Are You In, Out or Post-Menopause

By Alice Chang
Content provided by the Faculty of the Harvard Medical School

We read and hear so much about menopause that you would think that the definition is straightforward, and it would be easy for a woman to know whether she's experienced it or not. Not so. Menopause is a process, not an event.

Simply defined, menopause is when a woman stops having periods, signaling the end of her ability to have children. But women usually do not have regular periods that suddenly stop one day. There is a period of transition from regular periods to menopause, during which most women have irregular cycles. They may go one or more months without a period, then begin again.

So when can you be relatively certain that your periods have ended? Practically speaking, it's the test of time. If you haven't had a period for a year, chances are that you have gone through menopause. Having symptoms of menopause, such as hot flashes and/or vaginal dryness supports this diagnosis. But these symptoms can occur before, during and after your last period.

In addition to the test of time, a blood test usually can verify if you are in menopause. An FSH test measures the level of a substance called follicle stimulating hormone, which tells the ovary to develop an egg and then release it into the fallopian tube where it will travel to the uterus, waiting for a sperm. An FSH greater than 40 is the generally accepted level at which a women is considered through perimopause and in menopause.

The FSH test may be helpful for many women considering hormone therapy for hot flashes. However, some women need hormone therapy to treat hot flashes and vaginal dryness even if they have normal FSH levels or still have an occasional period.

Defining the Stages

A group of reproductive researchers convened in 2001 at the Stages of Reproductive Aging Workshop (STRAW) to finalize recommendations for defining menopause and the stages before and after. The researchers concluded that the transition into menopause occurs first as periods change in length, then as you skip periods or have very heavy bleeding. Menopausal symptoms usually begin in the late stage of the transition.

Perimenopause is that transitional phase between the time periods become irregular and when one year has passed since the last menstrual period. This phase often lasts several years. In addition to irregular periods, women can experience hot flashes, vaginal dryness, and mental or psychological symptoms.

The postmenopause stage begins after your last period. But since you don't know for sure it's your last period until a year has passed, it is better to wait until twelve months after your last period to say you are postmenopausal. During those months between what you think is your last period it is better to think of yourself as in perimenopause. Once the full year has gone by, then you know you are postmenopausal.

Stages

    Reproductive     

Menopausal Transition

       Postmenopause        

Early

Peak

Late

Early

Late

     Early     

     Late     

 

Perimenopause

 

Duration of stage

variable

variable

 

Mentrualcycles

regular to variable

regular

variable cycle length (more than 7 days different than normal)

more than 2 skipped cycles and 260 consecutive days without a period

 

FSH levels

normal

rising

rising

consistently above 40

Source: Adapted from the Stages of Reproductive Aging Workshop

A Path to Better Understand the Terms

So when I ask my female patients over the age of 50, "Have you gone through menopause, or the change of life?" I follow it up with, "When was your last period?" because some women don't realize they are in the transition to menopause if they have irregular periods. Similarly, I ask women in their 40s if their periods are regular, and if they are having any symptoms.


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Did You Know?

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The average age of a woman having her last period is age 51.