What is menopausal transition?
Menopausal transition signifies when physiological changes occur to a woman’s body as she nears the end of her reproductive ability. It starts with variation to the menstrual cycle length and increases in follicle stimulating hormone (FSH) secretion and ends with the final menstrual period followed by 12 months of amenorrhoea. Fertility declines quite quickly once the menopausal transition has begun and it is followed by the postmenopause phase. The hormonal changes which start during the menopausal transition are thought to cause the physiological changes which lead to the menopause.
Stages of menopausal transition
A woman’s reproductive stages can be identified based on the characteristics of her menstrual cycle and FSH levels. The reproductive stage is composed of early, peak and late stages, with FSH levels being elevated in the late phase. During the early menopausal transition phase the menstrual cycle is more variable in length. The late menopausal transition stage is characterised by more than two skipped cycles with periods of amenorrhoea. Once the postmenopause stage is reached the menstrual cycle will have stopped completely and FSH levels will have remained high since the late reproductive phase.
The symptoms of menopausal transition
It is important to note that not all women will experience symptoms during the menopausal transition and that these symptoms can appear in different combinations. As shown below, the symptoms which occur in the late reproductive phase, just before the menopausal transition, can differ from those which occur in late menopausal transition.
Symptoms of the late reproductive phase include:
Symptoms of the late menopausal transition phase include:[2,4]
These symptoms can be daunting and so it is important that women know what to expect from the menopausal transition. It is also useful to note that an earlier onset of menopausal transition is associated with a longer duration of transition. Additionally, some of the longer-term physiological changes which the menopause transition brings can indicate future health risks. [1,3] For example, severe vasomotor disorders may raise the risk of cardiovascular symptoms and depression can impact cognitive function.
How can the symptoms related to the menopausal transition be alleviated?
Any treatment should be individualised based on the symptoms experienced by the woman.  Treatments can include cognitive behavioural therapy or pharmaceutical products such as hormone replacement therapy (HRT).  HRT can be used to treat short term symptoms of menopause, such as hot flashes, night sweats and low mood, but the associated risks and benefits of this treatment should be explained to the patient. If HRT has not been successful, testosterone therapy can be prescribed for altered sexual function. 
Healthcare professionals (HCPs) should be aware of the lifestyle factors, including obesity, which increase the risk of later menopausal symptoms. This will allow them to educate patients on changes which could lessen the impact of the menopause on their health.  The National Institute for Health and Care Excellence provides further guidance on how to manage the menopausal transition.
Learn more about the menopausal transition
The EMAS conference is occurring this May where menopausal transition will be discussed further. We will be attending the key conference sessions and reviewing the new data presented. So, look out for these insights appearing in future blogs to stay informed on the key topics and trends in this area!
 Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM and de Villiers TJ. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging. The Journal of Clinical Endocrinology and Metabolism. 2012 Apr 4;97: 1159-1168.
 Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W and Woods N. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertility and sterility. 2001 Nov 5;76: 874-878.
 Monteleone P, Mascagni G, Giannini A, Genazzani AR and Simoncini T. Symptoms of menopause — global prevalence, physiology and implications. Nature Reviews Endocrinology. 2018 Feb; 14: 199-215.
 Paramsothy P, Harlow SD, Nan B, Greendale GA, Santoro N, Crawford SL, Gold EB, Tepper PG and Randolph JF. Duration of the menopausal transition is longer in women with young age at onset: the multi-ethnic Study of Women’s Health Across the Nation. Menopause. 2017 Feb; 24;2:142-149.
 National Institute for Health and Care Excellence (2015) Menopause: diagnosis and management. National Institute for Health and Care Excellence, 1-30.