
Many women begin to experience symptoms of menopause, such as hot flashes, before their periods stop. If you feel confused as to why you're prone to these symptoms when you're still getting your period (or are experiencing them long after menopause has occurred), you aren't alone! What most people don't know is that menopause actually occurs in the phases: perimenopause, menopause and post-menopause.
So what's the difference?
Perimenopause is the process of change in hormone levels leading up to menopause. A natural process, it can last for two to eight years. During this time, estrogen and other hormones begin to fluctuate, but periods don’t stop.
Menopause itself usually happens around age 50 and is the point in a woman’s life when she hasn't had a period for a year.
The term post-menopause refers the time after menopause and symptoms can last for five to 10 years or longer.
What are the symptoms of the menopause transition and when do they occur? A variety of symptoms related to hormone changes can occur at any stage, however it can be helpful to know the most common symptoms (and some natural remedies!).
Common symptoms during perimenopause
1. Hot flashes
The first sign of perimenopause is a change in your menstrual cycle and irregular periods. However, one of the first symptoms women experience are hot flashes. A hot flash is a transient wave of heat and sweating that is caused by changes in estrogen. It's one of the most troubling symptoms and can cause anxiety, stress, increased heart rate and discomfort. Most hot flashes last for just a few minutes, but some women can have up to 10 or more in a day.
Relaxation techniques and mental imagery can help with hot flashes. One technique, hypnotic relaxation, involves entering a deeply relaxed state and experiencing mental images of coolness – such as a cool mountain stream or snow, can reduce hot flashes. Some women find acupuncture, yoga, and foods like tofu and soy milk to be helpful.
2. Sleep disturbance
Changes in sleep occur naturally with aging. Most people find that they need less sleep as they get older. However, with the onset of menopausal symptoms, sleep can be interrupted by awakening in the middle of the night or having difficulty going to sleep.
Reducing stress and going to bed on a regular schedule can help. Try progressive relaxation. Progressive relaxation involves suggesting to yourself that each part of your body can become completely relaxed. Start at the top of your head and progress to your feet. Taking melatonin helps some people sleep better.
3. Mood swings
Feeling moody, more irritable, or slightly depressed can occur as estrogen levels vary. Our moods are affected by hormones and it's important to recognize this is the case. At other times, feeling more irritable or stressed can relate to conflicts or excessive demands of work and home.
Recognize your feelings and to express how you feel. Having a good friend or counselor to talk to can make a big difference. If you feel stressed, taking a deep breath and focusing on relaxation for just a moment can help. Also, exercise, such as yoga, is a good stress reducer.
Common symptoms during menopause
4. Increased hot flashes and night sweats
Night sweats are hot flashes that occur during sleep. They often occur during perimenopause, but can get worse after estrogen production stops all together.
Using relaxation and mental imagery at night, right before going to bed, is helpful for many women. Hypnotic relaxation has been shown to reduce both hot flashes and night sweats. Listening to audio recordings with suggestions for deep mental relaxation can improve sleep.
5. Fatigue
Feeling more tired than usual is a very common symptom of menopause.
Eating a good breakfast can boost energy during the day. Also, a healthy diet of fruits and omega-3 fatty acids (found in foods like tuna and salmon) can keep you feeling more mentally alert. Stretching exercises, such as yoga, during the day can restore physical energy and taking a break and going for a walk in nature can restore mental energy.
6. Decreased libido
Changes in sex drive relate to the estrogen decline, but can be affected by stress and relationship issues.
Talk with your partner about your feelings. Sexuality relates a great deal to how we feel about ourselves and a sexual partner. Getting away for a romantic weekend and away from day-to-day stresses can have a very positive effect on a person’s sex drive.
Common symptoms during post-menopause
7. Bone loss
There is an increased risk of osteoporosis post-menopause. This can lead to hip fractures and other serious medical problems, so preventative measures are a must.
Women should get plenty of calcium and take vitamin D. Good sources of calcium are yogurt, milk, and supplements. Some foods such as orange juice may be fortified with calcium. Also, weight bearing exercise can help strengthen bones.
8. Vaginal dryness
Vaginal dryness can be painful, causing discomfort during intercourse, spotting or bleeding.
The use of lubricants can reduce vaginal dryness. For example, vitamin E oil applied to the vagina can help improve lubrication. Soy based foods and taking herbs such as black cohosh may help ease dryness in some women.
9. Weight gain
Estrogen helps to control body weight, however, as women get older, maintaining their usual weight becomes more difficult. Many women gain weight post-menopause. For this reason, it's especially important to have healthy-eating habits and leading an active lifestyle.
Keeping a food diary can help control calories. Also, aim for foods such as whole grains, fruits, vegetables, and lean protein. Post-menopause is also a great time to start an exercise program. Find something you enjoy such as aerobics, working out at the gym, or even dancing!
10. Memory lapses
Everyone, men and women, sometimes experience forgetfulness, or memory glitches. However, it can become more frequent post-menopause.
Avoid high fat and high sugar foods that can make you feel sluggish. Also, get some exercise every day. Thirty minutes of aerobic exercise alone can improve memory and concentration. Exercising your brain is also important. Reading books, learning a new skill, or playing a musical instrument stimulate the memory centers of your brain.
Taking control of your health can be empowering!

Gary R. Elkins, PhD, ABPP, ABPH, is the director of the Mind-Body Medicine Research Laboratory at Baylor University. He is professor of psychology and neuroscience at Baylor University, where he is the director of the doctoral program in clinical psychology. He is also the author of Relief From Hot Flashes: The Natural, Drug-Free Program to Reduce Hot Flashes, Improve Sleep, and Ease Stress (Demos Health, July 9, 2014).