Premenopausal means the years from your first period until perimenopause begins. Perimenopause is the transition, when cycles and symptoms start to change. Menopause is one point in time: 12 months in a row with no period. Postmenopause is everything after that. Here is how The Menopause Society and NIH define each stage.
In medical use, "premenopausal" describes a woman who still has her regular cycles and has not entered the transition yet. The Menopause Society defines premenopause as the span of time from puberty to perimenopause. So a 30-year-old with regular periods is premenopausal.
Online, many people use "premenopause" to mean the years just before menopause, when symptoms begin. That is really perimenopause. If you are searching for "premenopause symptoms", you are most likely looking for perimenopause symptoms. Our perimenopause symptoms checklist covers them.
Perimenopause is a process. Menopause is a single date you can only see looking back.
During perimenopause, the ovaries make less estrogen and progesterone, and their output goes up and down (NIA). Periods may come more or less often. MedlinePlus notes that some women have irregular periods for 1 to 3 years before periods stop completely. You may also notice hot flashes, trouble sleeping or mood changes.
Menopause is reached when you have gone 12 months in a row with no period or spotting. You won't know the exact date until that year has passed. That is why NIA advises using birth control for at least 12 months after your last period if you don't want to get pregnant.
After menopause, the cycle has stopped for good, and estrogen stays low instead of swinging up and down. Some symptoms, like hot flashes, can continue for years after menopause for many women (NIA). Others may begin or grow, such as vaginal dryness and bladder changes.
Postmenopause also brings different health priorities. NIA notes that after menopause, women are more vulnerable to heart disease, stroke and osteoporosis. Regular checkups, bone health and heart health matter more at this stage.
One rule is very different after menopause: any bleeding 12 months or more after your last period is not normal and should be checked (ACOG). During perimenopause, irregular bleeding is common, though heavy bleeding, bleeding after sex and bleeding between periods should still be checked.
There is no set age. NIA says most women begin the transition between 45 and 55, and it may last several years. Some women notice changes earlier.
Menopause before age 40 is called premature menopause, and menopause earlier than the usual range is called early menopause (The Menopause Society). Menopause can also be "induced" when both ovaries are removed by surgery or damaged by cancer treatment. In that case, symptoms may start suddenly rather than over years. Our early menopause guide covers this in more detail.
It varies from person to person. NIA says menopause-related symptoms can last from 2 to 8 years. The STRAW+10 staging system splits the transition into an early stage (cycle length keeps changing by 7 days or more) and a late stage (60 days or more without a period). Tracking your period start dates is one of the simplest ways to see where you might be.
A quick guide, based on The Menopause Society and STRAW+10:
| Your situation | Likely stage |
|---|---|
| Regular cycles, no new symptoms | Premenopause |
| Cycles keep changing by 7+ days, or new hot flashes or sleep changes | Early perimenopause |
| 60+ days between periods | Late perimenopause |
| 12 months in a row with no period | Menopause reached; now postmenopause |
This is a rough guide, not a diagnosis. Some things can hide the stage, such as a hormonal IUD, birth control pills or a past hysterectomy. Thyroid problems, pregnancy and some medicines can also change periods. A clinician can help sort this out.
It can. The Menopause Society notes that hormone therapy is effective for bothersome hot flashes and night sweats. For women who are still having periods, hormone therapy may cause breakthrough bleeding, so some clinicians use options such as continuous combined birth control or a levonorgestrel IUD with estrogen during perimenopause. After menopause, the choices and doses may be different. Non-hormone options exist for people who can't or don't want to use hormones. Not everyone is a candidate for every option, and each has risks to weigh.
Is premenopause the same as perimenopause? Not in medical use. Premenopause is before the transition; perimenopause is the transition itself. Many websites use the words loosely.
Can a blood test tell me if I'm in perimenopause? Usually the diagnosis is based on age, symptoms and cycle history (NIA). Hormone levels swing during perimenopause, so a single test may not be clear. A blood test may be suggested in some cases, such as periods stopping at a young age.
Am I in menopause if I skipped a few periods? Not yet. Menopause is confirmed only after 12 months in a row with no period. Skipped periods are common in late perimenopause.
Is it normal to bleed after menopause? No. Any bleeding after menopause should be checked by a clinician (ACOG).
What is the average age of menopause? 52 in the United States (NIA).
Not sure which stage you're in? Talk it through with us. Book a visit or call (210) 903-1030. In-clinic in San Antonio • Telehealth for women located in Texas Yaso Wellness Health Clinic, 1907 Goliad Rd, San Antonio, TX 78223
Education only, not medical advice. In an emergency, call 911.
Leticia Vargas, MD, OB/GYN, sees patients at Yaso Wellness Health Clinic in San Antonio. About Dr. Vargas
Education only, not medical advice or a diagnosis. In an emergency, call 911.
