Understand the stages of menopause, symptoms, key health risks, and how to manage changes for long-term well-being.
This resource is part of a brief series on the importance of understanding menopause.
1. Understanding Menopause (current) | 2. Menopause and Osteoporosis
While we use the term “woman” in this article, we recognize that menopause is a life stage that can be experienced by transgender, non-binary, and gender-diverse people too.
For years, individuals navigating menopause received little information and their symptoms were often dismissed by the medical community. This article breaks down the stages of menopause, while addressing common symptoms and misconceptions. It also highlights key health risks, such as heart disease and osteoporosis that women face in menopause and offers solutions to manage these changes for better overall well-being.
Much like puberty, menopause is a natural phase of life experienced by all women. It occurs when a woman's ovaries stop producing eggs, leading to a decrease in estrogen and progesterone levels. Individuals who identify as cisgender, non-binary, transgender, and/or gender diverse may also experience menopause. This can be distinct for each person due to age-related hormonal changes, hormone treatments as part of gender-affirming care and surgeries.
Menopause consists of three stages spanning one third to one half of a woman’s life: perimenopause, menopause, and postmenopause.
What can I expect during the three stages of menopause?
Perimenopause is the time leading up to menopause and can last anywhere from two to ten years. Many women experience symptoms during this time that negatively impact their physical and mental health and can greatly impact their quality of life. On average, most women begin perimenopause between the ages of 40 and 50, however, some individuals go through menopause before the age of 40.
Menopause is marked when a woman has not had a period for 12 consecutive months. If a woman gets a menstrual period after 11 months and 12 days, the countdown begins again. In Canada, the average age for menopause is 51, with most women transitioning into menopause between 45 and 55. Early menopause (ages 40-45) and late menopause (ages 55-60) are also possible, while menopause before age 40 is considered premature. Menopause can be induced by surgery if both ovaries are removed (bilateral oophorectomy), which causes immediate menopause. A hysterectomy alone does not induce menopause unless the ovaries are removed, though it may cause menopause to begin earlier. Additionally, treatments like chemotherapy and radiation can also result in what is called "medical menopause."
After menopause, a woman is considered postmenopausal for the rest of her life. Some symptoms experienced during perimenopause may subside a few years after menopause, but others may persist for decades. The postmenopausal decrease in estrogen increases the risk of conditions like heart disease, osteoporosis, and genitourinary syndrome of menopause (GSM).
What are common symptoms?
Like many other experiences (e.g., menstruation, pregnancy, and childbirth), women often hear horror stories about menopause. The truth is that menopause symptoms can vary from non-existent to mild to severe and may be temporary or long lasting. For women in premature perimenopause (before age 40), symptoms can be confusing, especially if they’re not accompanied by other “classic symptoms” such as hot flushes or night sweats, and menstrual periods are still occurring. It can be really hard to understand what’s happening if you feel “off” or just not like yourself.
It’s the hormone fluctuations that can trigger a number of symptoms—over 30 symptoms have been identified as related to perimenopause and menopause. Many women are familiar with hot flushes (also referred to as hot flashes) and night sweats, but many women may also experience:
Abnormal menstrual bleeding (heavy and/or irregular periods, bleeding in between periods)
Sleep disturbance or insomnia
Brain fog, memory issues, or other cognitive changes
Vaginal dryness
Pain with sex
Decreased sex drive
Joint pain and muscle aches
Lack of energy
Fatigue
Mood changes, irritability
Headaches and migraines
See the symptom tracker for a more comprehensive list of symptoms.
Many women dismiss their initial symptoms, assuming these changes are simply part of aging, unaware that they’re related to menopause. Some may feel too embarrassed to discuss symptoms with their primary healthcare provider. Historically, healthcare providers have received limited training in recognizing perimenopause and menopause symptoms. This may lead to assessment of each symptom in isolation, potentially overlooking menopause as a possible explanation, resulting in a delayed or missed diagnosis.
Studies have suggested that age at the time of the final menstrual period in Black, Asian, and Latina women is, on average, earlier than for White women, though the exact timing can vary due to a combination of genetic, environmental, and socioeconomic factors. It can range from about 8.5 months earlier for Black women, 1.7 years earlier for Latina women and about 1.2 years earlier for Chinese women. Moreover, Black women were 50% more likely to have hot flushes and night sweats. These symptoms tend to last three and half years longer for Black women and two and half years longer for Latina women. Chinese and Japanese women typically experience hot flushes for fewer years. Additionally, Black women tend to have heavier menstrual periods, prolonged bleeding, and spotting during perimenopause.
What medical conditions are associated with menopause?
We may have learned in school that the hormones estrogen and progesterone are involved in the reproductive system, regulating our menstrual cycle. But these hormones play important roles in many other systems throughout the body. As estrogen and progesterone levels decline, women may face a higher risk of developing certain medical conditions, including:
Recurrent urinary tract infections
Heart disease
Osteoporosis
Dementia and Alzheimer’s disease
Metabolic syndrome
Type 2 diabetes
Genitourinary syndrome of menopause (chronic condition of the vulva, vagina and lower urinary tract leading to a number of symptoms, such as vaginal dryness, burning and irritation, vulvar atrophy, urgency with urination, painful urination, incontinence, painful intercourse, decreased arousal).
The biological effects of an earlier start to menopause in women of colour means that later in life consequences of osteoporosis, heart disease, and diabetes can occur earlier in life. Women with earlier menopause may be at risk for lower bone density and increased fracture risk in postmenopausal phase.
