Am I in perimenopause or menopause?
If you’re in your 40s and still get periods, even irregular ones, you're in perimenopause. Once you've gone 12 months without a period, you've reached menopause. Every day after that is postmenopause.
Perimenopause is the time leading up to when you stop getting your periods. It can continue for several years. A large US study found it lasted a median of 4.4 to 8.6 years, depending on when it started.¹
It's marked by fluctuating hormone levels and a plethora of symptoms, namely hot flashes, night sweats, irregular periods and sleep disturbances.²
In the US, women have their last period at a median age of 52.5.³ before entering the menopause phase. You can only know it looking back, so your stage comes from the pattern of your periods over many months.
The stages at a glance
Researchers divide these years into stages based on what your periods do.⁴
|
Stage |
What your periods do |
How long it usually lasts |
|
Before perimenopause |
Your usual pattern |
Until changes begin, most often in your 40s, though it can be your 30s or your 50s² |
|
Early perimenopause |
Cycle length keeps changing by 7 days or more |
Varies from woman to woman |
|
Late perimenopause |
60 days or more between periods |
1 to 3 years on average⁴ |
|
Menopause |
12 months in a row without a period |
One day, the 12-month mark |
|
Early postmenopause |
No periods |
About 5 to 8 years⁴ |
|
Late postmenopause |
No periods |
The rest of your life |
Symptoms don't follow the table exactly. Hot flashes and night sweats can start before your periods change, or only after they stop.⁵ Your mood, sleep and sex life can change in these years too.² As estrogen drops, vaginal tissue can get drier, which can make sex painful.² Our piece on perimenopause anxiety, rage and brain fog covers the mood side.
PCOS is the exception. If you have PCOS, irregular cycles are part of the condition, so these markers don't apply to you.⁴
Is there a test for perimenopause or menopause?
There's no single test that tells you your stage. If you're over 45, perimenopause can be identified from your hot flashes and irregular periods, not blood tests.⁶
It's natural to want a test result. Most hormone tests check FSH, the hormone that tells your ovaries to work. In perimenopause, FSH fluctuates a lot, so one result can't tell you where you are.⁴
Official guidelines suggest an FSH test only if you're 40 to 45 with symptoms, or under 40.⁶ After 45, it advises against other tests too, including an estrogen test and the AMH test, which estimates your egg supply.⁶
Home menopause kits also measure FSH, in your urine. The FDA says, "This test does not detect menopause or perimenopause."⁷ The pill, the patch and hormone therapy can also change the result.⁷
How can you tell if you've had a hysterectomy, use an IUD or take the pill?
If your periods have stopped or are controlled by hormones, your symptoms and age are a better guide than your bleeding. Here's how that works in three common situations.
After a hysterectomy or ablation: Without a uterus, or after an ablation to stop heavy bleeding, there are no periods to track.⁴ If you kept your ovaries, menopause symptoms shouldn't start right away. If both ovaries were removed, symptoms can start at once and may be stronger.⁸ Your stage is then judged from your symptoms.⁶
With a hormonal IUD: About 2 in 10 people using a Mirena IUD stop having periods within a year, and bleeding can be irregular in the first 3 to 6 months.⁹ So having fewer periods on an IUD tells you nothing about your stage.
On the pill or patch: Hormonal birth control makes menopause hard to spot.⁶ An FSH test is not recommended while you're on combined birth control that contains estrogen.⁶ However, if you want to test FSH levels to determine menopause, you'll need to switch to an alternative contraceptive method and test FSH after 7 days. Your physician will guide you on the process.
In all three cases, keep track of your hot flashes, night sweats and sleep instead.
How long does perimenopause last, and do symptoms stop at menopause?
Perimenopause usually lasts several years, and the earlier it starts, the longer it tends to last. A large US study of 1,145 women found it lasted a median of 4.4 years in women who started latest and 8.6 years in women who started earliest.¹ Smokers had shorter transitions, and African American women had longer ones.¹
Symptoms don't always stop at menopause. In a US study of 1,449 women with frequent hot flashes or night sweats, these lasted a median of 7.4 years in total, and 4.5 years after the last period.⁵ Women whose hot flashes started early had them longest, a median of more than 11.8 years.⁵
These are averages from large groups, so your own timeline may be shorter or longer. If night sweats keep waking you, our guide to herbs for sleep looks at what the research supports.
Ayurvedic Science also sees menopause as a stage that unfolds over several years. It is called Rajonivritti, a combination of two words: Raja (menstrual flow) and Nivritti (cessation).
In Ayurveda, menopause is a natural transition associated with changes in functional energies that shape how your body functions physically and mentally namely Vata, Pitta and Kapha, along with Dhatukshaya (age-related tissue depletion) and the end of Artava (menstrual function).
Vata is linked to movement, breathing and nerve function. Changes in Vata may be associated with dryness, poor sleep and anxiety. Pitta is linked to digestion and body temperature, and changes in Pitta may be associated with hot flashes, sweating and irritability. Kapha is linked to physical stability and lubrication, and changes in Kapha may be associated with low energy, heaviness and weight gain. These experiences vary from woman to woman.
When should a change in bleeding send you to a doctor?
See a doctor if your bleeding is very heavy, lasts more than 7 days or comes between periods, or if your periods come less than 21 days apart.
You should also see a doctor about any bleeding after you've gone 12 months without a period. In a review of 129 studies covering 40,790 women, 9 percent of women with bleeding after menopause had endometrial cancer, which is cancer of the uterine lining.¹⁰ In the North American studies, it was 5 percent.¹⁰
That means most bleeding after menopause has a less serious cause. It still always needs a check.
How LYBL supports you through perimenopause and menopause
If you're over 45, a blood test usually won't tell you your stage, so your period dates and symptoms do the work. That record helps most when a physician reads it with you.
Our Women's Health program starts with a one-on-one session of up to 60 minutes with a Holistic Health Physician. You talk through your cycle, sleep, stress and everything you already take. Your physician then builds a personalized plan, including nutrition, yoga therapy and targeted formulations such as Herbal Meno Care that combine Shatavari, Chlorophytum and Tribulus, herbs studied for their potential effects on hot flashes, night sweats and mood changes commonly experienced during perimenopause.*
One member, 47, came to us with four to five hot flashes a day, each lasting 20 to 30 minutes. They came on three or four days, in the seven to ten days before her period. By week eight, she reported one or two a month.
Her sleep changed over the same weeks. She'd been sleeping four to five hours a night and waking tired. By week eight, she slept about six hours and said she woke up rested.
Her result came from following the whole plan for eight weeks. Individual results may vary.
If vaginal dryness, low desire or discomfort during sex is your main concern, our Women's Sexual Health program focuses on those.
