Premenopause

Premenopause means "before menopause". In the Pakistan Menopause Society's 2026 recommendations it means the reproductive years: the time before the menopausal transition, when your periods come regularly (1.2.3).

The same recommendations name the stages that follow. Perimenopause starts when your cycle turns irregular and runs until a year after your last period (1.2.4). Menopause is the last period itself, confirmed only once a year has passed without another (1.2.2). Postmenopause is everything from that last period on (1.2.7).

Why the word confuses people

Because it has been used three ways. A World Health Organization group noted in 1996 that premenopause was used either for the year or two before menopause or for all the reproductive years up to the last period, and recommended the second. A 2022 review of research papers found the word was still defined inconsistently, and that about two in five studies did not define it at all.

In everyday talk, premenopause is also used to mean perimenopause. The Pakistan Menopause Society's definitions keep the two apart. If your doctor says premenopausal, it is fair to ask which they mean.

By the Pakistan Menopause Society's definition, premenopause is a stage of regular periods, not a set of symptoms.

The STRAW+10 staging system splits these years into early, peak and late. In the late reproductive stage, it says, fertility begins to fall, and towards its end cycles may get a little shorter or the flow may change. These changes are subtle. The lasting, irregular change is what marks the start of perimenopause.

STRAW+10 says some hormone levels and markers of the ovaries' egg supply start to change in the late reproductive stage, before the periods visibly do.

The NHS website: "One of the first signs of perimenopause is usually a change to your periods." That change is the line between the two stages.

• The Pakistan Menopause Society sorts a woman's reproductive life into the seven STRAW+10 stages, five before the final period and two after, built on her periods and her hormones (1.1). Three of them are the reproductive years.
• It says menopause symptoms may begin before the final period (section 2). It does not say they begin before the cycle changes.

Our reading

If you are 40 or over, your periods have not changed and yet sleep, mood or temperature have, you sit in a grey area the stage names do not cover well. The nearest STRAW+10 name is the late reproductive stage. Tracking your cycle and your symptoms now means you can see it when something shifts. Where am I? asks six questions and names the stage your answers point to.

By the Pakistan Menopause Society's definition, premenopause is the ordinary reproductive years, so there is nothing to treat in the stage itself. Symptoms that trouble you deserve to be looked at on their own terms, whatever the stage is called. The symptom score gives you a record to take with you.

The Pakistan Menopause Society lists bleeding after sex, unexplained bleeding between periods, and sudden heavy or prolonged bleeding as red flags (2.3), and asks doctors to investigate abnormal bleeding rather than put it down to menopause (Table 1).

It also lists symptoms before 40 that could point to premature ovarian insufficiency among its red flags (2.3). If your periods stop or turn irregular before 40, do not wait.

In many families nobody talks about any of these stages until periods stop. A word for the years before helps: menopause se pehle is plain enough to say at home. Knowing which stage you are in also helps with the practical questions women ask about prayer, fasting and bleeding. Those questions go to a qualified scholar. What the bleeding is goes to your doctor.