What is the typical duration of menopause?

Duration of Menopause

Menopause is not a temporary condition but a permanent cessation of menses that marks a lifelong physiological state, with the menopausal transition (perimenopause) typically lasting 4-7 years before the final menstrual period. 1

Definition of Menopause

Menopause is defined as the permanent cessation of menses resulting from loss of ovarian follicular activity. It is clinically diagnosed after 12 months of amenorrhea without any other pathological or physiological cause. 2, 1

Key diagnostic criteria for determining menopause include:

• Prior bilateral oophorectomy 3
• Age ≥60 years 3
• Age <60 years with amenorrhea for ≥12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, with FSH and estradiol in the postmenopausal range 3
• If taking tamoxifen or toremifene and age <60 years, then FSH and plasma estradiol levels must be in the postmenopausal ranges 3

Timeline of the Menopausal Transition

The menopausal experience consists of several distinct phases:

• Perimenopause (Menopausal Transition):

  • Begins several years before the final menstrual period 2
  • Characterized by fluctuating ovarian function and hormone levels 4
  • Typically lasts 4-7 years before the final menstrual period 1
  • Many women begin experiencing symptoms during this phase 2

• Menopause:

  • Occurs at a median age of 51 years in the United States (range 41-59 years) 3
  • Diagnosed retrospectively after 12 months without menstruation 2
  • Marks the permanent end of menstrual cycles 4

• Postmenopause:

  • The period following the final menstrual period 4
  • Women in the United States who reach menopause have an average life expectancy of nearly 30 years in the postmenopausal state 3

Symptom Duration

Menopausal symptoms vary significantly in duration:

• Vasomotor symptoms (hot flashes, night sweats):

  • Affect approximately 50-75% of women during the menopausal transition 1
  • Typically last more than 7 years 1
  • For 15-20% of women, these symptoms interfere with quality of life 5
  • Most symptoms diminish after several years, though some women experience them for longer periods 5

• Genitourinary symptoms (genitourinary syndrome of menopause):

  • Affect more than 50% of women 1
  • Often chronic and may persist indefinitely without treatment 1

Physiological Changes

During the menopausal transition, significant physiological changes occur:

• Hormonal changes:

  • Ovarian production of estrogen and progestin begins to decrease years before the complete cessation of menses 3
  • After menopause, there is a profound and permanent decrease in ovarian estrogen synthesis 3

• Bone density changes:

  • Bone density decreases by approximately 2% each year during the first 5 years after menopause 3
  • Following this initial period, there is an annual loss of approximately 1% for the rest of a woman's life 3
  • Up to 70% of women older than 80 years have osteoporosis based on commonly used criteria 3

Important Considerations

• Women will now live up to a third of their life being either peri- or postmenopausal, with the UK's average life expectancy for women being approximately 81 years 4

• In women who were premenopausal at the beginning of adjuvant chemotherapy, amenorrhea is not a reliable indicator of menopausal status, as ovarian function may still be intact or resume despite anovulation/amenorrhea after chemotherapy 3

• It is not possible to assign menopausal status to women who are receiving an LH-RH agonist or antagonist 3