Signs Perimenopause Is Ending (and Menopause Is Near)

The clearest sign that perimenopause is ending is a longer gap between periods: going 60 days or more without one marks the late stage of the transition. Hot flushes are common around this time. You reach menopause once you have gone 12 months without a period, and any bleeding after that needs checking by a GP.

This guide explains what the final stretch of perimenopause looks like, how doctors define the point when it ends, and what to ask at your appointment. For the full list of symptoms and treatments, see our perimenopause hub.

How do you know perimenopause is ending?

The main clue is your periods, not a test. Researchers describe the transition in stages using STRAW+10 (the Stages of Reproductive Aging Workshop + 10), a staging system agreed by scientists from five countries. In the STRAW+10 paper, two changes in the menstrual cycle mark the way through:

• Early transition: the length of your cycle starts to vary, defined as a difference of 7 days or more between consecutive cycles that happens again within 10 cycles.
• Late transition: you go 60 days or longer without a period.

The late transition is the last stage before your final period. STRAW+10 estimates that it lasts, on average, 1 to 3 years, so a first 60-day gap usually means the end is getting closer rather than that it has arrived.

Stage	What happens to periods
Late reproductive years	Periods are still regular, though cycles may start to get a little shorter
Early perimenopause (early transition)	Cycle length keeps varying by 7 days or more
Late perimenopause (late transition)	Gaps of 60 days or more without a period; lasts 1 to 3 years on average
Final period	Only recognised looking back, once 12 months have passed
Postmenopause	No periods; perimenopause officially ends 12 months after the final period

The stages and markers in this table come from the STRAW+10 staging system. It is a framework for research and clinical assessment, so your own pattern may not follow it neatly.

How do periods change near the end of perimenopause?

They usually become less frequent and less predictable. The NHS says periods in perimenopause may come more often or less often, bleeding may get heavier or lighter, and eventually periods stop altogether. The Menopause Society describes the same arc: at first you may skip the occasional period, but in the late menopause transition you may skip 60 days or more.

Behind this, the STRAW+10 paper says cycles in the late transition vary more in length, hormone levels swing widely, and cycles without ovulation (anovulatory cycles) become more common. That is why one month can bring a heavy period and the next can bring nothing at all.

Two things can hide these changes:

• Hormonal contraception. The NHS says the progestogen-only pill, the hormonal coil (IUS), the implant and the injection can make periods irregular or stop them, while the combined pill causes monthly bleeds for as long as you take it.
• HRT. HRT taken in perimenopause can make periods more regular, according to the NHS, so the gaps described above may not appear.

Because the gaps are easy to lose track of, write down the first day of each period. Our cycle length calculator shows how long your cycles are and whether they are stretching out.

Tap to enlarge

How do symptoms change as menopause gets closer?

Hot flushes (called hot flashes in the US) and night sweats often become more noticeable. STRAW+10 says these vasomotor symptoms are likely during the late transition and most likely in the early postmenopause, the first stretch of years after the final period. So your periods stopping does not mean your symptoms will stop too.

The mix of symptoms can also shift. The NHS says symptoms usually last for 7 to 9 years, sometimes longer, and can change during that time. For example, hot flushes and night sweats may improve and be replaced by low mood and anxiety. Some symptoms, such as joint pain and vaginal dryness, can continue after menopause.

If you are not sure which of your symptoms fit, our perimenopause symptoms checklist lists the common ones, and the menopause symptom diary helps you record how they change from month to month.

When are you officially in menopause?

You reach menopause when you have not had a period for 12 months. The NHS defines menopause as not having a period for 12 months while not using hormonal contraception, and says it usually happens between the ages of 45 and 55, though it can happen earlier.

UK doctors follow the NICE menopause guideline (NG23). For people aged 45 or over with menopause symptoms, it says menopause can be recognised without laboratory tests if they have not had a period for at least 12 months and are not using hormonal contraception. After a hysterectomy, menopause is recognised from symptoms instead. NICE says an FSH (follicle-stimulating hormone) blood test should be considered only for people aged 40 to 45 with symptoms and a changed cycle, or under 40 when menopause is suspected.

This means the date of your final period is only known in hindsight. If you are still having periods, even rare ones, you are in perimenopause. Our guide to perimenopause vs menopause sets out the differences side by side.

Why does bleeding after menopause need checking?

It needs checking because, although it is not usually serious, it can be a sign of cancer. The NHS says that if you have not had a period for more than 12 months and get any vaginal bleeding, you should see a GP, even if:

• it has only happened once
• there is only a small amount, spotting, or pink or brown discharge
• you have no other symptoms
• you are not sure if it is blood

The NHS page on postmenopausal bleeding lists the most common causes as thinning and inflammation of the vaginal or womb lining caused by lower oestrogen (estrogen in the US), polyps, and a thickened womb lining, which can be linked to HRT, high oestrogen levels or being overweight. Less often the cause is cancer, such as womb or ovarian cancer, and cancer may be easier to treat if it is found early.

The NHS says a GP should refer you to a hospital or a postmenopausal bleeding clinic, and you should not have to wait more than 2 weeks to see a specialist. Tests may include a vaginal ultrasound scan, an examination, and a camera test of the womb (hysteroscopy) with a tissue sample.

When can you stop using contraception?

Not as soon as your periods stop. Pregnancy is still possible in perimenopause, and the NHS says you still need contraception:

• for 2 years after your final period if you are aged 40 to 49
• for 1 year after your final period if you are 50 or over

This counting applies to non-hormonal methods in the FSRH guideline on contraception for women aged over 40, the guidance NICE points doctors to. Hormonal methods can hide your periods, so the guideline gives method-specific advice: combined hormonal contraception should stop at 50, with a switch to another method, while the progestogen-only pill, the implant and the hormonal coil can be continued to 55. The FSRH says that, in general, all women can stop contraception at 55, because natural pregnancy after that age is exceptionally rare.

The same guideline makes two further points. HRT is not a contraceptive, so you may need both. And a single blood test for FSH or other hormones during perimenopause can be misleading, because ovulation may still happen. In the US, The Menopause Society advises using birth control until menopause is confirmed 1 year after the final period. For more detail, read can you get pregnant during perimenopause.

What should you ask your GP?

Go in with your dates and a short list of questions. Bring the date of your last period, the length of recent gaps, the contraception or HRT you use, and your main symptoms with how much they affect your sleep, work and relationships. Then ask:

1. Does my bleeding pattern fit late perimenopause, or should anything else be checked?
2. Do I need a blood test at my age, or can you go by my symptoms?
3. When can I safely stop contraception with the method I use now?
4. Would HRT help my symptoms, and how would it change my bleeding?
5. Which kinds of bleeding should bring me back, and how quickly?
6. What can I do to protect my bones? NICE says doctors should give advice on bone health to people going through menopause.

When to see a doctor

See your GP (family doctor) if your symptoms are affecting your daily life or you want to know your options. The NHS says to contact your GP sooner if:

• you have not had a period for 12 months or more and then have any vaginal bleeding
• you still have periods but are bleeding more, not less, than before
• you have a fast or noticeable heartbeat (palpitations)
• you take HRT and still have irregular or heavier bleeding or spotting after 6 months

Also talk to a GP if your periods stop or symptoms start before 45, because the NHS says early menopause or premature ovarian insufficiency can happen before that age. In an emergency call 911 (US), 999 (UK) or 112 (EU), for example with very heavy bleeding and dizziness or fainting.