Put simply, you’ve reached menopause when you’ve had your last period and your menstrual cycle has stopped. But for most women, you won’t know for sure that you’ve hit this landmark (and a healthcare professional won’t diagnose it) until a full year after your last period.
Menopause occurs when your ovaries stop making estrogen and progesterone — female hormones that are key for menstrual cycles and fertility. In most women, menopause happens naturally, somewhere around age 52. Menopause can also be the result of a medical procedure, such as chemotherapy, pelvic radiation therapy or the surgical removal of the ovaries.
Most women will notice changes in their bodies in the years before menopause (perimenopause) and after menopause (postmenopause). These changes, like menopause itself, are different for everyone. Some women experience many symptoms of menopause, including hot flashes and drenching night sweats, which can be hugely disruptive to daily life and last for years. Others notice hardly any disruptions.
Each person’s experience is unique. And while some of the changes you encounter may be surprising or unpleasant — or both! — keep in mind that what you’re going through is a natural part of life. And, even more importantly, know that there are ways to treat or help manage these symptoms. You don’t have to suffer.
The stages of menopause
Menopause may be marked by your last period, but this life change doesn’t happen overnight. The menopause transition typically has three stages: perimenopause, menopause and postmenopause.
Perimenopause
Many of the symptoms that most women think of with menopause — from hot flashes to irregular periods — actually start in perimenopause.
Perimenopause, which means around menopause, is the time leading up to menopause (or your last period). Women typically start perimenopause in their mid-40s (47 is average). But it’s normal for it to start anywhere from the early 40s to early 50s.
Perimenopause is prompted by fluctuations in your estrogen and progesterone levels. Changes in your menstrual cycle are often the first sign. Initially, you may notice a longer time between periods, or notice that you are bleeding for more or fewer days than usual. Your menstrual blood may have more clots, or it may change color slightly. Hot flashes and night sweats are also common. Later in perimenopause, periods may change again. They might occur even further apart or closer together again for a time, and other symptoms may be added to the mix.
Perimenopause feels different for every woman who experiences it. A few lucky women will breeze through both perimenopause and menopause without any symptoms that disrupt their daily routines. Some will experience the signs and symptoms for just a year or two, while others will be in perimenopause for nearly 10 years before reaching menopause. Most often, women will remain in the perimenopause stage for 4 to 8 years.
While every person’s experience is unique, research has identified some patterns. For example, the Study of Women’s Health Across the Nation (SWAN) found that the perimenopause stage tends to be longer for women who begin it earlier. In addition, Black women in the study were in perimenopause longer than white, Chinese and Japanese women. More research is needed to fully understand these patterns.
Because symptoms aren’t always clear — and they can change over time — it can be hard to know exactly when you start perimenopause. If you’re experiencing menstrual changes and other perimenopausal signs and symptoms, it’s a good idea to talk to your healthcare team. Together, you can make sure there isn’t another reason for these changes.
Menopause
Menopause is a milestone you don’t know you’ve reached until an entire year has gone by. That’s because menopause is considered official only when you haven’t had a period for 12 full months.
Why wait a year to make the call? Because some people will think they’ve gone through menopause after going a few months without a period, only to be surprised by several more cycles. However, once you’ve gone a full year without a period, you can be pretty sure that you’ve made the transition. On average, this happens at about 52 years of age — though there is a wide range of “normal,” from the mid-40s to the later 50s.
Postmenopause
Postmenopause starts after your last period and continues for the rest of your life. This often means at least one-third of your life will be spent in this stage. For many people, after menopause symptoms become less frequent and less of a daily issue, this phase of life is full of newfound freedom.
Many women will tell you that the best part of reaching menopause is not having to worry about getting periods anymore. But there are other benefits too. For instance, you also don’t have to worry about getting pregnant. And many of the uncomfortable or disruptive symptoms you might have experienced in perimenopause — such as breast pain or mood swings — usually go away as well. Your hormones should settle into steady, low levels instead of fluctuating like they did during your reproductive life.
Some of the symptoms of perimenopause may continue into postmenopause. Hot flashes often stick around for a few years or more, and vagin*l dryness may stay for good or even worsen with time. Other body changes often crop up over time as well, thanks to lower levels of estrogen and other natural aging processes. Fortunately, many of these conditions can be managed with treatments and lifestyle changes to help you stay comfortable and active.
Changes to the menstrual cycle during the menopause transition
Often, one of the first signs of perimenopause is a change in the menstrual cycle. This is primarily due to natural changes in ovulation (including changes in the frequency of ovulation) and hormone levels, including those of estradiol, the primary estrogen made by the ovaries. No matter how regular (or irregular) your periods have been historically, these changes can disrupt your menstrual cycle.
For some, the changes are subtle. For others, the changes are obvious — and disconcerting. Your period may come more often or less often. It may last several more days than usual, or it might be surprisingly short. If you’ve had years of an unpredictable period, it may suddenly run like clockwork. It may be lighter, resulting only in brief spotting, or heavier than ever, bleeding through pads or even your clothing.
One of the most frustrating facts for many women is that all the above may be true. One month, your period may arrive a week late and be lighter. Then your next one comes a week early and seems alarmingly heavy.
For some, heavy or prolonged bleeding can affect social lives, sexual relationships or stress levels. Less frequently, unusually heavy menstrual cycles may cause fatigue, headaches or anemia. It’s important to contact your healthcare team if you have any abnormal bleeding.
It may be reassuring to know that you’re not alone — and that this roller coaster won’t last forever. Nearly all women (about 90%) who go through natural menopause will experience changes to their menstrual cycles before their last period. For most people, these changes will resolve in an average of 4 to 8 years. For some, symptoms can last longer.
Red flags: Menopause or something more?
Changes to your menstrual cycle are usually a normal part of perimenopause. But in some cases, abnormal bleeding may require further evaluation to rule out a more serious condition. Talk to your healthcare team if you experience any of the following:
- You stop having periods before age 45.
- Your periods become so heavy that you have to change tampons or pads every hour or two for two or more hours.
- Your periods last longer than seven days, or several days longer than usual.
- You are bleeding or spotting between periods.
- Your periods are becoming closer together.
Making it through menopause
Menopause is a natural part of life — not an illness. You may encounter none of the symptoms outlined in that lengthy list, or you may experience several of them. Whatever your experience is, know that more resources than ever before are available to help you understand and manage it. By working with a knowledgeable, trusted healthcare team, and gathering other tools of your choice, you have what you need to manage any of the symptoms you encounter and make it to the other side of menopause while living an active, vibrant and healthy life.
A version of this text appears in The New Rules of Menopause.
