How long does each stage of ageing last and what are their symptoms?
People often use “menopause” to describe a woman's entire midlife transition. Medically, it refers to one point in time which marks the end of reproductive years; the naturally-occurring process of reproductive ageing and follicular depletion.1
Perimenopause
Perimenopause is the beginning of the journey leading up to the last menstrual cycle and although timing varies from woman to woman, it usually begins in the 40s. The first noticeable changes may be a shorter, longer, lighter, heavier or less predictable menstrual period. Hot flashes, sleep disturbances, mood changes, vaginal dryness or urinary symptoms may also occur.
Menopause
Natural menopause is when a woman completes a full year without having their period. The average age is approximately 51 to 52 in the United States, but each individual may have a unique timeline.
Postmenopause
Postmenopause begins after menopause and lasts for the rest of the individual's life. Some symptoms ease, while others may persist; particularly hot flashes, sleep disruption, vaginal dryness, painful sex or urinary symptoms. During this phase, estrogen levels decrease which may also have an effect on bone density, cardiovascular risk, metabolic and brain Health.
How symptoms change
There is no universal symptom calendar. Some people experience few changes, while others may feel a range of symptoms.
Hot flashes and night sweats
Hot flashes and night sweats are known as vasomotor symptoms. In the Study of Women’s Health across the Nation, women who reported frequent vasomotor symptoms experienced them for a median total of 7.4 years, including an average of 4.5 years after the final menstrual period.1
Period changes
Irregular bleeding is common in perimenopause because ovulation becomes less predictable. Very heavy bleeding, bleeding between periods, bleeding after sex or any bleeding after menopause can be common symptoms but should not be automatically attributed to hormonal transition.4,2
Sleep, mood and concentration
Sleep can be disrupted by night sweats, changing hormone patterns or unrelated conditions. Irritability, mood changes, difficulty concentrating and brain fog may occur, but persistent depression, severe anxiety or major cognitive changes deserve medical attention rather than being dismissed as “just menopause.”4,2
Vaginal and urinary symptoms
Vaginal dryness, discomfort during sex, urinary urgency and recurrent urinary symptoms can emerge or continue after other menopausal symptoms resolve. Unlike some vasomotor symptoms, these changes may persist without treatment, so discussing them with a clinician can open the door to effective local or systemic options.4
References
Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539. doi:10.1001/jamainternmed.2014.8063.pubmed.ncbi.nlm.nih
Office on Women’s Health. Menopause basics [Internet]. Washington (DC): U.S. Department of Health and Human Services; 2026 [cited 2026 Sep 29]. Available from: https://womenshealth.gov/menopause/menopause-basicswomenshealth
Office on Women’s Health. Menopause symptoms and relief [Internet]. Washington (DC): U.S. Department of Health and Human Services; 2025 May 29 [cited 2026 Sep 29]. Available from: https://womenshealth.gov/menopause/menopause-symptoms-and-reliefwomenshealth
American College of Obstetricians and Gynecologists. Hormone therapy for menopause [Internet]. Washington (DC): American College of Obstetricians and Gynecologists; [cited 2026 Sep 29]. Available from: https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopauseacog
