Perimenopause, menopause and after: the stages

Perimenopause is the transition towards menopause; postmenopause is the time afterwards. A missed period alone cannot confirm menopause. Hormonal contraception and some operations can stop bleeding before menopause, and symptoms can continue after the final period.

Perimenopause is the transition

Perimenopause begins with changes associated with the menopausal transition. Periods may become closer together or further apart, and bleeding may be heavier or lighter. Hot flushes, sleep problems or vaginal dryness can occur along with those changes.

WHO describes perimenopause as continuing until one year after the final menstrual period. You can only recognise that point afterwards. WHO says it is not possible to predict when you will experience menopause.

How menopause is recognised

Natural menopause is recognised after 12 consecutive months without periods, where there is no other obvious cause and no clinical intervention causing the change. It reflects loss of ovarian follicular function and falling oestrogen levels.

WHO says natural menopause generally occurs between 45 and 55 years worldwide. The US National Institute on Aging gives an average age of 52 in the United States. These figures describe populations. They cannot tell you when your own periods will end.

Postmenopause means the time after

After menopause, the stage is called postmenopause. Symptoms such as joint pain and vaginal dryness can continue during this time. You can still discuss treatment options with a clinician after periods have stopped.

Book a GP appointment in the UK, or see your doctor in the US and elsewhere, for any vaginal bleeding after menopause. This includes a small amount or a single episode. Treat it as something to have checked rather than simply restarting a period count.

When it happens earlier

The NHS calls menopause before age 45 early menopause, and before age 40 premature menopause. If symptoms happen before age 45, a GP may use blood tests as part of the assessment. Discuss the symptoms and any hormone results with your clinician, who can arrange appropriate checks.

Earlier menopause needs attention beyond symptom relief. The NHS highlights greater risks to bones and heart health and the importance of discussing hormone replacement. Certain cancers can make hormone treatment unsuitable, so your clinician needs to consider your medical history.

Surgery and medical treatment change the pattern

Removing both ovaries can cause menopause. Chemotherapy or radiotherapy can also cause it by stopping ovarian function. These situations do not necessarily follow the gradual pattern of changing periods described above. NIA explains that symptoms may begin immediately after removal of the ovaries if hormones are not being taken.

Removing the womb and removing the ovaries have different effects. WHO notes that a hysterectomy can stop periods before menopause, while other changes associated with the transition can still occur. If you no longer have periods, a clinician will need more than your bleeding history to assess the stage.

Contraception advice differs between countries

Pregnancy remains possible during perimenopause. UK NHS advice is to continue contraception for 1 year after your final period if you’re 50 or over, or for 2 years if you’re aged 40 to 49 years old.

US NIA advice is birth control for at least a full 12 months after the last period if pregnancy is not wanted. These statements differ. Ask your GP or doctor how local guidance applies to your age and contraceptive method, especially if your method changes or stops bleeding.

Getting help without knowing the stage

Book a GP appointment in the UK, or see your doctor in the US and elsewhere, if you think you have menopause symptoms. Seek assessment particularly if they begin before age 45. You can ask for help before you know which stage you’re at. Tell the clinician about your symptoms and medical history, and what you want help with.