Menopause usually begins gradually. Many women first notice non-specific changes such as poorer sleep, increased irritability, or weight gain and wonder: How can you tell if you're in menopause? Medically, the transition can be roughly divided into four phases.

In the premenopause, the cycle slowly gets out of sync – often progesterone drops first. Typical early symptoms are:

• shorter or more irregular cycles
• stronger PMS
• sleep problems (especially before the period)
• inner restlessness, nervousness

Now estrogen fluctuates more strongly. Many of the typical menopause symptoms occur during this phase:

• hot flashes and night sweats
• sleep disturbances
• mood swings, irritability, "brain fog"
• palpitations, inner restlessness
• chills after hot flashes; sometimes also nausea

Menopause is considered the point in time when the last menstruation was 12 months ago. Only then is the absence of bleeding classified as permanent.

The strong fluctuations usually decrease, but the estrogen level remains lower. Topics such as bone health, cardiovascular health, and mucous membranes often come more into focus.