Urinary incontinence on its own is not a menopause symptom and is not associated with changes in estrogen level, but tends to begin around the time of menopause transition. It appears that urinary leakage is associated with aging, weight gain, and diabetes. Research has shown that Black and Latina women report worsening urinary incontinence during and after the menopausal transition. Women are more likely to seek treatment for urinary incontinence the longer they have this condition, but many women never seek treatment as they believe (inaccurately) that leaking is a normal part of aging or their healthcare provider has never discussed leakage problems with them.
It’s also important to be aware that mood changes may accompany menopausal symptoms. Studies have shown that 19-36% of women may experience depression during menopause transition. There are no clear-cut answers as to why this occurs but it’s not surprising given that depression can be triggered by hormonal changes. Be sure to monitor your mood and seek professional advice if symptoms interfere with your daily life. Speak to your primary care provider or reach out to your EFAP provider for support.
What are the challenges women face at work during menopause?
The symptoms of menopause can make it hard for women to focus or keep up their usual energy levels. Symptoms like hot flashes, night sweats, and brain fog can cause discomfort and make it difficult to concentrate, which can affect performance at work. It’s common that women feel embarrassed or hesitant to discuss their symptoms, fearing stigma or misunderstanding. This can lead to frustration, isolation, and lower confidence and self-esteem.
Despite its impact, menopause often goes unaddressed in the workplace. Raising awareness about menopause can help create a more supportive environment. Proactive and empathetic policies can make a substantial difference in both employee well-being and organizational success. The first step an organization can take is to recognize that there are women in the workplace that are in the prime of their careers but may also be suffering in silence.
What can women do to protect their health and manage their symptoms?
If you suspect you’re entering menopause, book a visit with your healthcare provider. Keep a record of your symptoms beforehand using the symptom tracker provided and bring it with you to your appointment. It's easy to forget details when you’re talking things through. Having a clear picture of what you’ve been experiencing helps your provider better understand your symptoms and guide next steps.
Many women, particularly those from underrepresented groups, may face discrimination and undertreatment in healthcare settings. Women who belong to more than one underrepresented group, not only face racism but also homophobia, transphobia, and hetero-cis-normativity. Healthcare providers often dismiss women’s symptoms as “normal” or simply a part of aging. Symptoms may be assessed individually, rather than holistically and a determination of perimenopause/menopause may not be explained as the root cause. In fact, only about 25% of women receive proactive discussions with their family doctor and of the women who seek medical advice, just over 25% found the advice to be helpful.
This can leave women feeling helpless and facing barriers in treatment for their symptoms. Many women try to figure out the puzzle of their symptoms on their own, while others suffer in silence. Seeking answers and managing symptoms without the guidance of a compassionate and knowledgeable healthcare provider can be overwhelming and expensive, as women look for solutions with psychologists or other mental health providers, naturopathic doctors, physiotherapists, osteopaths, or massage therapists. If you feel you aren’t receiving the answers or care you need from your primary care provider, ask for a referral to a menopause specialist in your area.
Unfortunately, as menopause receives more public attention, dishonest individuals and companies take advantage of the situation to promote and sell unregulated products, such as supplements, compounded hormones, and hormone pellets to women. These products may not provide help with the symptoms, are costly, and many can be harmful. That said, many women find that certain supplements reduce or ease some symptoms. As long as your primary healthcare provider is aware of the supplements you’re taking and they are safe for you, there is no reason to stop taking them.
In order to ensure better health outcomes, it’s important to seek care from healthcare providers who are knowledgeable about the unique menopausal experiences women go through. This also applies for people who are transgender, non-binary, or intersex, as they may experience symptoms of menopause. Finding a provider who understands the diverse challenges individuals face can make a significant difference in managing symptoms and protecting long-term health. This approach not only helps individuals receive more personalized care but also highlights the demand for a more inclusive and informed healthcare system, where everyone’s needs are acknowledged and addressed.
To help you manage the symptoms of menopause, it’s important to consider a combination of lifestyle changes and medical treatments to manage symptoms and protect your health. While hormone therapy is often the most effective option for managing hot flushes, vaginal dryness, urinary tract issues, and can support bone and heart health, there are other options available for women who cannot or prefer not to use menopause hormone therapy. Your healthcare provider can outline the various options that are now available.
Alongside medical options, the following can help reduce the risk of heart disease and osteoporosis and can also help improve overall well-being:
maintain a healthy diet
exercise regularly
quit smoking
limit alcohol consumption
limit caffeine intake
participate in weight-bearing exercises
consume foods rich in calcium, take calcium and vitamin D supplements if necessary (speak to your healthcare provider)
be aware of fall prevention strategies
exercise to help improve balance and build strength to help prevent future falls.
As you enter the menopause phase of your life, see your care provider at least annually to be screened and monitored for:
blood pressure and cholesterol levels
diabetes
depression
Menopause can be challenging, but you don’t have to navigate it alone. If you’re unsure where to begin or need extra guidance, reach out to your Employee and Family Assistance Program (EFAP) for confidential support. An EFAP professional can help you explore coping strategies and provide practical support as you manage this transition. Taking these steps early can make a significant difference in how you feel and function day to day.
Further Reading
Black Girl’s Guide to Surviving Menopause
Gunter J (2021) The Menopause Manifesto: Own your health with facts and feminism. Toronto: Random House Canada
McDonagh A, Gunstone C (2023) Let’s talk about the menopause: The views and experiences of women living in Hertfordshire. Healthwatch Hertfordshire. Accessed on 10 October 2025