For many women, menopause often feels inexplicably mysterious. Even though millions and millions of women experience menopause every year and, even though we know it’s coming long before we reach it ourselves, it’s still a subject many of us know woefully little about. That’s because there’s little education about this major physical milestone but also because many of us spend years avoiding thinking about it as much as possible, letting it linger way off in the “distant future” until one day, it’s not-so-distant anymore. Whether this is all-too-familiar and describes you perfectly or you’re actively doing your research to make sure it never does, let’s start this journey by answering one of the most fundamental questions about menopause: When does it actually happen?
Menopause Happens in Stages
Before it happens to us, most of us imagine menopause as one big, singular thing, waiting to end our fertility and youth. But the reality of menopause is far more nuanced. There are actually four stages associated with menopause: premenopause, perimenopause, menopause and postmenopause. The distinctions between these phases are important for research, but in terms of your experience, knowing exactly where you are can be academic — most treatment will be symptom-based, and some of these stages can be diagnosed only in retrospect. Many people refer to the process of “going through menopause” when they are talking about menopause or “being in menopause” after they have not had a period for 12 months. While this wouldn’t be a good way to conduct a research project, it’s not a bad way to discuss the experience.
These stages encompass most of a woman’s life, from puberty onward, and here are the basics of what defines each one:
● Premenopause: Also known as the reproductive years. This is the least commonly-used of the menopausal stage terms, probably because it’s so broad. Technically speaking, premenopause refers to the time in your life between your first period and perimenopause when you’re not yet experiencing any symptoms of menopause — aka most of your life thus far.
● Perimenopause: Perimenopause actually means “around menopause” and refers to the period when your body is transitioning out of its reproductive years to a new hormonal balance. During this time, the amount of estrogen produced by your body will rise and fall unevenly and you may start to experience irregular menstrual cycles, as well as symptoms associated with menopause like hot flashes and sleep problems. Perimenopause also includes the 12 months before your last menstrual period.
● Menopause: In terms of duration, menopause itself is actually often the shortest of the menopausal stages. It refers specifically to the 12 months following a woman’s last menstrual cycle. Since it can only be recognized retrospectively (because you can’t know which was your last period until those 12 months are passed), this technical terminology can feel a little confusing!
● Postmenopause: After the 12 months of official menopause, women enter postmenopause and the stage lasts the rest of your life. Some women still experience some of the symptoms associated with menopause in the first years of this stage (hot flashes, in particular, can persist, but mood changes and brain fog definitely improve), but for many, those symptoms will become less severe. Many women will live a third to a half of their lives postmenopausally. Regardless, postmenopause marks a time when women have to be more conscious of an increase in risk for several health conditions, including osteoporosis and heart disease.
When Does Perimenopause Happen?
Most women enter perimenopause in their mid-late 40s, but perimenopause can begin naturally as early as the mid-30s. And just to complicate things even further, perimenopause can be medically induced at any age (by chemotherapy, for example, or by hormone blockers). In addition to starting at different ages for different women, perimenopause doesn’t last the same amount of time for all women. While some women may only notice being in this stage for a few months, the average duration of perimenopause is about four years. It’s important to note that for some women, the experience of perimenopause is simply shorter and lighter periods, which they may hardly notice, while for others it is a symptomatically wild ride.
When Does Menopause Happen?
Like perimenopause, menopause itself happens at different ages for different women. Most women go through menopause in their 40s or 50s and the average age for menopause in the United States is 51. As a general rule, most women can predict the rough age at which they’ll experience menopause by turning to their female relatives, though because environmental as well as genetic factors play a role, a sister’s experience may provide the best guide. Research has found conflicting evidence regarding the ethnic, racial, and geographic differences in the ages of menopause, and working out what is related to genetics vs environmental vs. social factors requires more study, as it is likely all of those factors play a role.
What Happens if My Period Stops Before 40 or After 60?
Because everyone is unique — especially when it comes to the reproductive system some people naturally go through menopause earlier or later life than average. Having your last period before the age of 40 is called “premature ovarian insufficiency.” It only affects about 1% of women, but those women are often misdiagnosed, told they the symptoms they are having are probably not related to menopause, and may not get the care they need. They may only interact with the health care system around this if their fertility is affected, but not receive guidance or care that’s vital to promote their health for the rest of their life. If women with POI do not receive recommended hormone therapy until the average age of menopause they have higher risks of osteoporosis, heart disease, anxiety, and depression. Make sure to talk to a health care provider who is knowledgeable about the guidelines about POI.
If you happen to go through menopause later in life than most people, don’t worry. Studies show that later natural menopause onset is associated with some health benefits, including greater life expectancy and reduced risk of cardiovascular disease, stroke, and osteoporosis. On the downside, however, some studies have found that late-onset menopause may be associated with an increased risk of breast cancer, endometrial cancer, and ovarian cancer, so make sure you check in with your health care provider to get the screenings that are appropriate for your situation.
The information provided on StateOfMenopause.com is not intended and should not be construed as medical advice, treatment, or diagnosis. Always seek the guidance of a qualified healthcare provider with any questions or concerns regarding your health.