Understanding Menopause - the Symptoms and Risks

Photo by: Priscilla Du Preez

What happens during menopause?

Menopause is a natural biological process that occurs in stages, marking the cessation of menstruation and the end of a woman’s reproductive years. The timing, duration, and progression of these stages vary considerably from person to person. Despite growing research, there is still much to learn about the nuances of menopause. A simplified summary of the stages of menopause are as follows:

1. Perimenopause

Perimenopause is the transitional phase leading up to menopause, characterized by a progressive decline in estrogen production by the ovaries. This stage typically begins in a woman’s mid-40s, though it may start earlier or later, and lasts an average of 8–10 years. Despite the onset of perimenopause, pregnancy remains possible during this phase, as ovulation can still occur (Cleveland Clinic, 2025). Common symptoms during this stage result from fluctuating hormone levels and may include:

• Irregular menstrual cycles

• Hot flashes

• Night sweats

• Mood swings

2. Menopause

Menopause is officially diagnosed after 12 consecutive months without a menstrual period. During this stage, the ovaries produce minimal estrogen, and eggs are no longer released. Once menopause is reached, it marks the end of the reproductive phase of life, but it is not considered a prolonged stage; it simply represents a specific point in time.

3. Postmenopause

Postmenopause refers to the stage following menopause, extending for the rest of a woman’s life. Pregnancy is no longer possible during this phase. The average age of onset for postmenopause is 52, and while most perimenopausal symptoms subside, some women may experience occasional re-emergence of symptoms. Postmenopausal women may continue to face unique health challenges, including those related to decreased estrogen levels.

What are the symptoms of menopause?

As estrogen levels decline during perimenopause, a range of physiological changes occur, leading to the onset of various symptoms. Symptoms during this time are very common and can even interfere with quality of life.  Below is a list of common symptoms associated with the menopause transition:

• Irregular periods (during perimenopause)

• Hot flashes

• Night sweats

• Mood changes

• Vaginal dryness

• Decreased libido

• Changes in skin and hair texture

• Sleep disturbances

• Increased frequency of urination

In postmenopause, many symptoms usually improve, although the degree of relief varies between individuals.  Some symptoms may persist, though usually they are less severe. The decreased estrogen that occurs in menopause can also result in some health risks.

What are the health risks of menopause?

Risk of osteoporosis

Estrogen plays a crucial role in maintaining bone density. As estrogen levels decline, bone resorption may exceed bone formation, leading to decreased bone mass. By age 60, some women may lose up to 25% of their bone density, making them more susceptible to fractures (Słupski et al., 2021). To mitigate the risk of osteoporosis, it is essential to prioritize bone health through:

• Resistance training (weight-bearing exercises)

• Adequate intake of calcium and vitamin D

• Supplementation with isoflavones from sources such as soy or red clover may also support bone health

Cardiovascular risks

Estrogen has a protective effect on the cardiovascular system, including its influence on lipid metabolism and endothelial function (Erdélyi et al., 2023). As estrogen levels decline post-menopause, the risk of cardiovascular diseases such as atherosclerosis and hypertension increases. Strategies to support cardiovascular health include:

• Regular physical activity, particularly resistance training

• Dietary modifications, such as prioritizing fiber intake from fruits and vegetables and consuming omega-3 fatty acids from sources like fatty fish and chia seeds

Loss of muscle mass 

Age-related muscle loss, or sarcopenia, accelerates during the menopausal transition. A decrease in muscle mass can impair mobility, reduce strength, and contribute to a diminished ability to perform daily activities. Additionally, loss of muscle mass can impair insulin sensitivity, increasing the risk of metabolic disorders, such as insulin resistance (Merz & Thurmond, 2020). 

To counteract muscle loss, it is essential to engage in: 

• Regular resistance training 

• Adequate protein intake to support muscle maintenance and function

Weight changes 

The decrease in estrogen levels during menopause can lead to a reduction in metabolic rate, resulting in a decrease in daily caloric requirements by approximately 250–300 calories (Erdélyi et al., 2023). Estrogen also influences hunger regulation, and some women experience increased appetite during postmenopause. Weight gain is a common experience for women after menopause. Strategies to manage weight include:

• Mindful and intuitive eating

• Regular physical activity including weight training 

• Increased fiber intake from whole grains, vegetables, and fruits

Managing Menopausal Symptoms: Who Can Help?

Managing menopausal symptoms effectively requires a multidisciplinary individualized approach. Healthcare professionals, including:

• Menopause specialists

• Physicians

• Registered dietitians (like us at Katie Chapmon Nutrition!) 

can provide invaluable support in developing a personalized plan that addresses both the symptoms and health risks associated with menopause. Collaboration with these experts can help mitigate symptoms and improve overall quality of life during this natural transition. By understanding the stages, symptoms, and health risks associated with menopause, women can make informed decisions about lifestyle modifications, nutrition, and physical activity to optimize health and well-being during and after this transition.

Published: December 15th, 2025

Written by Shauna Watts. Shauna Watts is a dietetic intern with Nutrition Ink, who received her Master’s degree in Nutritional Science from California State University Los Angeles. She discovered her interest in nutrition during her youth, and is particularly interested in the role of nutrition in autoimmune diseases and for optimal wellness.

Blog updated by Amanda Sikkema, registered dietitian with Katie Chapmon Nutrition, and is accepting new clients.