Age at menopause

Menopause is one day: your final period. The Pakistan Menopause Society says it can only be confirmed once 12 months have passed without another (sections 1.2.1 and 1.2.2). Your age at menopause is your age on that last period, which means you only know it looking back.

The years before it are perimenopause, when periods start to change and symptoms often begin. The Pakistan Menopause Society says perimenopause typically lasts about four to seven years (section 1.2.4). So if the average menopause in Pakistan falls somewhere between 45 and 49, the changes can start in your early forties, sometimes earlier.

The numbers, and where they come from

• In Pakistan, the Pakistan Menopause Society's 2026 recommendations put the average between 45 and 49, and say this is lower than among Caucasian women.
• For Pakistani women, the British Menopause Society's guidance on ethnic minority women gives a mean of 47.16 years, from a 2006 study of urban women in Hyderabad, Pakistan. The same guidance gives 46.7 for Indian women living in India, and 51 for western countries.
• In the UK, the NHS website says usually between 45 and 55, and the British Menopause Society's workplace guidance gives an average of 51.

The Pakistani figure rests on a small number of studies, and one city is not a country. But the direction is the same in every source we checked: younger than the UK average.

When your estrogen falls for good depends partly on things you cannot change and partly on things you can.

The NHS website says early menopause is more likely if it runs in your family, if you started your periods early, if you smoke or if you are underweight. Some treatments bring it on directly: chemotherapy, radiotherapy, certain hormone medicines and surgery to remove the ovaries.

Ethnic background is part of it too. NICE NG23 asks doctors in England to be aware that women from some ethnic minority backgrounds may reach menopause younger (1.3.3), though it does not say which. The British Menopause Society's workplace guidance is more direct: for some ethnic groups, it says, the average age is younger, and it names South Asian women among them.

A few years matter. The British Menopause Society notes a higher rate of heart risk factors in South Asian women during the transition, including insulin resistance, diabetes, weight around the middle and high blood pressure.

That is why the Pakistan Menopause Society asks doctors to use the menopause visit for prevention. Its Table 1 lists:

• blood pressure and BMI
• fracture risk
• blood sugar, with a glucose or HbA1c test
• cholesterol
• tobacco use
• a look at lifestyle, muscle strength and activity

If your menopause comes earlier than the UK average, those checks come earlier too. That is the practical reason to know your number.

You do not need to wait for a particular birthday. If your periods are changing and the symptoms are getting in the way of your life, that is reason enough to book.

Some ages carry their own guidance:

• Under 40, symptoms that could mean premature ovarian insufficiency are on the Pakistan Menopause Society's list of red flags that need checking (section 2.3).
• Menopause between 40 and 44 is called early menopause. The same list names early menopause with distress or a fertility concern, and NICE says a doctor can consider an FSH blood test at 40 to 45 when there are symptoms and a change in your cycle (1.3.6).
• At 45 and over, NICE and the Pakistan Menopause Society both say perimenopause is usually identified from your symptoms and your periods, without blood tests. More in Is there a test for menopause?

Bleeding again after 12 months without a period is never something to wait on. The Pakistan Menopause Society lists it as a red flag (section 2.3).

The NHS says early menopause is more likely if it runs in your family. That makes your mother, your khala and your older sisters a source of real information, if you can ask them. Many women of that generation never talked about it, and some will say only that it stopped and that was that.

It is still worth asking. When did your periods stop? Were they early? A rough age, or a family event it happened near, is something you can take to your own appointment.