Still getting your periods but noticing changes in your sleep, mood or body? It’s Menopause Awareness Month, and World Menopause Day is this Sunday, 18 October. So it’s a good moment to get the words right. Here's how to understand the stages of menopause, when they typically begin and why the first signs can appear years before your periods stop.
You might be in your early 40s, still getting your period every month and assuming menopause is something you'll deal with much further down the track, yet lately you've been waking at ridiculous hours, forgetting words mid-conversation or feeling strangely irritable about things that never used to bother you.
Perhaps you've blamed your workload, a particularly stressful few months or the fact that you're getting older, because nobody really explained that hormonal changes can begin while your periods are still turning up.
Here's what many women don't realise until they're already experiencing it: perimenopause and menopause aren't the same thing, and the symptoms associated with this transition can begin years before your final period.¹ ²
Understanding the difference won't explain every ache, sleepless night or change in mood, but it can help you recognise what's worth paying attention to and when it might be time to have a conversation with your healthcare professional.
Wondering whether the changes you've noticed could be connected to perimenopause?
Our 60-second perimenopause quiz can help you explore common signs and identify what you might want to discuss with your doctor.
Take the 60-second perimenopause quiz
What's the difference between perimenopause and menopause?
Although we often use the word 'menopause' to describe the entire experience, there are actually three stages to understand: perimenopause, menopause and postmenopause.
Perimenopause is the hormonal transition surrounding your final menstrual period, during which your periods may change and menopausal symptoms can begin. Menopause refers specifically to your final menstrual period, although you'll only know you've reached it after 12 consecutive months without another period, provided there isn't another medical explanation. Postmenopause describes the years after that milestone.¹ ³
One detail worth knowing is that clinical definitions of perimenopause can include the first 12 months after your final period, which is why you may see slightly different descriptions of when it officially ends.²
It sounds technical, but the important thing is that your body doesn't wait until your periods stop before hormonal changes begin, and knowing where you might be in the transition can make those changes easier to understand.
Stage one: Perimenopause, when your hormones start changing
Perimenopause often begins in your 40s, although the timing varies considerably between women.
According to Jean Hailes for Women's Health, perimenopause typically begins around age 47 in Australia and lasts an average of four to six years, while healthdirect describes a broader duration of around four to eight years.² ⁴
During this stage, your ovaries begin producing hormones differently, particularly oestrogen and progesterone, and the changes aren't necessarily gradual or predictable. Hormone levels can fluctuate significantly, which helps explain why symptoms may appear, disappear and change over time.¹ ²
Your menstrual cycle is often one of the clearest places to notice these changes, with periods becoming heavier or lighter, arriving closer together, stretching further apart or occasionally skipping a month altogether.
But periods are only part of the picture.
Some women experience hot flushes and night sweats, while others notice changes in their sleep, mood, memory or concentration. Joint and muscle aches, headaches, breast tenderness, vaginal dryness and changes in sexual desire can also occur during this transition.⁴ ⁵
You might find yourself waking in the middle of the night and struggling to get back to sleep, then spending the next day wondering why your concentration has disappeared and your patience feels unusually thin.
For another woman, the first noticeable change might be a period that suddenly becomes much heavier than usual, or an uncomfortable hot flush during an otherwise ordinary meeting.
There isn't one set of symptoms that every woman experiences, and their severity can vary considerably. Some women have few noticeable difficulties, while others find the changes affect their work, relationships, sleep and everyday wellbeing.² ⁶
Because many of these symptoms overlap with other health conditions, it's important not to assume that every new change is hormonal, particularly if symptoms are persistent, severe or affecting your quality of life.
Stage two: Menopause and the meaning of 12 months without a period
Menopause is your final menstrual period, but unlike birthdays and anniversaries, it's a milestone you can only identify after the event.
If you've gone 12 consecutive months without a period and there isn't another explanation for your periods stopping, you've reached menopause. The average age of natural menopause in Australia is approximately 51, although most women experience it between the ages of 45 and 55.³ ⁷
This is where the 12-month rule can become confusing, especially when your periods have already been unpredictable for some time.
Imagine you haven't had a period for eight months and have started wondering whether they're finally finished, only to have one arrive unexpectedly. That means you haven't yet met the 12-month definition of menopause, and the count begins again.
For women using certain forms of hormonal contraception, however, things aren't always as straightforward because contraception can make periods irregular or stop them altogether. Similarly, women who have had a hysterectomy may not be able to use menstrual bleeding to identify where they are in the transition.³ ⁸
In these circumstances, a healthcare professional can assess your symptoms, medical history and other relevant factors rather than relying on the calendar alone.
It's also important to remember that any vaginal bleeding after menopause needs medical assessment, even if it's only light spotting or you otherwise feel completely well.⁹
Stage three: Postmenopause and what happens afterwards
Once you've passed the 12-month milestone, you're considered postmenopausal, which means you've entered the stage of life following your final period.
Your reproductive hormone levels generally remain lower than they were during your reproductive years, but that doesn't mean every symptom disappears once menopause has been confirmed.
