A Doctor’s Guide to (Peri)Menopause: Symptoms, Stages, and Blood Tests

Menopause is a natural stage of life that every woman will experience. However, because its symptoms can appear gradually and vary greatly from person to person, this transition is often confusing and challenging. Understanding what to expect can make menopause easier to navigate.

This article is the first in a three-part series featuring insights from Dr. Dovilė Kalvinskaitė, an obstetrician-gynecologist and lifestyle medicine specialist at a menopause clinic in England. Drawing on her clinical experience, she explains what happens during menopause and how healthy lifestyle habits can help women manage symptoms and improve their quality of life.

What Are Menopause, Perimenopause, and Postmenopause?

Menopause is officially diagnosed after 12 consecutive months without a menstrual period. It typically occurs between the ages of 45 and 55.

While some menopause symptoms improve within five to ten years, others—such as vaginal dryness or bone loss—may gradually worsen without appropriate care.

If menopause occurs before the age of 40, it is considered premature ovarian insufficiency and requires medical evaluation and treatment.

Early menopause occurs between the ages of 40 and 45. It may happen naturally or result from medical treatments such as hysterectomy, chemotherapy, or radiation therapy.

Perimenopause is the transitional phase leading up to menopause. It can begin seven to ten years before the final menstrual period, and symptoms vary widely between women.

Postmenopause refers to the years following menopause and continues for the remainder of a woman's life.

Common Symptoms of Perimenopause

The timing and duration of symptoms differ from one woman to another. Some symptoms improve over time, while others may become more noticeable without treatment.

Possible symptoms include:

• Changes in the menstrual cycle.
• Insomnia and sleep disturbances.
• Hot flashes and night sweats.
• Heart palpitations.
• Dizziness.
• Fatigue.
• Brain fog.
• Difficulty concentrating.
• Memory changes.
• Mood swings.
• Anxiety or panic attacks.
• Depression.
• Weight gain.
• Headaches.
• Joint, muscle, and bone pain.
• Frozen shoulder.
• More severe PMS or PMDD symptoms.
• Tinnitus (ringing in the ears).
• Changes in body odor.
• New or worsening allergies.
• Paresthesia (tingling or crawling sensations).
• Sleep apnea.
• Bloating and digestive issues.
• Lower self-esteem.
• Feeling disconnected from yourself.
• Difficulty balancing work, family, and relationships.
• Skin changes, hair thinning, and collagen loss.
• Reduced libido.
• Vaginal dryness.
• Pain during intercourse.
• Urinary incontinence or bladder irritation.
• Recurring urinary tract infections.
• Sexual dysfunction.

Perimenopause is also associated with changes in the menstrual cycle, including irregular or heavier bleeding. Choosing gentle, non-irritating menstrual products can help improve comfort during this transition.

Gentle Day pads and liners provide reliable protection while being designed for sensitive intimate skin.

Why a Healthy Lifestyle Matters

Research suggests that up to 40% of women may reduce or better manage perimenopausal symptoms by consistently following healthy lifestyle habits.

However, every woman's experience is unique. Some women continue to experience significant symptoms despite maintaining a healthy lifestyle because of individual differences in hormone levels and sensitivity to estrogen.

Even when symptoms persist, healthy habits remain essential for supporting long-term health and reducing the risk of chronic disease.

The Three Pillars of Symptom Management

Dr. Dovilė describes menopause care using the analogy of three buckets, each representing a different level of support.

1. Healthy Lifestyle

The foundation includes:

• Balanced nutrition.
• Regular physical activity.
• Quality sleep.
• Stress management.
• Avoiding smoking and limiting alcohol.
• Maintaining positive social relationships.

These habits have the greatest impact on overall health and should always come first.

2. Supplements and Complementary Approaches

Dietary supplements and selected complementary therapies may help support symptom management when used appropriately.

3. Medical Treatment

When lifestyle changes and supplements are not enough, hormonal or non-hormonal medical treatments may be recommended by a healthcare professional.

What's Next?

In the next articles of this series, we'll explore each of these three pillars in greater detail, including nutrition, supplements, physical activity, sleep, stress management, and medical treatment options.

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