Perimenopause is the transition before menopause. Menopause is a point reached after 12 consecutive months without a menstrual period. Postmenopause is the time after that point. Perimenopause generally begins in the mid-40s, though it may start in the mid-30s or the mid-50s, and it lasts about four years on average, with an upper end of eight years [1]. A hormone test can help, but changing hormone levels can make the result difficult to interpret during the transition [1].
What does perimenopause mean?
Perimenopause is the period before menopause when estrogen levels begin to decrease [1]. Menopause and postmenopause refer to different points on the same timeline.
During perimenopause, menstrual cycles may become longer or shorter than usual, and bleeding may become heavier or lighter than normal [1]. Cleveland Clinic lists irregular periods, mood changes, low libido, hot flashes, night sweats, vaginal dryness with discomfort during sex, urinary urgency and trouble sleeping among the symptoms that may occur [1].
This article stays focused on the timeline and the definitions. A symptom list alone does not establish which stage you are in.
When does perimenopause start?
Perimenopause generally starts in the mid-40s. Cleveland Clinic says it may begin as early as the mid-30s or as late as the mid-50s [1].
Cleveland Clinic also says the menopause transition can begin eight to 10 years before menopause and usually starts in a person’s 40s [2]. Its perimenopause description gives about four years as the average length, with eight years as the upper end [1].
These figures use related terms. They do not describe exactly the same interval. At an appointment, ask: “When you say menopause transition, do you mean the whole period before menopause, or the perimenopause stage?”
What is menopause, exactly?
Menopause is reached after there has been no menstrual period for 12 months in a row [1]. That makes menopause a point in time, rather than a stage lasting for years.
Cleveland Clinic dates menopause to the completion of 12 consecutive months without a period. In the United States, the average age is 52 [2]. Write down the date of your last menstrual period when you are tracking this timeline.
If bleeding happens before 12 consecutive months have passed, the published definition of menopause has not yet been met [1][2].
Very heavy bleeding, bleeding that lasts longer than usual, bleeding between periods, bleeding after sex and periods that come less than 21 days apart are reasons Cleveland Clinic says to contact a provider [1]. Cleveland Clinic also says prompt professional evaluation is needed when bleeding reaches at least two pads or tampons per hour for two to three consecutive hours [1].
What is postmenopause?
Postmenopause is the period after menopause. Cleveland Clinic describes it as lasting for the rest of life [2]. It follows the completion of the 12-month interval without a menstrual period that establishes menopause [1][2].
The terms can be kept separate:
- Perimenopause is the transition before menopause [1].
- Menopause is reached after 12 consecutive months without a menstrual period [1][2].
- Postmenopause is the time after menopause and lasts for the rest of life [2].
“I haven’t had a period in 12 months” describes the interval used to establish menopause. “My periods are changing” describes a change that can occur during perimenopause [1].
Why can a hormone test mislead?
Cleveland Clinic says perimenopause is usually identified from symptoms, age, medical history and a physical exam [1]. Follicle-stimulating hormone testing can help, but hormone levels rise and fall erratically during perimenopause [1].
That changing pattern means a hormone result may not settle the question by itself. Ask: “If hormone levels can rise and fall erratically during perimenopause, what will this test tell us?” [1]
You can also ask whether the assessment is being based on your symptoms, age, medical history and physical exam, which Cleveland Clinic lists as the usual way perimenopause is identified [1].
Does an irregular period prove it is perimenopause?
Cleveland Clinic lists irregular periods, heavier or lighter bleeding and changes in cycle length among the things that can occur during perimenopause [1]. Those changes do not identify the cause of bleeding.
Cleveland Clinic lists hormone imbalance, polyps, fibroids, adenomyosis, infections, pregnancy complications, bleeding disorders, liver or kidney disease, cancers and some medications, including blood thinners, among the causes of heavy menstrual bleeding [1].
Contact a provider about bleeding that is very heavy, lasts longer than usual, happens between periods, follows sex or occurs when periods come less than 21 days apart [1].
How should you read the timeline?
