As women age, their hormones and menstrual cycles go through natural changes. These changes don’t happen overnight—they unfold gradually over time in a series of stages that move from regular periods to the time well after your last one.
A key moment in this process is the Final Menstrual Period (FMP)—this is the last natural period you’ll ever have. You can only know it was your final one in hindsight, after you’ve gone a full 12 months with no period. Once that happens, you are considered to be in menopause.
Here’s a simple guide to the stages that lead up to and follow this important milestone:
1. Reproductive Years
During this time, most women have regular monthly periods and your body is naturally fertile. Your hormones will usually follow a predictable rhythm, and ovulation (the release of an egg) happens most months.
2. Early Menstrual Changes (Late Reproductive Stage)
Even before your periods start to feel different, your hormone levels may begin to shift. Ovulation might not happen every month, and you might notice subtle changes such as:
- Slightly heavier or lighter flow
- More or less cramping
- Mood or sleep changes before your period
You’re still having regular cycles, but your body is beginning to prepare for the next phase.
3. Perimenopause
Perimenopause has two sub-stages:
Menopausal Transition: The time when your periods become increasingly irregular and symptoms begin. This is the stage just before your final menstrual period.
First 12 months after your final menstrual period: Although your periods have stopped, your hormones are still adjusting.
During the menopausal transition, your periods become irregular — they may come closer together or further apart, and/or the bleeding may become heavier, lighter, longer, or shorter than usual.
Your hormone levels—especially estrogen and progesterone—fluctuate a lot during this time, which can cause symptoms such as:
- Hot flashes and night sweats
- Mood swings or anxiety
- Trouble sleeping
- Brain fog or memory issues
- Breast tenderness or bloating
- Vaginal dryness or discomfort
Sometimes, your body may produce an extra surge of estrogen during the second half of a cycle—when hormone levels are usually dropping. This can lead to especially intense symptoms or unexpected spotting between periods. This kind of hormone pattern becomes more common as you get closer to menopause.
4. Final Menstrual Period
This marks the official end of your reproductive years. You’ve reached this point once you’ve gone 12 months in a row without a period. This is the milestone that signals the beginning of menopause.
5. Postmenopause
These are the years after your final menstrual period and is made up of two phases:
- Early Post-menopause: The first few years after your final period. After the first twelve months of this stage, hormone levels settle at their new, lower levels but some symptoms may improve, continue or even peak.
- Late Post-menopause: This lasts for the rest of your life. For most women, many symptoms like hot flashes usually fade, but other changes—like bone thinning, vaginal dryness, or increased heart risk—may become more noticeable as a result of having lower estrogen levels long term.
If you’re unsure which stage you’re in, or you’re experiencing bothersome symptoms, speak with your healthcare provider. If you would like to see one of our doctors, this GUIDE can explain the step-by-step process in getting to see one of our menopause specialists.