Staging
Which stage am I in?
Specialists stage the transition using cycle variability, not hormone levels. That is the useful thing to know, because it means the answer is in a diary rather than in a blood test.
Early perimenopause is marked by a persistent difference of seven days or more between consecutive cycle lengths. Late perimenopause is marked by a gap of 60 days or more between periods, and typically runs one to three years before the final period. Menopause is confirmed twelve months after that final period, looking backwards.
| Stage | What defines it | What it usually feels like |
|---|---|---|
| Late reproductive | Cycles still regular, but subtly shorter than they used to be | Often nothing obvious. Some women notice heavier bleeding or a shorter gap. |
| Early perimenopause | Persistent difference of seven days or more between consecutive cycles | Sleep breaking, mood changes, heavier or closer-together periods. Hot flushes may not have started. |
| Late perimenopause | A gap of 60 days or more between periods | Typically the peak of hot flushes and night sweats. Usually one to three years before the final period. |
| Menopause | Twelve consecutive months with no period | Identified only in retrospect. Symptoms frequently continue past this point. |
| Postmenopause | Everything after that day | Vasomotor symptoms often persist for years. Bone and cardiovascular health become the longer-term focus. |
Why there is no blood test that settles it
FSH and oestradiol swing substantially from week to week during the transition. A single measurement can look entirely typical of a thirty-year-old in a woman who is unambiguously perimenopausal, which is why a normal result is not reassurance and an abnormal one is not proof.
Testing does have a real role under 45, and particularly under 40, because premature ovarian insufficiency is a different diagnosis with different long-term management.
The one rule that does not bend
Any bleeding after twelve months without a period is investigated, every time, regardless of how light it was. Most causes turn out to be benign. The rule is absolute because the one cause that is not is highly treatable when it is found early.
The questions to ask your doctor
A one-page guide built from what women told us their appointments were missing. Free, and we will not sell you anything in it.
One email to deliver it, then a weekly note you can leave whenever you like. We never sell your address, and we never attach it to anything you type into the check or the assistant.