What is menopause? Many women are unaware there is an agreed-upon definition, set by the STRAW and STRAW+10, the Stages of Reproductive Aging Workshop in 2001 and STRAW+10: Addressing the Unfinished Agenda of Staging Reproductive Aging in 2011, respectively. This was done to standardize research and discussions about women’s health, so that everyone was on the same page as to what stage they were discussing. Menopause, by definition, occurs once a woman has gone 12 months without a period, after which she is considered postmenopausal. Being a retrospective definition, though, presents problems as women don’t know which menstrual period is their last at the time. Perimenopause and/or the Menopausal Transition are defined as beginning with changing cycles of variable length; there is no concrete marker, as FSH may be raised but is often variable up until 3 or more years after the final menstrual period. Contrary to popular belief, estrogen levels in perimenopause may be higher instead of lower, and are often chaotically up and down. Progesterone levels go down. The FSH level being variable makes it an unreliable marker of menopause. Vasomotor symptoms, hot flashes and night sweats, are most likely to be problematic in the one to three years prior to the final menstrual period (FMP) until two years after. The work of defining the stages of reproduction in women is ongoing, as the 2011 meeting identified seven areas of research priorities.
In a nutshell, the answer to the question is that there is no actual point in time that is menopause. A woman is premenopausal throughout her reproductive years until her periods start to change in frequency or amount of bleeding, at which time she becomes perimenopausal. Perimenopause lasts until a year after the final menstrual period (FMP), when a woman is regarded as postmenopausal. Many changes occur to us over this time, and they affect all the systems of the body. This is menopause.