The 3 Stages of Menopause—and How They Affect Your Health

Menopause is often linked to hot flashes, but this major life transition can also impact everything from your bones to your heart. Here’s what to expect during each stage—and how to support your body through it.

Are you a woman in your mid-40s? You may soon be entering perimenopause—the transitional phase leading up to menopause. During this time, your body begins the gradual hormonal shift of winding down your reproductive years. While hot flashes and irregular periods are the symptoms most people expect, this life stage can also bring changes in body composition, bone density, cholesterol levels, and even mood.

Related: Women Face More Health Risks Than Men

The menopause transition happens in three phases—perimenopause, menopause, and postmenopause—each with its own set of symptoms and health impacts. Here’s what to expect, and how to support your body along the way.

‍Perimenopause

The precursor to menopause, perimenopause typically begins 8 to 10 years before menopause and most commonly occurs in a woman’s mid 40s. This marks the beginning of your body’s transition out of its reproductive years. On average, perimenopause lasts 3 to 4 years but it can be longer or shorter in some women. This phase often comes with a variety of new symptoms, including:

‍Hormonal Changes

During perimenopause, the hormones in the body begin to change. “During your reproductive years, your ovaries produce estrogen, which is essential for ovulation,” says Dr. Shannon Ashley, MD, senior preventive medicine physician at Prenuvo. “When you enter perimenopause, these levels begin to decline.” This can lead to irregular menstrual cycles or even missed periods. 

These hormone changes can also lead to hot flashes, which can occur during perimenopause or may not show up until the menopausal years. “Additional changes due to hormonal fluctuations include vaginal dryness that can make intercourse less comfortable, a reduced sex drive and mood changes,” says Ashley. 

‍Shifts in Body Composition

Less estrogen doesn’t just affect your cycle and mood. It can also impact how much energy your body uses and your appetite. This can lead to a slowed metabolism, weight gain and altered body fat distribution. Some studies show that fat in the abdominal area can become more prominent. This fat behind the abdominal wall, known as visceral fat, is  invisible to the naked eye and can increase one’s risk of conditions like cardiovascular disease, diabetes, and even Alzheimer’s disease. 

NOTE: Prenuvo’s Whole Body MRI Enhanced Screen with body composition analysis tracks how your body changes over time, revealing fat distribution, muscle-to-fat ratios, and early signs of potential health risks—so you can take action sooner.

“During perimenopause, muscle mass also begins to dip slightly due to estrogen’s waning protective effect, setting the stage for further loss later,” says Ashley. And as estrogen fluctuates, she notes, bone density can begin to decline during the end of this phase.

‍Additional symptoms of perimenopause can include:

• Insomnia: “Hot flashes, night sweats and changing hormones can sometimes make it harder to fall asleep at night or can lead to interrupted sleep,” says Ashley. 
• Bladder problems: Reduced estrogen can increase your risk of urinary tract infections. It can also lead to a need to urinate more frequently. 
• Mood swings, irritability and increased risk of depression: “Hormonal shifts and physical symptoms can take a toll on one’s mood during this phase of life,” says Ashley. 
• Changing cholesterol: Declining estrogen can sometimes lead to an increase in LDL (bad) cholesterol or a decrease in your HDL (good) cholesterol. 

‍Menopause

Once you’ve had 12 consecutive cycles with no menstrual cycle, you’ve transitioned from perimenopause to menopause. This can happen in your 40s or 50s but the average age of onset for women in the United States is age 51. During this time, you’ll likely continue to experience some of the familiar symptoms of perimenopause and may encounter some new ones.

‍Hormonal Changes

Estrogen and progesterone production will continue to decline as ovarian function ceases. “The drop in these hormones solidifies the changes that began in perimenopause,” says Ashley. “Hot flashes may peak, vaginal dryness intensifies, and mood swings can persist as the body adjusts to this low-hormone state.” These hormonal changes can also lead to night sweats, a decreased sex drive, irregular periods, enhanced PMS symptoms while still ovulating, breast tenderness and thinning hair. 

‍Shifts in Body Composition

“During menopause, the gradual loss of estrogen accelerates changes in body composition,” says Ashley. As a result, many women experience an increase in abdominal fat, which can occur even if they are not gaining weight overall. Bone density, says Ashley, also continues to decline in this phase, putting women at greater risk for osteoporosis. “The loss of muscle mass may continue as well, contributing to a slower metabolism,” Ashley adds. 

