What Is Menopause, How Long Does It Last and What Are Its Stages

In my clinical practice I am increasingly asked: “Am I in menopause already, and how long will it last?” Menopause is a natural part of every woman’s life. Yet there is still a lot of confusion around it. Many women, for example, use the word “the change” for the whole period of hormonal shifts, even though from a medical point of view menopause has a very precise definition. According to the guidance of the British Menopause Society (BMS), menopause is just one specific moment in a woman’s life – the day of her final period. The whole period of hormonal changes before and after it is described using other terms.

What is menopause?

Menopause is the last spontaneous menstrual period in a woman’s life. Because it is impossible to know in advance whether a period will truly be the last one, the diagnosis of menopause is made retrospectively – only after 12 months without menstruation (amenorrhoea) have passed. This means a woman does not actually know when her menopause occurred until a full year without bleeding has gone by.

At what age does menopause occur?

For most women, menopause occurs between the ages of 45 and 55. There are exceptions, however. In some women menopause can begin between the ages of 40 and 45 – this is defined as early menopause. Sadly, a small number of women experience premature menopause or POI (premature ovarian insufficiency) before the age of forty.

The age of menopause is influenced by a number of factors, including genetics, lifestyle, smoking, certain illnesses and surgical procedures.

What are the stages of menopause?

1. Premenopause

Premenopause covers a woman’s entire reproductive period. It begins with the first menstrual period (menarche) and ends with the final one. During this time a woman menstruates, ovulates and is fertile. In some women, the first changes in cycle length or hormone levels may already appear in the later part of the reproductive years.

2. Perimenopause

Perimenopause is the period of transition towards menopause. The British Menopause Society defines it as the phase when the first clinical, biological and hormonal signs of approaching menopause begin to appear.

Typical symptoms include:

• irregular cycles
• hot flushes
• night sweats
• sleep disturbances
• anxiety
• mood changes
• palpitations
• reduced libido
• brain fog

Perimenopause ends at the moment of menopause, which is why healthcare professionals often refer to it as the menopausal transition. In some women it lasts a few years; in others it can last up to ten years before the final period.

3. Menopause

Menopause itself is not a period of time. It is one specific point in time – a woman’s final menstrual period. That is why it is more accurate to say “I am five years past menopause” than “I have been in menopause for five years”.

4. Postmenopause

Postmenopause begins after menopause and continues for the rest of a woman’s life. In this phase hormone levels stabilise and the ovaries produce significantly less estrogen, progesterone and testosterone. Although hot flushes and other symptoms may ease over time, some changes related to estrogen deficiency can persist or continue to develop.

These include, for example:

• vaginal dryness
• genitourinary syndrome of menopause (GSM)
• loss of bone density
• increased cardiovascular risk
• changes in sleep quality

What is the climacteric?

Older medical literature often uses the term climacteric. It describes the transition from the reproductive to the non-reproductive period of a woman’s life. Today, however, it is used less frequently, and most professional bodies, including the BMS and NICE (National Institute for Health and Care Excellence), prefer the term menopausal transition.

The STRAW system – the gold standard for assessing reproductive ageing

The BMS uses a system known as STRAW+10 (Stages of Reproductive Aging Workshop). It is an internationally recognised system that divides a woman’s reproductive ageing into several stages:

• Reproductive period – STRAW stages −5 to −3
• Menopausal transition – STRAW stages −2 and −1
• Postmenopause – STRAW stages +1 and +2

This system helps professionals determine more precisely which phase of the hormonal transition a woman is currently in.

So how long does menopause last?

How long menopause lasts is one of the most common questions women ask healthcare professionals. The answer often surprises many of them. Menopause does not last long at all – it is, in fact, a single day: the day of the final menstrual period. What most women describe as menopause is the period of several years before and after it, when they experience the symptoms that lead them to seek help.

Source: This article is based on the educational materials and terminology of the British Menopause Society (BMS), including the definition of menopause and the STRAW+10 system, which is considered the international standard for classifying female reproductive ageing.