The Journey to Menopause, what to expect and when

Most women are never told what to expect as they approach menopause. There’s no handbook, no clear roadmap — just years of confusion, self-blame, and frustration as symptoms slowly appear. It’s heartbreaking that we enter one of the biggest biological transitions of our lives unprepared — often told to “just get on with it.”

In this episode, Joanne breaks down the menopause journey — a stage-by-stage guide explaining what’s happening in your body, when it’s likely to happen, and the conversations you should be having with your doctor (and yourself). While every woman’s experience is unique, there’s a general timeline most women follow. And understanding it can completely change how you experience this chapter.

The Menopause Journey: What to Expect 🌱 Early 40s — The First Shifts (Perimenopause Begins)

This is when subtle hormonal changes start — long before your period stops.

• What’s Happening: Progesterone starts to decline, while estrogen spikes and dips unpredictably.

• How It Feels: PMS mood swings, sleep disruption, midsection weight gain, heavier or shorter periods, and that vague sense that “something’s changing.”

• What’s Going On in Labs: FSH begins to fluctuate, progesterone drops, and thyroid issues may surface.

• What to Focus On:

  • Track your cycles and symptoms.

  • Prioritize protein, sleep, and strength training.

  • Correct nutrient deficiencies (iron, vitamin D, magnesium, B12, omega-3s).

  • Balance blood sugar to calm cortisol.

This stage is often missed because cycles are still regular — yet the foundation for your next decade is being set right here.

🎢 Mid 40s — The Rollercoaster Years

The hormone swings now become much more noticeable — and unpredictable.

• Hormones: Estrogen fluctuates dramatically; progesterone is often very low.

• Symptoms: Irregular cycles, night sweats, hot flashes, brain fog, migraines, joint aches, and skin changes.

• Blood Work: FSH and LH become erratic but trend upward; estradiol fluctuates widely.

• Possible Next Step: Many women start low-dose progesterone therapy here — it can calm heavy bleeding, improve sleep, and offset estrogen dominance.

This is when women often feel like they’re “losing control” of their body — but it’s biology, not failure.

🔄 Late 40s — The Transition

The true shift begins here — ovulation becomes inconsistent, and estrogen begins its long-term decline.

• Symptoms: Persistent hot flashes, stubborn weight changes, mood shifts, slower recovery, loss of muscle tone.

• Labs: FSH often >30 IU/L, estradiol trending lower, DHEA and pregnenolone decline.

• HRT Evolution:

  • Combined estrogen + progesterone therapy is common (patches, gels, or pills).

  • DHEA or pregnenolone may help with fatigue and resilience.

Some women move through this stage smoothly — others don’t. Lifestyle, genetics, stress, and body composition all play a huge role.

🌸 Early 50s — Menopause (12 Months Without a Period)

This marks the official definition of menopause.

• Hormones: Estrogen and progesterone are now both very low.

• Symptoms: Vaginal dryness, poor sleep, hot flashes, loss of libido, and declining bone density.

• Blood Work: Estradiol low (<30 pg/mL), FSH high, testosterone often reduced.

• HRT Options:

  • Estrogen (patch/gel/cream) for brain, bone, and heart health.

  • Progesterone for uterine protection (if uterus intact).

  • Testosterone for strength, motivation, and libido.

This is often the stage where women finally seek help — but the truth is, this conversation should start years earlier.

🌤 Mid 50s and Beyond — Postmenopause

The storm calms — but long-term health now depends on what you’ve built (or lost) during the previous stages.

• Hormones: All ovarian hormones remain at baseline low.

• Symptoms: Hot flashes may subside, but now bone loss, muscle loss, and cardiovascular changes become the priority.

• Labs: Low estrogen, progesterone, and androgens; higher LDL and fasting insulin levels.

• Long-Term HRT: Many women continue estrogen and testosterone therapy for life, at lower doses, to maintain bone density, cognitive health, and quality of life.

Final Thoughts

Every woman deserves to enter menopause informed and empowered, not confused and blindsided. This isn’t just about hormones — it’s about identity, vitality, and confidence.

Understanding the stages allows you to prepare, protect your long-term health, and take control of you