Signs perimenopause is ending, and does menopause ever end?

Your periods have started skipping. Two months, then three, then one turns up out of the blue. The hot flushes seem worse than ever, or perhaps they've eased and something else has taken their place. You find yourself wondering: is this nearly over?

There isn't one clear sign that perimenopause is ending. But there are some signs perimenopause is ending that doctors and researchers recognise. The main one is your periods getting much further apart. The only sure sign, though, comes afterwards: 12 months in a row with no period at all.

This guide covers what those signs look like, what signals the end of menopause, and whether menopause ever really ends.

What are the signs perimenopause is ending?

Perimenopause is the stretch of time when your periods become irregular, as the NHS puts it. It ends with your final period. Researchers split it into an early stage and a late stage, and the late stage has its own signs.

1. Longer gaps between periods

This is the clearest sign. In the early stage, your cycle starts to vary in length by a week or more. In the late stage, you start to go 60 days or more without a period.

These stages come from STRAW+10, a set of definitions agreed by menopause researchers from five countries. The STRAW+10 summary estimates that this late stage lasts 1 to 3 years on average.

So if you're starting to miss periods for two months or more at a time, you're probably in the later part of perimenopause. It's a sign the end is getting closer, but it isn't the end itself.

2. Hot flushes and night sweats

It can feel unfair, but hot flushes (hot flashes) are common at this point. STRAW+10 says symptoms, most notably hot flushes and night sweats, are likely to happen during this late stage.

So worse flushes don't mean things are going wrong. They're often part of this phase.

3. Symptoms that shift and change

The NHS says symptoms can change over time. Some may improve and be replaced by other symptoms, such as low mood and anxiety.

So you might notice, for example, that the heavy periods have settled but your mood feels less steady. That shift is common.

4. Changes that come later

Some changes tend to appear or grow nearer to the end of perimenopause and after it. STRAW+10 notes that vaginal dryness and bladder changes become more common in the later years after menopause. The NHS also lists vaginal dryness and joint pain as symptoms that can continue after menopause.

Late perimenopause symptoms

Late perimenopause symptoms are much the same as the ones earlier on. They may just feel stronger, or show up in a different mix. The NHS lists these among the common ones:

• periods that come more or less often, and bleeding that gets heavier or lighter
• hot flushes and night sweats
• sleep problems, which can leave you irritable, stressed and anxious
• mood swings, low mood or depression
• problems with memory or concentration
• headaches and migraines that are worse than usual
• dry and itchy skin, and thinning hair
• vaginal dryness and burning, and more urine infections
• a lower sex drive

You can see the full picture in our plain-English list of perimenopause symptoms.

Can my periods come back after a long gap?

Yes, while you're still in perimenopause. A gap of two or three months is a sign of the late stage, not proof that your periods have stopped for good.

That's why doctors wait for a full year. The STRAW+10 definitions only count your final period as final once 12 months have passed without another one.

If you're in perimenopause and have bleeding that worries you, such as very heavy periods, our page on perimenopause period changes explains when to see a GP.

What signals the end of menopause?

The signal is a simple one: 12 months in a row with no period.

NICE's menopause guideline (NG23) says doctors can recognise menopause, without any lab tests, in women aged 45 or over who haven't had a period for at least 12 months and aren't using hormonal contraception.

A few things to know:

• You only know looking back. Your final period is only "final" once a year has gone by.
• Hormonal treatments can hide the signal. NICE notes that it can be hard to tell when menopause has happened in women taking hormonal treatments, such as some treatments for heavy periods. If that's you, ask your GP or nurse.
• After a hysterectomy, there are no periods to count. NICE says menopause is judged on your symptoms instead.
• You usually don't need a blood test. For women aged 45 and over, NICE advises against several hormone tests for diagnosing menopause. It says a blood test (FSH) may be used to confirm menopause in women aged 40 to 45 with symptoms, and in those under 40 where it's suspected.

Don't stop contraception too soon

Long gaps between periods don't mean you can stop contraception straight away.

Women's Health Concern, the patient arm of the British Menopause Society, gives this guide:

• If you're under 50, keep using contraception until you've gone two years without a period.
• If you're 50 or over, you can stop after one year without a period.

If your periods are hidden by the contraception you use, speak to whoever prescribes it about when to stop. And the NHS points out that HRT doesn't prevent pregnancy.

Does menopause ever end?

Menopause itself is a single point in time: your last period. After it comes postmenopause, which isn't a phase that finishes. It's simply the rest of your life.

What most women really want to know is whether the symptoms end. For most, they ease over time, but not on a fixed date.

• Overall: the NHS says symptoms usually last 7 to 9 years, sometimes longer.
• Hot flushes: a large US study called SWAN found that frequent hot flushes carried on for a typical 4.5 years after the last period (Avis and colleagues, 2015). For women whose flushes started early in perimenopause, the typical figure was 9.4 years. That's a middle figure, so some women stop much sooner and some go on longer.
• Some symptoms continue: the NHS says joint pain and vaginal dryness can carry on after menopause. Vaginal dryness often becomes more common with time, and there are treatments for it, so it's worth raising with your GP.

There's good news too. A Women's Health Concern factsheet on CBT notes that after the menopause, women in general tend to report better wellbeing than they did in their 40s.

For more on how long each part lasts, see how long does menopause last. For what life after the change can bring, see post menopause symptoms.

When to see your GP

You don't need to wait for things to end before asking for help. See your GP if:

• you have any bleeding after 12 months with no period, even once or just spotting
• your periods stop before 45. NICE notes this may need a blood test to confirm, and stopping before 40 has its own name, premature ovarian insufficiency (POI)
• symptoms are affecting your life, sleep, work or relationships. The NHS suggests seeing a GP if you want to know your options
• you feel low most of the time, or anxious in a way that's new for you
• you're not sure about contraception and whether you still need it

If you're thinking about what treatment might suit you, our guide to menopause without HRT explains the main options, hormonal and not.

Related: menopause mood swings, perimenopause period changes and perimenopause spotting.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.