Use the table to keep the published terms separate. The test column reports what Cleveland Clinic says about identification and follicle-stimulating hormone testing.
| Stage | What is happening | Typical length | What it means for periods | What a test can and cannot tell you |
|---|---|---|---|---|
| Perimenopause | It is the transition before menopause, when estrogen levels begin to decrease [1] | About four years on average, with an upper end of eight years [1] | Cycles may become longer or shorter, and bleeding may become heavier or lighter [1] | Follicle-stimulating hormone testing can help, but hormones rise and fall erratically. Identification usually uses symptoms, age, medical history and a physical exam [1] |
| Menopause | It is the point reached after no menstrual period for 12 consecutive months [1][2] | A point in time, not a multi-year stage [1][2] | The absence of a menstrual period for 12 consecutive months establishes the point [1][2] | The published definition uses the menstrual period history. Cleveland Clinic does not describe a hormone test as replacing that definition [1][2] |
| Postmenopause | It is the time after menopause [2] | The rest of life [2] | It follows menopause after the 12-month interval has been completed [1][2] | The published timeline places postmenopause after menopause [1][2] |
The sources describe both a perimenopause duration and a broader menopause transition. Perimenopause lasts about four years on average and may last up to eight years [1]. The menopause transition can begin eight to 10 years before menopause [2]. Ask which term is being used when the figures seem to conflict.
Does the timeline look the same for Black women?
The published sources report differences in menopause timing. After adjustment for selection at study entry, Black women had earlier natural and surgical menopause than white women by an average of 1.2 years in the SWAN analysis [4]. The authors also reported that uncorrected analyses overestimated median menopause age in Black and Hispanic women and understated the disparity [4].
A separate SWAN analysis reported a median total duration of frequent vasomotor symptoms of 10.1 years for African American women. The median was 6.5 years for non-Hispanic white women, 8.9 years for Hispanic women, 5.4 years for Chinese women and 4.8 years for Japanese women [3]. The overall median total duration was 7.4 years, and the median persistence after the final menstrual period was 4.5 years [3].
Those findings describe groups. They do not date your menopause. At an appointment, ask: “What definition are we using, and what dates in my period history support it?”
What should you track if the dates are unclear?
Write down the date of every menstrual period. Mark whether the bleeding was lighter, heavier or similar to your usual bleeding. Record bleeding between periods or after sex, because Cleveland Clinic lists both as reasons to contact a provider [1].
Keep the period dates separate from bleeding outside the period. Bring that record to an appointment so it can be considered with your age, medical history, symptoms and physical exam [1].
If bleeding reaches at least two pads or tampons per hour for two to three consecutive hours, Cleveland Clinic says it calls for prompt professional evaluation [1].
What to do next
- Write down the date of your last menstrual period and the dates of the periods before it.
- Record whether each period was heavier, lighter or similar to your usual bleeding.
- Mark any bleeding between periods or after sex, because Cleveland Clinic lists both as reasons to contact a provider [1].
- Ask, “Are you using perimenopause to mean the transition before menopause, or the broader menopause transition?”
- Ask whether your assessment is based on symptoms, age, medical history and a physical exam, which Cleveland Clinic lists as the usual way perimenopause is identified [1].
- If follicle-stimulating hormone testing is offered, ask, “What will this result tell us, given that hormones can rise and fall erratically during perimenopause?” [1]
- Ask which date will count as your menopause date after 12 consecutive months without a menstrual period [1][2].
- Contact a provider for bleeding that is very heavy, lasts longer than usual, happens between periods, follows sex or occurs when periods come less than 21 days apart [1].
- If you soak at least two pads or tampons per hour for two to three consecutive hours, seek prompt professional evaluation [1].
Related on Ruby: when does perimenopause start? and perimenopause symptoms
Sources
- Cleveland Clinic, Perimenopause. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
- Cleveland Clinic, Menopause. https://my.clevelandclinic.org/health/diseases/21841-menopause
- Avis 2015, Duration of menopausal vasomotor symptoms over the menopause transition, JAMA Internal Medicine, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4433164/
- Reeves 2022, Systematic exclusion at study commencement masks earlier menopause for Black women in SWAN, Innovation in Aging, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9770235/