--- title: "Perimenopause, menopause and after: the stages" description: "What the stages of menopause mean, how age and medical treatment affect them, and why missed periods alone can’t tell you." url: "https://myruva.co/learn/menopause-stages-explained" language: "en-GB" topic: "Menopause" published: "2026-10-18" updated: "2026-10-19" author: "Ruva team" reading_minutes: 4 --- # Perimenopause, menopause and after: the stages What the stages of menopause mean, how age and medical treatment affect them, and why missed periods alone can’t tell you. *Written and reviewed by the Ruva team · Updated 2026-10-19 · Menopause* ## Key points - Perimenopause is the time of change leading up to menopause. - Natural menopause is confirmed after 12 months in a row without periods, with no other cause. - Symptoms can carry on after menopause (postmenopause). - Menopause can happen early, or after surgery or medical treatment. Perimenopause is the time of change leading up to menopause. Postmenopause is the time afterwards. A missed period alone can’t confirm menopause. Hormonal contraception and some operations can stop bleeding before menopause, and symptoms can carry on after your last period. ## Perimenopause is the transition Perimenopause starts with the changes that lead up to menopause. Periods may come closer together or further apart, and bleeding may be heavier or lighter. You may have hot flushes, sleep problems or vaginal dryness along with these changes. WHO says perimenopause lasts until one year after your last period. You can only know when that point was afterwards. WHO says it isn’t possible to predict when you’ll reach menopause. ## How menopause is recognised Natural menopause is confirmed after 12 months in a row without periods, when there’s no other clear cause and no medical treatment behind the change. It happens because the ovaries stop releasing eggs and oestrogen levels fall. WHO says natural menopause usually happens between 45 and 55 years around the world. The US National Institute on Aging gives an average age of 52 in the United States. These figures describe large groups of people. They can’t tell you when your own periods will stop. ## Postmenopause means the time after The stage after menopause is called postmenopause. Symptoms such as joint pain and vaginal dryness can carry on during this time. You can still talk to a clinician about treatment after your periods have stopped. Book a GP appointment in the UK, or see your doctor in the US and elsewhere, for any vaginal bleeding after menopause. This includes a small amount or bleeding that happens once. Get it checked, rather than just starting to count your periods again. ## When it happens earlier The NHS calls menopause before age 45 early menopause, and before age 40 premature menopause. If symptoms start before age 45, a GP may use blood tests as part of the check. Talk to your clinician about your symptoms and any hormone results. They can arrange the right checks. Early menopause needs more care than just easing symptoms. The NHS points out higher risks to bone and heart health, and says it’s important to talk about hormone replacement. Some cancers can mean hormone treatment isn’t suitable, so your clinician needs to look at your medical history. ## Surgery and medical treatment change the pattern Having both ovaries removed can cause menopause. Chemotherapy or radiotherapy can also cause it by stopping the ovaries working. In these cases, periods may not change slowly in the way described above. The NIA explains that symptoms may start straight after the ovaries are removed if you’re not taking hormones. Removing the womb and removing the ovaries have different effects. WHO notes that a hysterectomy (removal of the womb) can stop periods before menopause, while other changes that come with menopause can still happen. If you no longer have periods, a clinician will need more than your bleeding history to tell which stage you’re at. ## Contraception advice differs between countries You can still get pregnant during perimenopause. UK NHS advice is to keep using contraception for 1 year after your last period if you’re 50 or over, or for 2 years if you’re aged 40 to 49 years old. US NIA advice is to use birth control for at least a full 12 months after your last period if you don’t want to get pregnant. These two pieces of advice differ. Ask your GP or doctor how local guidance applies to your age and method of contraception. This matters most if your method changes your bleeding or stops it. ## Getting help without knowing the stage Book a GP appointment in the UK, or see your doctor in the US and elsewhere, if you think you have menopause symptoms. It’s especially important to get checked if they start before age 45. You can ask for help before you know which stage you’re at. Tell the clinician about your symptoms, your medical history and what you want help with. ## When to get help - **Book an appointment:** Book a GP appointment (UK) or see your doctor (US and elsewhere) for menopause symptoms, especially before age 45, or for any vaginal bleeding after menopause. ## Where you live Services and advice differ between countries. - **UK:** The NHS advises using contraception for 1 year after your last period if you’re 50 or over, and for 2 years if you’re aged 40 to 49 years old. Ask a GP how this applies to your method. - **US:** If you don’t want to get pregnant, the NIA advises using birth control for at least a full 12 months after your last period. Talk to your doctor about your method. - **Elsewhere:** WHO defines natural menopause as 12 months in a row without periods, where there is no other cause or medical treatment behind it. ## Sources 1. [Menopause](https://www.who.int/news-room/fact-sheets/detail/menopause), World Health Organization 2. [Symptoms of menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/), NHS 3. [Early or premature menopause](https://www.nhs.uk/conditions/early-or-premature-menopause/), NHS 4. [Postmenopausal bleeding](https://www.nhs.uk/symptoms/post-menopausal-bleeding/), NHS 5. [What Is Menopause?](https://www.nia.nih.gov/health/menopause/what-menopause), National Institute on Aging --- This guide is general information to help you keep and use your own records. It isn’t medical advice. If you’re worried about a symptom, or something changes suddenly, talk to a doctor, nurse or pharmacist.