: explaining what menopause actually is,” says Gervase Fay, co-founder Health & Her®, an online platform designed to support women through the menopause with qualified and independent, expert advice.

With that in mind here’s everything you need to know about the menopause, from the three stages and early symptoms to treatments and what to expect.

What causes the menopause?

According to the NHS the menopause is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.

“It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month,” the site reads.

“Premature or early menopause can occur at any age, and in many cases, there’s no clear cause,” it continues.

READ MORE: Grandmother who believed she was in menopause gives birth at age 50

What are the stages of menopause?

The menopause takes place in three stages: peri-menopause; menopause; post-menopause.

Peri-menopause

Consultant gynaecologist Anne Henderson describes the average peri-menopause as: “In the developed world, the ten years between 45 and 55 where women still have periods and hormonal activity, but egg reserves have declined and ovulation is less frequent.”

The period can last anything from two to 10 years

The NHS says the first sign of menopause can be a change to your periods, either becoming closer together or further apart.

“You may start having either unusually light or heavy periods,” the site explains.

“The frequency of your periods may also be affected. You may have them every 2 or 3 weeks, or you may not have them for months at a time.”

Peri-menopause symptoms:

• Periods become erratic. “They’re often more painful and usually heavier. Eventually periods may only happen two to three times a year,” explains Henderson.

• Your moods and ability to cope with stress may change. “These are symptoms people don’t physically see and so can often be difficult to deal with,” says Henderson. “They can include: low mood, anxiety, irritability, panic attacks, feeling tearful, low self-esteem, mood swings and poor concentration (brain fog).”

• Your body, skin and sex drive could start to change

How to manage symptoms:

• Up your exercise: Regular aerobic exercise and practicing yoga boost energy and improve sleep. Exercise also releases endorphins, the ‘happy hormones’ that help stabilise mood. “Women should get themselves as fit and healthy as possible in their early 40s, as they approach the peri-menopause,” suggests Henderson. “Bone and muscle loss are the two key health problems of menopause and there’s a lot women can do themselves to prevent problems. Weightbearing and weightlifting exercise are absolutely vital.”

• Cognitive Behavioural Therapy (CBT): This is a well-recognised treatment for stress, anxiety and low concentration that includes techniques to improve mental health, relaxation, mindfulness and sleep hygiene.

• Good food choices: “What we eat can have a dramatic effect on the way we feel,” says nutritional therapist, Rosie Letts. “Eating wholegrains and legumes, seeds and nuts, tofu, eggs, meat, poultry, fish and seafood, for example, help our bodies to produce the ‘feel good’ hormone serotonin.”

READ MORE: How a woman’s period changes throughout her life

Menopause

Anne Henderson says a loose definition of menopause is when a woman has gone two years without a period if they’re under the age of 50, or one year, if they’re over 50. “However, this can be a bit old-fashioned and it may be more helpful to base whether you’ve been through the menopause on actual symptoms,” she adds.

Menopause symptoms:

• Periods have stopped. “Your body is no longer releasing an egg every month so menstruation (the release of the body’s preparations for an egg to be fertilised) ends,” explains Henderson.

• Hot flushes. Though not everyone experiences them, hot flushes happen to 70 – 80% of menopausal women. “They can start in the peri-menopause stage and may increase in the final one-to two-years before menopause,” explains Henderson. Often described as intense warmth through the body and face, Henderson says flushes can range from mild heat once or twice a day to a raging inferno every fifteen minutes.

• Heart Palpatations. Described by the NHS as heartbeats that suddenly become more noticeable.

• Joint aches. One of the less common menopause symptoms, joint aches occur as decreasing oestrogen affects the levels of collagen in our joints.

• Painful sex. According to Henderson vaginal and anatomical changes can lead to poor lubrication, as well as changes to the shape of your vagina – it can actually become shorter, narrower, and less stretchy. All these can make sex feel uncomfortable and even painful.

How to manage symptoms:

• Hormone Replacement Therapy (HRT). “HRT is a treatment designed to replace the hormones in your body that you no longer make around the menopause,” explains GP Shilpa McQuillan. “The type and dose of hormones you need varies between women so HRT is tailored to your individual needs. HRT mainly aims to relieve symptoms related to oestrogen deficiency such as hot flushes, urogenital irritation (bladder and vaginal area), joint pains, headaches and mood disorders.”

• Exercise. “When we are younger, we have fluid in our joints like runny honey, but the older we become the more it’s like glue,” explains Jane Dowling, personal trainer and founder of Meno&Me. “The positive thing is exercise can make that glue become more like honey again! Shoulder rolls, feet circles, squats, side bends and head twists are all great for lubricating your joints and helping with aches and stiffness. Stretching is also important, each muscle in the body crosses a joint – if that isn’t stretched you’ll feel stiff in the joint and the muscle.”

• Don’t just put up with it. According to the experts at Health & Her women shouldn’t let embarrassment stop them getting help with symptoms such as painful sex or vaginal dryness. Both are common and something as straightforward as using a good lubricant can make all the difference.

READ MORE: Better sex, style confidence and other reasons to celebrate ageing

Post-menopause

The average age to enter post-menopause is 51.

Though a woman is in post-menopause for the rest of her life, the NHS says it typically takes four years for symptoms to stop but can be anything up to ten years.

Post-menopause symptoms:

• You may notice a loss of sex drive. Menopause can make sex feel less enjoyable and contribute to decreased desire. Dealing with hot flushes and night sweats can also leave you too exhausted to initiate sex.

• Changes to the water works. Little leaks, increased frequency or urgency around going to the loo and incontinence can all happen in the run up to and around menopause. “These kinds of issues occur as declining oestrogen affects bladder lining and muscles,” explains Anne Henderson.

• Difficulty falling and then staying asleep. Women in all stages of the menopause can find it hard to fall asleep and can be prone to night time or early morning wakening. This poor sleep has a knock-on effect and can make other symptoms feel worse or harder to manage.

How to manage symptoms:

• Talk to someone. Seeing a sex therapist can give you support to address any underlying relationship issues that may be there; a lack of sex can put strain on a relationship, particularly if you haven’t explained things to your partner and they assume you’re no longer attracted to them.

• Support good sleep through diet and supplements. “GABA, the brain chemical that calms us and helps us sleep is created using magnesium,” explains Rosie Letts. “You can top up magnesium levels by taking a warm bath with a cup of magnesium-rich Epsom Salts twice a week. Eating foods like leafy green vegetables, Jerusalem artichokes, berries and apples also promote gut health; important as 90% of serotonin (the chemical that produces the hormone that helps us sleep) in your body is produced in your gut.”

• See a specialist physio. Pelvic floor physiotherapy can improve bladder incontinence issues and there are bladder drills and ways of timing drinks to minimise getting caught out.

• HRT. “Local treatment goes directly onto the area and can have an immediate benefit on the bladder area, without systemic treatment,” Henderson adds.