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Wellbeing, My Body


Although menopause and perimenopause are experienced by half the population, it affects each person differently.

Find out about the changes that take place in the body during menopause and the sorts of symptoms someone going through menopause might experience.

What is menopause?

Menopause is experienced by all women and people with uteruses. It’s when periods (monthly bleeding) stop because of lower hormone levels. It usually happens between the ages of 44 and 56 but some people experience an early menopause which can be brought on by genetics, surgery (for example, removal of the ovaries) or medication (to help treat certain conditions such as endometriosis).  

Did you know?

The menopause is used as an umbrella term to refer to the perimenopause (the time leading up to the menopause) as well as the actual menopause.  

In reality, the menopause itself actually only lasts one day; you reach the menopause after a year of having no periods if you’re over 50, or two years after having no periods if you’re under 50.

Before this day you are perimenopausal, and after this day, you are postmenopausal. 

Stages of menopause

There are three main stages to menopause which begin with the perimenopause, followed by the menopause itself and then the postmenopause. These stages are characterised by changing levels of the hormones oestrogen and progesterone.

Graph showing hormone levels throughout the menopause. Oestrogen and progesterone fluctuate cyclically in the pre-menopause, then become unstable and fluctuate irregularly in the perimenopause and are low levels in the post-menopause

Stage 1: Perimenopause

During perimenopause, it’s common to experience changes to your body, mood and relationships because of your hormone levels following less of a pattern and being very unpredictable.  

Perimenopause may start up to 10 years before you experience the menopause itself (when your periods stop completely), beginning on average at around the age of 46. For a lot of people, perimenopause can be a challenging time when they experience a lot of changes to their body, emotions and relationships. 

However, some people have also reported a positive experience of perimenopause, experiencing little or no symptoms or finding it a time of relief if they’ve suffered with painful periods their whole life. In fact, 20% of people don’t experience menopausal symptoms.

The important thing to remember is that, although everyone with a uterus goes through it at some point, menopause affects each individual differently.  

What happens during the perimenopause?

During perimenopause, hormone levels are rising and falling unpredictably. Hormones play an important role in daily life, and with changes to hormone levels also come changes to menstrual cycle, mood and relationships.  

Let’s take a look at some of the changes a person might experience during perimenopause and the related symptoms: 

Changes to ovulation and eggs

During perimenopause, the activity of the ovaries might change. Ovulation may not occur every month and the quality of eggs will decline because of changes to the hormone levels. This means that fertility (the ability to get pregnant) will also reduce. 

Cycles become more irregular

Irregular periods are often the first symptom of the perimenopause.

As fertility declines, the body starts to increase the number of menstrual cycles, meaning more periods, in order to maximise the chances of getting pregnant (whether that’s what you want or not!). 

But then as the number of eggs and cells that produce hormones in the ovaries decline, the body isn’t able to develop an egg ready for ovulation each month. This means your cycles become less frequent and you may go months without a period.

Oestrogen dominance

With less eggs remaining and fewer periods, this means the ovaries start to produce less and less hormones. However, progesterone levels begin to fall before oestrogen levels do. Progesterone has a calming effect on the body which helps with things like sleep and reducing anxiety. 

This dominance of oestrogen can lead to:

Changes to your body

  • Heavier and longer periods 
  • PMS 
  • Tender breasts 
  • Bloating  
  • Insomnia (difficulty sleeping)  

Changes to your mood

  • Mood swings
  • Anxiety and depression 
  • Tiredness 

Oestrogen levels decline

Over time, oestrogen levels also begin to decline. This can bring different symptoms including:

Without oestrogen, the vagina produces less natural lubrication (the liquid that the vagina produces which is most obvious when aroused.)  

This can cause discomfort during normal daily activities such as sitting, exercising or peeing.   

With less lubrication, sex can become uncomfortable or painful due to more friction and you may find yourself reaching for more lube or trying non-penetrative sex.  

Ovulation (and the days leading up to it) is the time in the menstrual cycle where sex drive is usually at it’s highest. This is because oestrogen levels peak around then.

With less oestrogen being produced during the perimenopause, many people experience a lower level of sexual desire. 

Overactive bladder is where you need to pee more often and/or with greater urgency. Around 1 in 6 women have overactive bladder symptoms.  

Lower levels of oestrogen can thin the lining of the urethra (where you pee from). This may also be accompanied by a weakening of the pelvic floor muscles. Both of these can lead to different types of bladder conditions including:  

  • Urinary incontinence (being unable to hold it until you make it to a toilet)  
  • nocturia (waking up in the night because you need to pee) 
  • Stress incontinence (peeing when the bladder is put under sudden pressure for example when sneezing, coughing, laughing) 

Hot flushes are the most visible and common symptom of perimenopause.

The hormone changes can affect how your body regulates temperature, leading to periods of feeling very hot and becoming flushed on chest and face. When these happen at night, they’re often called night sweats. 

Hot flushes can occur at any time, night and day and can also be accompanied by a change in mood and lack of concentration.  

Some people experience hot flushes as frequently as every hour lasting around four minutes.  

The changing hormone levels can lead to a difficulty remembering things or a sense of feeling lost for words. 

Hormones have a huge impact on our lives. They not only affect our mood but can also affect what we care about, how we see ourselves and our relationships with others.

  • Oestrogen causes you to care more for others and with less of it you may find yourself prioritising yourself more. Whilst this isn’t necessarily a bad thing, it might be something that triggers changes in some relationships.
  • If you have a partner(s) and you experience a lower sex drive and vaginal dryness, your relationship may also be affected by changing the frequency, or type, of sex you have.
  • Changing hormone levels may also cause you to doubt yourself, lose confidence and self-esteem.

You may experience all of these, just a couple of them or you might experience symptoms for a couple of months and then they disappear. All of this is normal.  

Stage 2: The Menopause

You have reached the menopause once your periods have stopped for one year if you’re over 50 or for two years if you’re under 50. 

The menopause refers to the point that you transition from perimenopausal to postmenopausal.

Chemical menopause

Although most people will follow the three stages in a linear way, some people may move between the stages. This is often the case for people using medication to artificially start the menopause, this is known as a chemical menopause and it is used to treat certain conditions such as endometriosis.

There are lots of different types of chemical menopauses and they are experienced differently for every person. Sometimes they are temporary and the person’s periods return once they stop taking the medication, other times the change is long-term or permanent.

Stage 3: Postmenopause

After the menopause, you are then in the postmenopausal phase which lasts for the rest of your life.  

During this stage, your body is still producing hormones but in much smaller amounts and more consistently. For this reason, many people find this stage to be one of stability, self-assuredness and confidence. Without hormones affecting your mental state, the postmenopause phase can be a time to put yourself first, discover new things and care less about what other people think.  

This stage can also bring challenges and some of the symptoms from the perimenopause are here to stay due to the low levels of oestrogen: 

  • Low sex drive  
  • Vaginal dryness and painful penetrative sex  
  • Risk of osteoporosis (weakened bones) and heart disease 
  • Overactive bladder  

Because of this, many women continue to take hormone replacement therapy if they were also taking it during the perimenopause. It’s also a good idea to live a healthier lifestyle incorporating exercise and a balanced die into your diet to reduce the impact of this on your health. 

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