The Stages of Menopause: A UK Guide by Age

“What stage am I at?” is the question I hear most often, and it usually arrives with an apology attached. Sorry, I should probably know this. Sorry, I’ve been searching for an hour and every site gives a different number.

Some say menopause has three stages. Some say four. One chart insists on seven. And none of them tell you what to do with the fact that you are 47, still bleeding now and then, waking at 4am with your heart going, and not sure whether you count yet.

You do count, so let me lay out the map and show you where you are on it.

Menopause has three stages. Perimenopause is the transition, usually beginning in your forties, when hormone levels fluctuate and periods change. Menopause is the single point twelve months after your last period, at an average UK age of 51. Postmenopause is everything after that, for the rest of your life. Symptoms can run through all three.

The three stages of menopause, by age

Here they are in order, with the age band you are most likely to meet each one in, and with what the charts leave out: what is happening inside a woman at the same time. I’m a counsellor, not a doctor. The physical detail below is the NHS and NICE picture; the inner detail is what I see in my therapy room.

Perimenopause: late thirties to early fifties. This is the longest stage. Your ovaries gradually make less oestrogen, but not in a straight line, and the swings are what cause most of the trouble: broken sleep, anxiety from nowhere, heavier or lighter periods, a shorter fuse, a word that will not come. The NHS says menopause usually happens between 45 and 55, and the transition begins some years before that, sometimes much earlier. Perimenopause has its own four sub-stages based on what your cycle is doing, and I have mapped those in full in the four stages of perimenopause, so I won’t repeat them here. This is the stage of not knowing, and almost every woman I work with says those unnamed years were the hardest part. The inner work here is recognition, and then the honest grief of perimenopause, which is real mourning and deserves to be treated as such.

Menopause: around 51. Here is the part that surprises people. Menopause is not really a stage at all. It is a single day: the one that marks twelve months since your last period. You only know you have reached it by looking backwards. The NHS puts the UK average at 51, and NICE guidance says that if you are over 45 your GP can confirm it from your symptoms and cycle history alone, with no blood test. If it arrives before 45 it is called early menopause, and before 40 it is premature menopause, or premature ovarian insufficiency. Both have their own article: early, premature and surgical menopause. The year of waiting for that twelve-month mark is an uncertain time in its own right, and I’ve written about it in how long menopause lasts, and how you know you’ve reached it.

Postmenopause: fifties onward, for the rest of your life. Once the twelve months have passed, you are postmenopausal, and you stay that way. Hormone levels settle at a new, lower level rather than swinging, and for many women symptoms ease with time. Symptoms can still continue for months or years, and some can appear later. This is also the stage where the NHS advises paying attention to bone and heart health. I cover all of this properly in the postmenopause series, starting with postmenopause symptoms by age. The inner work of this stage is rebuilding: the periods have stopped, the symptoms are quieter, and many women find themselves asking whether this is who they are now. That question, has menopause changed who I am, is the heart of this series.

Where the “4 stages” and “7 stages” come from

If the internet has confused you, it is not your fault. Different sources are counting different things.

The four-stage version is usually perimenopause split into its sub-stages, or the three main stages with the reproductive years added at the front as “premenopause”.

The seven-stage version comes from a research framework called STRAW, the Stages of Reproductive Aging Workshop, which researchers use to describe a woman’s whole reproductive life, from the early reproductive years to late postmenopause. It is a specialist tool, not an exam you need to pass.

The three-stage version is the one the NHS, NICE and the British Menopause Society use, and it is the one I use, because it matches how women actually experience this: the years leading up to it, the point itself, and the life afterwards.

How to work out which stage you are in

You do not need a test. You need a calendar and some honesty.

If your periods still come, but they or you have changed, you are almost certainly in perimenopause. The perimenopause article above will help you narrow down which sub-stage.

If your periods are skipping months at a time, you are in late perimenopause, and menopause itself is not far off.

