We often hear women say:
“I’m in menopause” — as if menopause were a period of several years.
But medically, it’s a little more interesting than that.
Menopause is the final natural menstrual period in a woman’s life.
We can only confirm that it was indeed the final period after 12 consecutive months without menstruation.
The years leading up to this event are known as perimenopause, or the menopausal transition.
WHEN DOES IT BEGIN?
There is no exact age or date when it begins.
Perimenopause begins when the menstrual cycle starts to change consistently.
At first, the changes may be subtle: the cycle becomes slightly shorter or longer.
Then, the difference between cycle lengths becomes more noticeable — 7 days or more.
Later, menstrual periods may occasionally be skipped, and the intervals without menstruation may reach 60 days or longer.
This is considered the late stage of the menopausal transition.
On average, the transition lasts several years — often around 4–8 years — but it can vary from woman to woman.
AND HERE’S THE MOST IMPORTANT PART
Perimenopause is not simply a gradual decline in estrogen.
The ovaries are still functioning, but their activity becomes less predictable.
Ovulation may occur in one cycle and be absent in the next.
Estrogen levels can fluctuate significantly.
As a result, a woman may still have regular or irregular menstrual periods while already experiencing:
- Hot flashes
- Night sweats
- Sleep disturbances
- Anxiety
- Mood changes
- Difficulty concentrating
- “Brain fog”
- Changes in sexual desire
That’s why the appearance of symptoms does not automatically mean that menopause has already occurred.
IS IT STILL POSSIBLE TO GET PREGNANT?
Yes.
As long as ovulation is still possible, pregnancy can occur — even if the menstrual cycle has become irregular and periods are occasionally missed.
Therefore, contraception is still necessary during perimenopause if pregnancy is not desired.
WHAT HAPPENS NEXT?
Once 12 consecutive months have passed without menstruation after the final natural menstrual period, we can confirm that menopause has occurred.
The next stage is postmenopause — the period of life after menopause.
Ovarian function declines significantly, ovulation ceases, and estrogen levels remain consistently low.
So, remember:
PERIMENOPAUSE — the transition.
MENOPAUSE — the final natural menstrual period.
POSTMENOPAUSE — the period after menopause.
And this is not just a matter of terminology.
Understanding which stage a woman is in helps us properly assess her menstrual cycle and symptoms, determine whether contraception is needed, and choose the most appropriate treatment approach.