menopausal transition

Last reviewed 01/2018

menopausal transition

The change from reproductive period (marked by cyclical ovulation and menstrual bleeding) to post menopausal period (marked by amenorrhoea) is known as the menopausal transition (1).

• the World Health Organization (WHO) and the Stages of Reproductive Aging Workshop have defined menopausal transition as the time of an increase in follicle-stimulating hormone and either increased variability in menstrual cycle length, two skipped menstrual cycles with 60 days or more of amenorrhea, or both
• usually it concludes with the final menstrual period after which post menopause begins (although it is not recognized until after 12 months of amenorrhea)(2)
• although this term can be used synonymously with “premenopause”, the WHO recommends the term “menopausal transition” to avoid confusion (3)

The menopausal transition usually begins in the mid-to-late 40s and lasts for about 4 years (1).
Changes during the menopausal transition are as follows:

• menstrual cycle - there is changes in duration or amount of menstrual flow
• in the early part of transition 1 or 2 cycles are missed per year which increases to 3 or more missed cycles per year during latter part of transition
• hormone levels
• estrogen levels are generally normal or even slightly elevated
• follicle-stimulating hormone (FSH) begins to increase but is generally in the normal range
• as the transition progresses, estrogen levels fall markedly while the FSH levels increase (1)

Reference:

• (1) Grady D. Clinical practice. Management of menopausal symptoms. N Engl J Med. 2006;355(22):2338-47. 
• (2) Rao SS et al. Health maintenance for postmenopausal women.  Am Fam Physician. 2008;78(5):583-91   
• (3) The International Menopause Society (IMS). Menopause Terminology