Menopause: How to Know You Are There and What Happens

Q: How do you know you have reached menopause rather than still being in perimenopause?

Menopause is confirmed looking back: you have reached it once you have gone 12 months in a row without a period, and you are not using hormonal contraception. Until that 12-month point has passed, you are still in perimenopause. If you are unsure, your GP can help you work out where you are in the transition.

Q: What are the early signs that the menopause transition is beginning?

The first sign is usually a change in your cycle: periods may come more or less often than usual, or feel heavier or lighter. Other early signs can include hot flushes, night sweats, broken sleep, mood changes, and trouble with memory or concentration. These often start during perimenopause, which can begin several years before menopause itself.

Q: Do symptoms always stop after menopause?

Not always. Many symptoms, like hot flushes, may ease or stop once you are postmenopausal, though some can carry on. The experience varies a lot. If symptoms are sticking around and affecting your quality of life, raise this at your next GP appointment.

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The periods that have been part of your life for decades start to shift. They arrive at different times, feel heavier one month and almost absent the next, and eventually stop altogether. This change in pattern is usually the first sign that the menopause transition has begun. Knowing how to recognise the signs you are in menopause, and what is driving them, gives you a clearer picture of where you are in this process.

What is menopause?

Menopause is the point where you have not had a period for 12 months in a row, as long as you are not using hormonal contraception. It marks the end of your natural reproductive years. If you are using hormonal contraception, your periods can be masked, so the 12-month count does not work in the same way. This is worth talking through with your GP.¹

In the UK, the average age to reach menopause is 51, and the change usually happens between the ages of 45 and 55. These are averages, and falling outside that range is common and completely normal.²

Menopause is a natural part of getting older. It happens as your ovaries gradually make less oestrogen and stop releasing eggs. It is a normal life stage and transition to be honoured rather than overlooked.³

Perimenopause: the transitional years

Before you reach that 12-month mark, you are in perimenopause. This is the stretch where your hormones start to shift and the first symptoms can appear. You may notice a change in your cycle, with periods coming more or less often, or feeling heavier or lighter, though for some people the first signs are things like hot flushes or vaginal dryness. Perimenopause can last anywhere from a few months to several years.⁷

The hormonal picture during perimenopause is one of irregular change. Oestrogen does not fall in a steady line. It rises and dips, sometimes sharply, and these swings are behind many of the symptoms you may notice during this phase.⁴

Rest, menstruation and woman on couch with ibs, discomfort and stomach ache with symptoms. Health, fatigue and female person in house with cramps, endometriosis and abdominal pain for period.

What changes hormonally at menopause

After menopause, your ovaries make very little or no oestrogen. Where perimenopause brings erratic swings, oestrogen after menopause settles and stays consistently low. That shift from unpredictable to steady, though low, levels is one of the main differences between the two phases.⁵

Oestrogen receptors sit throughout your body, including in your brain, skin, bones, and your heart and blood vessels. Because of this, lower oestrogen touches a wide range of functions, which is why menopause symptoms can feel so varied.⁶

How to know you are in menopause: the signs to recognise

Many of the symptoms tied to menopause actually start during perimenopause. The ones you are most likely to notice are hot flushes, night sweats, broken sleep, and mood changes like anxiety or low mood. If mood changes are really affecting your daily life, it is worth speaking with your GP, as these can have several causes and are not always down to hormones alone.⁸

Other signs you may recognise include trouble with memory and concentration, sometimes called brain fog, vaginal dryness, headaches, joint and muscle aches, palpitations, and a lower sex drive. If you notice palpitations that are unexplained or keep happening, mention them to your GP to rule out other causes.⁹

You may find some symptoms more noticeable than others, and they can vary in intensity over time. If they are affecting your daily life, raise this with your GP.¹⁰

What to expect going forward

Postmenopause begins once you have gone 12 months without a period. Many symptoms, including hot flushes, may ease or stop during this phase. For some, certain symptoms carry on. The timeline is your own.¹¹

The steady, lower level of oestrogen after menopause can raise your risk of certain health conditions over the longer term, including osteoporosis and heart disease. These are increased risks, and both are areas where lifestyle and medical support can make a difference.¹²

Oestrogen helps keep your bones strong and dense. After menopause, the drop in oestrogen can speed up bone loss, which raises the risk of osteoporosis and fractures. Weight-bearing exercise, enough calcium and vitamin D, and regular reviews with your GP all matter here.¹³

Lower oestrogen can also bring changes that raise the risk of heart disease and stroke, including rises in cholesterol and blood pressure. Your GP can check your heart health and talk through ways to support it.¹⁴

Frequently Asked Questions

How do you know you have reached menopause rather than still being in perimenopause?

What are the early signs that the menopause transition is beginning?

Do symptoms always stop after menopause?

Why does oestrogen affect so many different parts of the body?

What long-term health considerations follow menopause?

Sources

[1] Treatment for symptoms of the menopause

Menopause is defined as the point at which you have not had a menstrual period for 12 consecutive months, provided you are not using hormonal contraception. It marks the end of natural reproductive life.
[2] nhsinform.scot

In the UK, the average age to reach menopause is 51, and the transition typically occurs between the ages of 45 and 55.
[3] Menopause and perimenopause - Keeping Well

Menopause is a natural part of ageing. It happens because the ovaries gradually produce less oestrogen and stop releasing eggs.
[4] What is the menopause?

During perimenopause, oestrogen levels do not fall smoothly; they fluctuate, sometimes dramatically, causing the classic symptoms.
[5] mymenopausecentre.com

After menopause, the ovaries produce very little or no oestrogen. Oestrogen levels then settle and remain consistently low, contrasting with the erratic fluctuations of perimenopause.
[6] worcsacute.nhs.uk

Oestrogen receptors are present throughout the body, including in the brain, skin, bones, and cardiovascular system. The reduction in oestrogen affects a wide range of bodily functions.
[7] Symptoms of menopause and perimenopause

The first sign of perimenopause is usually a change in the menstrual cycle pattern.
[8] Treatment for symptoms of the menopause

Common symptoms include hot flushes, night sweats, difficulty sleeping, and mood changes such as anxiety or low mood.
[9] Symptoms of menopause and perimenopause

Other recognised signs include problems with memory and concentration (brain fog), vaginal dryness, headaches, joint and muscle pains, palpitations, and reduced libido.
[10] cuh.nhs.uk

For a significant proportion of women symptoms can be severe enough to affect daily life, relationships, and work.
[11] NHS Inform Scotland — After the Menopause

Many symptoms such as hot flushes may ease or stop during postmenopause, though some can continue.
[12] NHS Inform Scotland — After the Menopause

The sustained lower level of oestrogen after menopause can increase the risk of osteoporosis and cardiovascular disease.
[13] What is the menopause?

Oestrogen helps maintain bone strength and density. After menopause, the fall in oestrogen can lead to accelerated bone loss, increasing the risk of osteoporosis and fractures.
[14] NHS Inform Scotland — After the Menopause

Lower oestrogen levels can lead to changes that increase the risk of heart disease and stroke, including rises in cholesterol and blood pressure.