# When does menopause start? · Unpaused > Source: https://unpaused.cc/articles/when-does-menopause-start Perimenopause ## When does menopause start? The final period usually occurs between the ages of 45 and 55, and it can happen earlier. Perimenopause is the time before that, when periods change and symptoms can start. By Ines Kovac. Published 23 October 2026\. 5 minute read. ### Perimenopause, menopause and postmenopause Perimenopause is when your periods become irregular, and menopause is when they stop altogether. Menopause means 12 months with no period when you are not using hormonal contraception ([NHS: menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/what-are-menopause-and-perimenopause/)). Perimenopause ends at that point. Postmenopause is the time after it. A fall in hormone levels is what causes menopause, and it can affect anyone who has periods. The usual ages above come from that same NHS page. The [NHS fertility page](https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/) gives 51 as the average age for menopause in the UK. ### What age does perimenopause start? There is no single age at which perimenopause starts. It begins when the cycle changes and symptoms begin. Menopausal symptoms can begin months or even years before periods stop ([nidirect: menopause](https://www.nidirect.gov.uk/conditions/menopause)). The [Canadian Menopause Society](https://www.canadianmenopausesociety.org/professionals/menopause-hub/definition/), in its summary of the STRAW staging used in international guidance, says perimenopause can last about 4 to 8 years before menopause, and in some people 10 years or longer. That span is the length of the stage. [How long menopause lasts](/articles/how-long-does-menopause-last) is the separate question of how long the symptoms themselves go on. [NICE](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause) says people from some ethnic minority backgrounds, and people with some lifelong conditions, may reach menopause at a younger age. Early menopause means regular periods have stopped before 45\. Premature menopause means periods have stopped before 40 ([NHS: early or premature menopause](https://www.nhs.uk/conditions/early-or-premature-menopause/)). The labels and the tests used at those ages are in the [early menopause](/articles/early-menopause) guide. ### The first signs of perimenopause One of the first signs of perimenopause is usually a change to your periods. They may happen more often or less often, and bleeding may get heavier or lighter ([NHS: menopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/)). The [National Institute on Aging](https://www.nia.nih.gov/health/menopause/what-menopause) describes the transition as usually starting with a change in cycle pattern, often with hot flashes or other symptoms alongside. Menopause symptoms can occur before the cycle changes, and menstrual cycle changes can occur without menopause symptoms. The Canadian Menopause Society notes both patterns. The [Menopause Society](https://menopause.org/patient-education/menopause-topics/perimenopause) describes how cycles tend to change. As perimenopause progresses, cycle length may vary by 7 days or more from your usual pattern. Near the beginning, a skipped period may only be occasional. In the late menopause transition, women may go 60 days or more without a period. The [perimenopause or menopause stage checker](/articles/perimenopause-or-menopause-a-stage-checker-from-your-age-and-your-last-period) sets your age and the date of your last period against that kind of gap. ### Early signs of perimenopause A hot flush is when the face, neck and chest suddenly feel very hot or very cold. It can make you sweat a lot, and it can cause palpitations, anxiety or dizziness. Flushes can happen in the daytime. At night, the same episode is a night sweat. When a racing heart is the part that worries you, the [heart palpitations](/articles/heart-palpitations-menopause) guide sets out when to talk to a GP. Hot flashes and night sweats are the most commonly reported symptoms of the menopause transition. The Menopause Society uses those names for the daytime episodes and the night-time ones just described. Sleep and mood can shift in the same years. The [menopause symptom checklist for your GP](/articles/menopause-symptom-checklist-to-print-and-take-to-your-gp) is the wider list to print, with the period changes and the flushes on it. When flushes are the symptom you want to track, a [hot flush diary](/articles/hot-flush-and-night-sweat-diary-log-episodes-and-triggers-for-your-gp) logs episodes and triggers for that visit. ### How doctors identify perimenopause from age 45 From age 45, NICE says perimenopause can be