How Do You Know When Menopause Is Starting?

For most women menopause starts at about age 43. But let's be clear on the question. When most women ask "When does menopause start?" what they are really asking is when can I expect to begin experiencing symptoms and complaints that are related to menopause. And for that question, the answer is that on average menopause complaints begin at about age 43. But it can be as early as age 35. Let's understand more about the terminology doctors use around menopause so that it isn't a source of confusion.

From premenopause--perimenopause to menopause and on to post menopause

That heading (above) is a cute attempt to clarify the sequence of events as we transition out of our reproductive years, stop having menstrual cycles and stop releasing eggs. The main point is that this transition generally happens over a period of years, not overnight.

"Menopause" is when your periods stop for good (the pause). For most women menstrual cycles become erratic and irregular for a few years, and then eventually stop all together. In this stage its hard to know whether this period will be the last, even though it may have been several months since the last one. So the medical profession arbitrarily says that menopause is when you haven't had a menstrual period for one year. That makes it impossible to say "I am now in menopause" because you can only do that (according to this definition) by looking back in time.

Meanings of premenopause and perimenopause

Premenopause and perimenopause translate to "before menopause" and "around menopause", respectively. Both of these terms refer to the period of time before your periods stop for good, when your levels of estrogen and progesterone are dropping and you are experiencing menopause related complaints as a result. The medical profession prefers the term perimenopause over premenopause. Post menopause is the time after you've had your last period.

What really concerns women are the symptoms of menopause. And the question "When does menopause start?" usually is in reference to symptoms one is beginning to experience. In the back of one's mind is "Could I be starting menopause?" The technically correct way to ask the question would then be "When does perimenopause start?" or in other words "When do symptoms of the menopause transition begin?"

What determines when perimenopause starts?

We said that the start of menopause related symptoms results from dropping levels of estrogen and progesterone. These hormones are secreted from the ovaries in a cyclic pattern each month. They prepare the uterus and stimulate the release of an egg for possible fertilization. We only have a certain number of eggs. From puberty on each month a number of egg follicles mature in preparation for releasing their egg. Usually only one is released. We start at birth with about 2 million eggs. By puberty the number has decreased to about three hundred thousand. During our reproductive years some eggs are released and lost that way, and many more deteriorate as a function of time. Each maturing egg follicle releases estrogen. Once an egg is released from a mature follicle it changes itself and begins releasing progesterone. In this way our ovaries secrete estrogen and progesterone in a cyclic manner during our reproductive years.

As we enter perimenopause the number of remaining eggs has declined and so has the number of ovarian follicles which mature each month. As the number of maturing follicles decreases, so does the amount of estrogen and progesterone that is secreted. The dropping level of estrogen and progesterone is responsible for the onset of perimenopausal complaints and eventually results in the complete cessation of menstrual periods all together. That's menopause.