June 23, 2025, 2:05 am | Read time: 5 minutes

Menopause–also known as the climacteric–brings a variety of physical and emotional changes. Many women are surprised by how diverse the symptoms can be. FITBOOK author Laura Pomer explores the different phases and explains how a woman can recognize that her body is entering this new stage of life.

Menopause is not the same as menopause

The terms “menopause” and “menopause” are often used interchangeably–this is not medically correct. Menopause encompasses several stages: premenopause, perimenopause, menopause, and finally postmenopause. The last three phases are particularly significant for affected women.

1. Phase: Premenopause–the beginning of hormonal changes

Even before periods become irregular, hormonal changes begin in the body. Women are born with their complete number of follicles, which are depleted over a lifetime. In premenopause, the decline of these reserves approaches a critical point, causing the production of the hormones estrogen and progesterone to decrease. This also reduces fertility, which can be relevant for women wishing to have children.

First signs: Cycle fluctuations

Typical for this phase are irregularities in the menstrual cycle. There may be intermenstrual bleeding, or the monthly period may be significantly shorter or longer than usual. This phase is very individual and can last from a few months to several years.

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2. Phase: Perimenopause–the transition to menopause

Perimenopause often begins in the mid to late 40s. During this transition to menopause, the decline in egg reserves reaches the aforementioned critical point, and hormonal chaos ensues–with large, unpredictable cycle fluctuations, meaning fluctuations in the hormones estrogen and progesterone.¹

Symptoms like hot flashes, mood swings, and sleep problems

Typical during this time are hot flashes–experienced by about 85 percent of women in menopause–as well as night sweats, breast tenderness, sleep disturbances, and emotional instability up to depression.² Women in perimenopause are significantly more at risk of developing depression than women in premenopause, according to studies.³ Sexual perception can also change.

Changes in the intimate area and urinary tract

Due to the decreasing estrogen levels, the mucous membrane in the intimate area becomes more sensitive. This often leads to vaginal dryness, itching, burning, increased susceptibility to injuries, and a higher likelihood of infections. The latter is related to pH imbalances in the vaginal flora. Libido may also decrease. Additionally, the breakdown of the mucous membrane affects bladder function. Many women experience the onset of urinary incontinence during this phase of menopause, as the pelvic floor muscles weaken.

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3. Phase: Menopause–the end of menstruation

Menopause marks the complete cessation of menstruation. However, there may still be occasional bleeding, as the ovaries may continue to produce hormones sporadically. A classic menstrual period no longer occurs.

Physical and psychological symptoms

Menopause often brings strong physical reactions: intense hot flashes, insomnia, and depressive moods are not uncommon. Sexual interest may also completely disappear.

4. Phase: Postmenopause–when hormonal changes are complete

About a year after the last period, postmenopause begins. The hormonal changes have stabilized, and no more menstrual bleeding occurs. Any bleeding that occurs now should be medically evaluated to rule out serious causes in the uterus.

Treatment options for menopausal symptoms

Hormone replacement therapy is considered particularly effective for alleviating symptoms. Estrogens–usually in the form of gels–are applied externally to compensate for the deficiency in the body. Experts recommend starting therapy early to achieve the best possible results. However, women should seek comprehensive medical advice, as hormone therapy can increase the risk of certain cancers if there is a genetic predisposition. It is also important to know that the alarming study results from the early 2000s, which led to a temporary halt in hormone therapy, are now considered outdated or misinterpreted in research. This is emphasized by internationally renowned menopause expert Dr. Mary Claire Haver in her book and various interviews.

Ultimately, every woman should seek individual advice and make an informed decision. For women who do not want to take hormones, there are also alternative, hormone-free methods–although these are often less effective. A healthy, protein- and vitamin-rich diet, sufficient exercise, and especially targeted muscle building are important to prevent osteoporosis and frailty in old age. Additionally, omega-3 fatty acids as dietary supplements can be helpful. Stress avoidance also plays a major role in well-being during this phase of life.

More on the topic

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Phases and Symptoms How Women Can Tell Their Menopause Has Started

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Conclusion

Menopause occurs in various phases, each with its own challenges. To navigate this time well, it is crucial to recognize symptoms early and choose appropriate treatment paths–whether through hormone therapy or alternative approaches. An open, informed engagement with the topic helps women actively and confidently shape this phase of life.

With expert advice from Dr. med. Christian Albring, specialist in gynecology