identified without laboratory tests in otherwise healthy women, trans men and non-binary people registered female at birth. The pattern is vasomotor symptoms that have recently started, together with any change in the cycle. Vasomotor symptoms are those flushes and sweats. The NHS says there is no routine test for perimenopause or menopause. A doctor may diagnose it from your age and your symptoms. From 45, measuring follicle-stimulating hormone does not help with the diagnosis, because levels fluctuate during perimenopause and the result would not change management ([NICE quality statement 143](https://www.nice.org.uk/guidance/qs143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause)). The early menopause guide covers testing before 45. ### When to book a GP appointment Talk to a GP if menopausal symptoms are troubling you, including if they start before 45\. nidirect gives that advice. See a GP if you still have periods and the bleeding has become heavier than it was. The NHS symptoms page includes that warning. Print the checklist and take it in. If you want to see which stage your age and last period point to before the visit, use the stage checker. [HRT for menopause](/articles/hormone-replacement-therapy-for-menopause) covers what the treatment is for, and the timing while periods continue or after they have stopped. ### What to read next The [perimenopause topic hub](/topics/perimenopause) links to the other guides on this stage. The duration guide covers how long symptoms continue, from the first changes through the years after menopause. That question is separate from how long the perimenopause stage can run. ### My take I would start by noting the month your periods changed in frequency or flow, and whether flushes had already begun, because either can happen first. From 45, that pair is what NICE uses to identify perimenopause without a hormone test, and it is what I would take to a GP. If symptoms are troubling, bleeding is heavier, or the changes began before 45, I would book the GP visit with the printed list. ### Sources * [NHS: what are menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/what-are-menopause-and-perimenopause/) * [NHS: fertility in the menstrual cycle](https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/) * [NHS: menopause and perimenopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/) * [NHS: early or premature menopause](https://www.nhs.uk/conditions/early-or-premature-menopause/) * [NICE NG23: diagnosis of perimenopause and menopause](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause) * [NICE quality statement 143: diagnosing perimenopause and menopause](https://www.nice.org.uk/guidance/qs143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause) * [nidirect: menopause](https://www.nidirect.gov.uk/conditions/menopause) * [National Institute on Aging: what is menopause](https://www.nia.nih.gov/health/menopause/what-menopause) * [Canadian Menopause Society: definition of perimenopause](https://www.canadianmenopausesociety.org/professionals/menopause-hub/definition/) * [The Menopause Society: perimenopause](https://menopause.org/patient-education/menopause-topics/perimenopause) Written by Ines Kovac Menopause guides: symptoms, HRT, sleep and everyday changes Ines Kovac writes the practical guides on Unpaused: perimenopause, symptoms, hormone therapy, sleep, hot flushes and weight. She builds each piece from NHS and NICE pages, The Menopause Society's position statements and the studies behind them, and links every claim a reader might want to check. She states clearly what the evidence supports and where the evidence stops, and she never advises a reader to start or stop a medicine. Corrections are added to the page that had the error. [ikovac@unpaused.cc](mailto:ikovac@unpaused.cc) Last checked 2026-10-23 --- Plain, practical menopause advice Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies. [desk@unpaused.cc](mailto:desk@unpaused.cc) ### Topics * [Perimenopause](/topics/perimenopause) * [Symptoms](/topics/symptoms) * [Hormone therapy (HRT)](/topics/hrt) * [Hot flashes](/topics/hot-flashes) * [Sleep](/topics/sleep) * [Weight and diet](/topics/weight-and-diet) * [Mood and mind](/topics/mood-and-mind) * [All guides](/articles) ### About us * [About](/about) * [Authors](/authors) * [Editorial policy](/editorial-policy) * [How we make money](/how-we-make-money) ### Legal * [Terms](/terms) * [Privacy](/privacy) * [Contact](/contact) Unpaused © 2026 Unpaused. General health information, written from sources we link. It does not replace advice from your own doctor, nurse or pharmacist. [How we make money](/how-we-make-money) [Editorial policy](/editorial-policy) [Who writes here](/authors)