This stage usually lasts around 4-5 years, and begins before the menopause itself.
at the time when you might first experience menopausal symptoms (e.g. hot flushes,
night sweats). Menstrual periods usually become less predictable during this phase.
You may notice that they become less or more frequent, less regular, heavier or lighter.
When you have had a whole year (or two if you are under 50) without menstrual periods,
this marks the end of the perimenopause and the onset of the menopause.
Women are considered postmenopausal once menstrual periods have stopped for 12 consecutive
months. That doesn't mean that symptoms also stop. Most women report having hot flashes
for up to 7 years after their FMP, and a few women will experience symptoms longer.
See Figure 1, which shows a timeline of typical ages for experiencing the first menstrual
period, perimenopause symptoms, menopause, and postmenopause. Some women go through
perimenopause without any symptoms, so it is possible to get past menopause and wonder
what all the fuss was about.
It is important to recognise that whilst the menopause can cause distressing symptoms,
it is not strictly an illness. It will happen to every woman who reaches menopausal
age. The average age for a woman to reach menopause is 51, though having your last
period at any time between the ages of 45 and 55 is considered completely normal.
When we refer to 'menopausal symptoms', we specifically mean symptoms that occur
any time during the climacteric phase.
The menstrual cycle is a series of changes in the female reproductive system that
occur every 28 days, though the length of the cycle can vary by up to a week in different
women. Each cycle begins with up to a week of bleeding from the uterus, known as
a menstrual period. You will have started having periods, or menstruating, during
puberty (at a point known as the menarche) and it is quite likely that you will continue
to menstruate into your late 40s or beyond. During that time, a number of factors
can cause temporary breaks in your menstrual cycle, and therefore your periods, including
When a girl is born, there are hundreds of thousands of eggs in her ovaries. When
she starts her menstrual cycle at puberty, she will lose one of these eggs (an ovum)
in each menstrual period, providing she does not become pregnant.
On average, a woman might have around 500 periods in her lifetime, and therefore
a large proportion of the original eggs in her ovaries are never shed or fertilised.
The exact timings of the stages of a menstrual cycle vary between different women,
but typically during an average 28-day cycle the following events occur:
days 1-5 - menstrual bleeding (period)
day 7 - eggs in the ovaries begin to 'ripen'
day 7-11 - the lining of the uterus starts to thicken, in preparation for the fertilised
egg (an egg that has been penetrated by a sperm) to become embedded within its spongy
day 14 - the egg is released from the ovary into the fallopian tube, a process known
day 14--28 - the egg travels down to the uterus. If the egg is fertilised it can
implant into the uterus lining, and a pregnancy begins. If it is not fertilised,
the egg is released, along with much of the uterus lining, in a period beginning
on day 1 of the next cycle.
Hormones And The Menstrual Cycle
The menstrual cycle is a very complicated process, and yet for some women, their
periods are completely predictable and as regular as clockwork. How are these changes,
which are so vital for a woman's fertility, controlled so tightly? The most important
way in which the menstrual cycle is controlled is by means of your hormones. There
are four main hormones involved in controlling your menstrual cycle.
A hormone is a naturally occurring chemical which is made by specialised cells and
released into the blood. The blood carries the hormone to cells elsewhere in the
body, where it exerts its effects.
Early in the cycle, moderate levels of FSH provide a signal for eggs to mature in
the ovaries. The eggs are contained in little sacs called follicles. Usually one
follicle matures quicker than the rest. FSH also stimulates the ovaries to produce
oestrogen. Oestrogen encourages the maturing follicle to develop further, and ensures
that the lining of the uterus becomes thicker, in preparation for a fertilised egg
to be implanted. A surge in LH stimulates the process of ovulation, where the mature
egg is released from the follicle in the ovary into the fallopian tube. The empty
follicle turns yellow (called a corpus luteum) and starts producing progesterone.
Progesterone causes the lining of the uterus to thicken even more, in preparation
for the fertilised egg (known as an embryo) to implant within it. The muscles in
the walls of the fallopian tube contract gently to propel the egg along. About 6
days after an egg has been released from the ovary, it will reach the uterus. If
the egg was fertilised by a sperm whilst in the fallopian tube, then the embryo will
implant into the lining of the uterus and levels of progesterone will remain high.
This heralds the beginning of pregnancy.
If the egg was not fertilised, levels of both oestrogen and progesterone fall. This
causes the thick lining of the uterus, as well as the unfertilised egg, to be shed
during a period.
The whole process starts again.
the entire period of time during which a woman can become pregnant, from puberty
to the menopause.
You may also wish to consult a doctor if you simply want some advice on how to stay
healthy after your menopause. This may involve basic dietary advice and exercise
regimens, but is more critical if you are considered to be at particular risk of
the potential complications of menopause, such as osteoporosis and cardiovascular
Ensuring that you have a healthy lifestyle will help your body to adapt to the changes
that the menopause brings with it. Not only can your diet and your level of exercise
help to control any menopausal symptoms that you might be experiencing, but they
can also minimise your risk of future health problems that are associated with postmenopausal