For some women, hot flushes, night sweats and sleep disturbances gradually become less troublesome, while others continue experiencing symptoms for several years. Vaginal dryness, urinary changes and discomfort during sex can also continue or develop during postmenopause.⁵ ¹⁰
This stage brings some longer-term health considerations, too, because declining oestrogen levels are associated with changes in bone health and cardiovascular risk. It makes conversations about physical activity, nutrition, bone density and heart health increasingly relevant as you move through midlife.¹⁰ ¹¹
There's no reason to view postmenopause as the end of feeling healthy, energetic or comfortable in your body, although it does help to understand what may be changing and what support is available.
Why can the signs of perimenopause start years before menopause?
One of the biggest misconceptions surrounding menopause is that symptoms begin when your periods finish, when the reality is that the hormonal transition often starts considerably earlier.
Throughout your reproductive years, oestrogen and progesterone levels rise and fall as part of your menstrual cycle, but during perimenopause those patterns become less predictable as ovarian function changes.¹ ²
These hormones influence several systems throughout the body, which is why the effects aren't limited to your periods or reproductive health.
Changes in hormone levels can affect temperature regulation, sleep, mood and vaginal tissues, while the wider menopausal transition may also be associated with difficulties concentrating, changes in memory, headaches and musculoskeletal discomfort.⁵ ¹²
Sometimes these symptoms occur together, which can make it difficult to know where one problem ends and another begins.
For example, night sweats may interrupt your sleep, leaving you exhausted the following day, and that tiredness can make it harder to concentrate or manage everyday frustrations. Over time, it can feel as though several things have changed at once, even when some of them are connected.
This doesn't mean every symptom in your 40s is caused by perimenopause, but it does mean that changes to your sleep, mood or physical comfort deserve attention rather than being automatically dismissed as stress or ageing.
If you'd like to explore the broader picture, our article on the 48 signs of perimenopause and menopause looks at many of the changes women report and why they're worth discussing.
Can you be in perimenopause if your periods are still regular?
Yes, menopausal symptoms can sometimes begin before obvious changes to your menstrual cycle, although changes in bleeding patterns remain an important indicator when healthcare professionals assess perimenopause.
If you're still getting regular periods but have developed unexplained night sweats, sleep problems or other symptoms associated with menopause, it's reasonable to raise the possibility with your doctor rather than assuming you're too young or that your periods rule it out.² ⁶
A healthcare professional will look at the overall picture, including your age, symptoms, menstrual history and other possible explanations, because similar symptoms can occur with thyroid problems, iron deficiency, medication effects and other health conditions.
The important distinction is between recognising a possible pattern and treating that pattern as a confirmed diagnosis.
Is there a blood test that can tell you if you're in perimenopause?
It would certainly make life easier if one blood test could tell you exactly which stage you're in, but for most women over 45, diagnosing perimenopause isn't that simple.
Hormone levels can fluctuate considerably during this transition, which means a single measurement of follicle-stimulating hormone (FSH) or oestradiol may not provide reliable information about whether you're approaching menopause.³ ¹³
The Australasian Menopause Society advises that, for women over 45 with typical menopausal symptoms, routine hormone testing is generally unnecessary because the results are unlikely to change how their symptoms are assessed or managed.³
Instead, your doctor will usually consider your symptoms, menstrual history, age and overall health, while investigating other possible causes when appropriate.
Testing may be recommended for women aged 40 to 45 who have symptoms suggesting early menopause, and for women under 40 when premature ovarian insufficiency is suspected.¹³
Keeping a simple record of your symptoms and menstrual cycle can also be helpful, particularly if you're struggling to remember when changes began or whether they've become more frequent.
You don't need a complicated tracking system or a spreadsheet devoted to every sleepless night, but a few useful notes can give your healthcare professional a clearer picture of what you've been experiencing.
What if menopause happens earlier than expected?
While menopause usually occurs between 45 and 55, some women reach it earlier.
Menopause occurring between ages 40 and 45 is described as early menopause, while loss of ovarian function before age 40 may be associated with premature ovarian insufficiency, often shortened to POI.³ ¹⁴
These circumstances deserve particular attention because they can have implications for fertility, bone health, cardiovascular health and longer-term wellbeing.
Early changes can happen naturally, although menopause may also occur following certain surgeries or medical treatments, including treatments that affect ovarian function.¹⁴ ¹⁵
If you're younger than 45 and your periods have become irregular or stopped, particularly alongside symptoms such as hot flushes, night sweats or vaginal dryness, speak to your doctor so the cause can be properly investigated.
Can you still get pregnant during perimenopause?
Yes, pregnancy is still possible during perimenopause because ovulation can continue, even when your periods have become irregular or less frequent.
Although fertility naturally declines with age, an unpredictable menstrual cycle doesn't necessarily mean pregnancy is no longer possible, which is why contraception remains important if you don't want to become pregnant.⁸ ¹⁶
The length of time contraception is recommended depends on factors including your age, the type of contraception you're using and when your final menstrual period occurred.
Your healthcare professional can help you understand what's appropriate for your circumstances rather than relying on missed periods as proof that contraception is no longer needed.
