The 3 Stages of Menopause: What to Expect

Be prepared with this mini manual

by The North American Menopause Society
female woman stomach torso belly picture
Photograph: Sheryl Griffin

How Can I Confirm Menopause?
The most common symptoms women in their 40s notice are changes in periods and the onset of hot flashes. To date, there is no simple test to predict when menopause will occur but research continues.

During perimenopause, hormone tests are often not helpful because hormone levels change throughout a menstrual cycle. Sometimes testing is done to check specific hormone levels, especially with fertility problems or when periods stop at an early age. This can help women make decisions about beginning or adjusting medications. For some women, it may make sense to test for other causes of symptoms that can seem like perimenopause, such as thyroid disease.

Follicle-stimulating Hormone
Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause, especially in women who have had a hysterectomy and have no menstrual period to follow to let them know what is happening. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

However, a single FSH level can be misleading in perimenopause since estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. One elevated FSH level is not enough to confirm menopause. More importantly, a low FSH level in a woman who is having hot flashes and changing periods does not eliminate the likelihood of perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid.

Saliva Testing
Some clinicians recommend testing a woman’s saliva for estrogen or other hormone levels. Saliva hormone levels are not recommended in this setting and should not be used to evaluate or treat menopausal symptoms.

For more information on symptoms and solutions visit

Next: Join the Club: How to Confirm Your Menopause Status

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First Published April 2, 2012

Share Your Thoughts!


Faye Green12.13.2013

I had a suspicion that I was starting perimenopause at 42 plus having irregular menses with irritability, mild flushing and feeling like someone turned up the furnace, mild mood swings. I barely have any symptoms, if I do, it is very mild to where it doesn't bother me. Now I am 50 I am skipping 2 to 4 months of menses and don't have the furnace effect or flushing much anymore, I am in the threshold of between perimenopause and menopause, I can't wait for the menses to be completely over; every time I skip a cycle for longer than 2 months I start counting and there are times I have to start all over again when the cycle pops up in the form of barely there for two day and gone or spotting for 4 days and heavy flow for one day and spot 3 more days and stop. I'll be 51 in 4.5 months so I can't wait to stop my cycle all together.
Please keep the information coming. My mom nor my sisters in my family told me about what I am going to go through 3 stages of menopause, I had to search the web for info.

Linda Renegar05.08.2012

Correction to previous comment.... It should read "notice I didn't write he" I wrote doctor.

Linda Renegar05.03.2012

Keep these stories coming please! At 41 I am so already there even though my doctor told me years ago it wouldn't happen til 52... notice I wrote "he".

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