If it has been twelve months since your last period, you have reached menopause and are now postmenopausal. Any bleeding after this point should always be checked by your GP.

If you are under 45 and any of this is happening, please see your GP; earlier changes deserve proper investigation.

A woman I worked with, in her late forties, spent most of our first session apologising for “not being at menopause yet”, as though it were an exam she kept failing. She had been in perimenopause for six years, and nobody had told her that those six years were the stage she was looking for. Once she could see herself on the map, the shame went out of it almost overnight.

The emotional side of each stage

Everything above describes what your body is doing. In my counselling room I see a second, emotional process happening at the same time, and it is the one I am actually here for.

I have spent my working life with grief, and readers will know the 12 stages of grief that shape my bereavement work. Menopause is one of life’s great transitions, and it has a recognisable emotional shape of its own. Perimenopause is the mourning stage: the loss of a self you had for decades. Menopause is the point where that loss becomes final. Postmenopause, done well, is the rebuilding: meaning, choice, and a woman who is more herself than she has ever been.

Another woman, 53 and two years past her last period, told me the symptoms were “basically fine now” and she couldn’t understand why she felt so lost. Her body had finished the transition. She hadn’t. That gap, between the medical end of menopause and the human one, is where most of my work happens.

What this series will cover

One article on each part of this, linked here as each goes live, so this page can serve as your map:

1. The stages of menopause (this article)
2. How long does menopause last, and how do you know you’ve reached it?
3. Early, premature and surgical menopause
4. Has menopause changed who I am?
5. Menopause, libido and your relationship
6. Menopause at work
7. The empty nest and menopause
8. What is a menopause coach, and what do they do that a GP doesn’t?

Nothing in this series is medical advice. HRT and other treatments are a conversation for you and your GP, and I’d encourage you to have it. What I offer is the other half of the picture: the emotional, psychological and practical side that a prescription doesn’t reach.

Frequently asked questions

How do you know what stage of menopause you are in?

Look at your periods, not a blood test. If they still arrive but have changed in length, flow or timing, or you have new symptoms such as poor sleep and anxiety, you are in perimenopause. If they are skipping months, you are in late perimenopause. If twelve months have passed since your last period, you have reached menopause and are now postmenopausal. NICE guidance says that over 45, your GP can confirm this from symptoms alone; under 45, ask for a proper assessment.

What is the hardest stage of menopause?

For most women I work with, late perimenopause: the stretch when periods start skipping and oestrogen swings are at their widest, so flushes, sleep, mood and memory are all under strain at once, often before anyone has named what is happening. That said, “hardest” is personal. Some find the twelve months of waiting hardest, and some find postmenopause unexpectedly difficult, because once the symptoms ease the question of who they are now finally gets their full attention.

What are the signs menopause is coming to an end?

Menopause itself ends the moment twelve months have passed since your last period; after that you are postmenopausal. The signs you are approaching that point are periods spacing out to gaps of several months and, for many women, hot flushes and mood swings gradually softening as hormone levels stop swinging and settle. Symptoms do not switch off on the anniversary, though. The NHS says they can continue for months or years afterwards, usually easing with time.

What are the key things I should know about menopause?

Five things. It has three stages: perimenopause, menopause and postmenopause. The UK average age is 51, but the transition usually starts years earlier. Over 45, you do not need a blood test; your symptoms are the diagnosis. Under 45, see your GP, because early and premature menopause need proper care. And the emotional side is not a side effect: identity, grief, relationships and confidence all shift, and they deserve support in their own right, alongside whatever you and your GP decide about HRT.

Walking women through this map, and through the grief and rebuilding that go with it, is the heart of my menopause coaching in Surrey and online. If you’d like to work out where you are with someone who understands life’s transitions, book a free discovery call here. Next in the series: How Long Does Menopause Last, and How Do You Know You’ve Reached It?

This article is part of The Menopause Journey, an eight-part series.
Next: part 2