When should you speak to your doctor about perimenopause?
You don't have to wait until symptoms become overwhelming before asking for advice, particularly if changes to your sleep, mood, menstrual cycle or physical comfort are beginning to affect your everyday life.
It's also important to seek medical assessment if your periods become unusually heavy, bleeding lasts longer than normal, you experience bleeding between periods or after sex, or you have any vaginal bleeding once you've reached menopause.⁶ ⁹
For symptoms that are less urgent but still troubling, starting the conversation with your GP can help you understand what may be happening and what options are available.
A helpful place to begin is by explaining what has changed, how long you've noticed it and how those changes are affecting you, rather than feeling you need to arrive with a diagnosis already worked out.
So, how do you know which stage you're in?
If you're in your 40s and noticing changes to your menstrual cycle, sleep or other aspects of your wellbeing, perimenopause may be worth discussing with your healthcare professional.
If you've experienced 12 consecutive months without a menstrual period and there isn't another explanation, you've reached menopause, while the years following that milestone are described as postmenopause.
The stages may sound neat and orderly when they're written down, but the experience itself isn't always quite so straightforward, particularly when symptoms overlap, periods become unpredictable and day-to-day changes are easy to attribute to everything else going on in life.
And perhaps that's the most useful thing to understand: you don't have to wait for your periods to stop, or for your symptoms to become difficult to manage, before taking your concerns seriously.
Knowing what to look for gives you a better starting point for understanding your body and asking the questions that matter.
Wondering if what you're experiencing could be perimenopause?
If some of these changes sound familiar, our 60-second perimenopause quiz can help you explore common signs and organise what you've been noticing, so you're better prepared for a conversation with your healthcare professional.
It won't diagnose perimenopause or tell you definitively which stage you're in, but it can help you take that first step towards understanding what's happening.
Take the 60-second perimenopause quiz
And with World Menopause Day approaching, we'll be continuing the conversation about another part of this transition that doesn't always get the attention it deserves: the aches, pains and physical changes that can accompany midlife.
Because the more we understand about menopause, the easier it becomes to recognise the signs and talk about them.
Know the Sign. Look for the MTick.
Frequently asked questions about perimenopause and menopause
What is the main difference between perimenopause and menopause?
Perimenopause describes the hormonal transition around your final menstrual period, when symptoms and menstrual changes may occur, while menopause itself is the final period, confirmed retrospectively once 12 consecutive months have passed without menstruation.¹ ³
How long does perimenopause usually last?
Jean Hailes reports an average of four to six years, although the experience varies considerably and some women transition more quickly or over a longer period.²
What is the average age of menopause in Australia?
The average age of natural menopause is approximately 51, although most women experience it between 45 and 55 years of age.³ ⁷
Can perimenopause start before your periods become irregular?
Menopausal symptoms may sometimes be noticed before clear changes to the menstrual cycle, but symptoms alone aren't enough to confirm perimenopause because other health conditions can produce similar changes.² ⁶
Do you need a blood test to confirm perimenopause?
For most women aged 45 or older with typical symptoms, routine hormone testing isn't recommended because hormone levels fluctuate and the results may not reliably establish which stage of the transition they're experiencing.³ ¹³
Do menopause symptoms stop after your final period?
Not necessarily, because some symptoms can continue for several years after menopause, although the experience and duration vary between women.⁵ ¹⁰
References
1. Jean Hailes. Menopause: Symptoms, causes and management. https://www.jeanhailes.org.au/health-topics/menopause/
2. Australasian Menopause Society. Diagnosing Menopause. https://www.menopause.org.au/hp/gp-hp-resources/diagnosing-menopause
3. healthdirect. Perimenopause. https://www.healthdirect.gov.au/perimenopause
4. NHS. Symptoms of menopause and perimenopause. https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
5. Jean Hailes. Perimenopause and menopause symptom checklist. https://www.jeanhailes.org.au/wp-content/uploads/2026/03/Perimenopause-and-menopause-symptom-checklist_TGD.pdf
6. healthdirect. Bleeding after menopause. https://www.healthdirect.gov.au/bleeding-after-menopause
7. Australasian Menopause Society. Contraception. https://www.menopause.org.au/hp/information-sheets/contraception
8. healthdirect. Post menopause. https://www.healthdirect.gov.au/post-menopause
9. The Menopause Society. Position Statements: Hormone Therapy, Osteoporosis and Menopause Care. https://menopause.org/professional-resources/position-statements
10. Jean Hailes. Ask Jean Hailes about menopause. https://www.jeanhailes.org.au/articles/menopause-ask-jean-hailes/
11. National Institute for Health and Care Excellence (NICE). Menopause: Identification and Management (NG23). https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
12. Australasian Menopause Society. Menopause before 40 and spontaneous premature ovarian insufficiency. https://www.menopause.org.au/health-info/resources/menopause-before-40-and-spontaneous-poi
13. Australasian Menopause Society. Early Menopause: Chemotherapy and Radiation Therapy. https://hub.menopause.org.au/Play?pId=b1bc898a-c90f-49da-810b-09c3b6e59c4a