‍Additional symptoms of menopause can include:

• Joint pain and muscle aches
• Urinary urgency
• Fatigue
• Thinning hair
• Dry skin, mouth and eyes
• Difficulty concentrating:
• Headaches

‍Post Menopause

The time after menopause is known as post menopause. The good news? Once you complete the menopause transition, the majority of your symptoms should subside. But staying proactive with your health is still crucial, as you may face increased risks for certain conditions.

‍Hormonal Changes

“While most symptoms disappear, some women still experience hot flashes in this phase as hormones continue to decline,” says Ashley. Women in this phase of life can also continue to experience conditions like vaginal dryness, urinary incontinence, and an increased risk of urinary tract infections. Anxiety, depression and moodiness can also still linger. 

And the continued decline in estrogen causes postmenopausal women to continue to be at higher risks of conditions like heart disease. "Estrogen has a protective effect on the cardiovascular system, so its decrease during menopause increases the risk of heart-related conditions," explains Ashley. 

‍Shifts in Body Composition

Post menopause, weight gain, especially around the abdomen, can be a continued concern. In fact, one study found that visceral fat increases from about 5%-8% of total body fat in the premenopausal state to 15%-20% in the postmenopausal state. “And estrogen also plays a role in bone health, so less concentrations of it in the body can lead to weaker bones over time,” says Ashley. Research has found that  women can lose 1% to 2% of their bone density per year after menopause.

‍How to make the menopausal transition easier

There are steps you can take to prioritize your health during perimenopause, menopause and postmenopause – and to make these transitions more comfortable. Here are a few things to try. 

1. Monitor with Prenuvo: Stay ahead of the changes happening inside your body with insights you can act on. Prenuvo’s Whole Body Scan checks for hundreds of conditions—even before symptoms appear. And Prenuvo’s Enhanced Screen with body composition analysis gives you a detailed look at your fat-to-muscle ratio, visceral fat levels, and early signs of muscle loss. Catching these shifts early can help you make proactive choices to protect your strength and reduce disease risk.

2. Prioritize calcium and vitamin D: These two nutrients are essential for strong, healthy bones—especially as estrogen declines. Eat foods high in calcium, such as cheese, leafy greens, yogurt or fortified cereal. While your body can absorb vitamin D from sunlight, many women benefit from supplements. Talk to your doctor about checking your levels. 

3. Get your heart pumping: Research suggests that cardiovascular exercise – specifically high intensity interval training (HIIT) may help you to lose belly fat, which is known to accumulate easier during menopause. 

4. Pump some iron too: Strength training is extra important for women who are in the midst of menopause and beyond. A 2025 study found that resistance training can help to reduce loss of strength and maintain flexibility during and after perimenopause and menopause. 

5. Take a chill pill: Stress can worsen symptoms like anxiety, sleep trouble, and hot flashes. Some research has even linked stress to earlier onset menopause. Try calming activities like meditation, yoga, journaling and spending time in nature. 

6. Sleep smarter: Night sweats, hormonal shifts, and mood changes are among the many reasons that your sleep can take a hit in the menopausal years. Prioritize a good night’s sleep by keeping your room cool, avoiding screens before bed and maintaining a consistent bedtime routine. 

7. Stop smoking and cut back on alcohol: Women who smoke can start menopause as soon as 2 years earlier than those who don’t. Alcohol can make it harder to maintain a healthy weight, can disrupt sleep and can exacerbate menopausal symptoms like hot flashes.

8. Consider a lubricant: 50% of postmenopausal women experience some form of vaginal dryness and pain during intercourse. Lube can help to make things more comfortable while being intimate. 

9. Ask your doctor for help: Your doctor can prescribe an array of medications that can help to ease symptoms during and after menopause, including antidepressants, prescriptions to protect your bones from osteoporosis, non-hormonal medications for hot flashes and mood changes, and hormone replacement therapy (HRT).

10. Seek out social support: Menopause can bring a range of physical and emotional challenges, and navigating it alone may feel overwhelming. Consider joining a support group, scheduling a session with a therapist, or opening up to friends who are in a similar stage of life to help you feel supported throughout this transition. 

“While menopause can bring challenges, it’s also a time to reconnect with your health, listen to your body, and embrace the next chapter with strength and clarity,” says Ashley. She stresses that with the right support and tools, you can thrive in every stage.

‍To learn more about how a Prenuvo whole body scan can help you stay on top of your health throughout menopause, no matter which stage you're in, book a call with a member of our care team.