Diagnosing Menopause: 5 Signs Your Body Is Entering the Transition

Perhaps the most important thing to understand about menopause is that it doesn't happen overnight. In fact, for most women, it is a gradual process that occurs over several years. These years are referred to as the menopause transition or perimenopause. Most of your worst symptoms will probably occur during these years and may actually get better once you hit menopause.

Actual menopause is not diagnosed until it has been one full year since your last menstrual period.

A woman looking tired on the side of the road with a bike

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Now let's be clear, menopause is not a disease. It is a normal part of the aging process in women. Over time your ovaries will continue to lose follicles and oocytes (eggs). The rate at which this happens is not the same for every woman. This is why your age is not a good predictor of whether or not you are in menopause. Although the average age of menopause is 51, the recognized age range is from 40-58 years old. The rate at which your ovaries age and eventually bring you into menopause is influenced by both your genetics and environmental exposures.

Hormone Tests Can Be Misleading

The hormone level considered potentially helpful to diagnose menopause is FSH or follicle stimulating hormone. FSH is produced by your pituitary gland and it plays an important role in your menstrual cycle. FSH stimulates your ovaries to produce estrogen, and when sufficient estrogen is produced, it feeds back and decreases your FSH. This is partially the basis of your regular menstrual cycle.

But when the menopause transition hits and your ovary decreases its estrogen production, your FSH levels begin to rise, trying to stimulate your ovary to make enough estrogen to keep the cycle going.

Rising FSH levels do indicate decreasing ovarian function. But this happens over time, and your FSH and estrogen levels will continue to fluctuate. In the menopause transition years, your FSH level may be high one day and significantly lower the next, yet you may not have any symptoms. It is also possible that you may be having very unpleasant symptoms with hormone levels that are still within the normal value ranges.

Bottom line, checking FSH and other ovarian hormone levels in most women can be very misleading.

Perhaps the only clinical situation when an FSH level is helpful is if you have had a prior hysterectomy or endometrial ablation. Because you have stopped getting your period due to surgery you can't correctly determine when it has been one year without your period.

It's All About the Symptoms

When it comes to diagnosing and managing the menopause transition, it is all about your symptoms. It is important to recognize the changes in your body and to discuss these with your healthcare provider. Depending on the severity of the symptoms you may want to consider your treatment options.

Night Sweats

This falls under the broader category of vasomotor symptoms which also includes hot flashes. You may have noticed that in the later part of your menstrual cycle you have started waking up drenched even if you aren't having any daytime symptoms. This can be very problematic, as it disrupts your sleep and can lead to chronic fatigue. And if you share a bed with someone, that can add a whole other layer to the problem.

Abnormal Bleeding Pattern

Due to the changing hormone levels caused by the decline in the function of your ovaries, your menstrual cycle will become irregular. Your periods may become lighter and/or less frequent. This type of change in your bleeding pattern is completely normal.

But sometimes you can have heavier and or more frequent bleeding. It is important to discuss this type of change with your healthcare provider. Due to the hormonal imbalances of the menopausal transition, certain uterine conditions like fibroids and uterine polyps can become more symptomatic. Also depending on your other risk factors or medical problems, your practitioner may suggest additional testing to evaluate this type of abnormal bleeding.

Mood Swings

This can be one of the most troubling symptoms of the menopause transition. You may never have had any significant mood issues in the past but suddenly you feel tremendously anxious or depressed. You may feel like you are literally losing your mind.

Or perhaps you have struggled with mood symptoms in the past and are noticing a worsening of the symptoms. This can be especially true for women who have had a prior hormone-mediated or reproductive mood disorder like postpartum depression or premenstrual dysphoric disorder (PMDD). Of course, it doesn't help that the menopause transition comes at a time of many other social stressors like work, kids, and aging parents.

It is extremely important for you to discuss these symptoms with your healthcare provider. Do not suffer in silence and do not be ashamed of the way you are feeling.


For some women, migraine headaches may first appear during the menopause transition. This is not surprising as many of the factors that are thought to act as triggers are common in the menopause transition including:

  • Sleep disturbances
  • Mood changes
  • Decreasing estrogen levels

Although it's not surprising that normal types of headaches may develop during the menopause transition it is very important to discuss any new headaches or any changes in your typical headaches with your healthcare provider.

Skin Breakouts

Perhaps one of the most frustrating signs that you may be going through the menopause transition is skin breakouts. Even if you didn't have any problem with your skin when you were a teen, the hormone changes of menopause transition can bring on problems with acne.

A Word From Verywell

When it comes to figuring out whether or not you are going through the menopause transition don't get fixated on chasing numbers. This is a clinical situation when your symptoms are much more reliable for establishing a diagnosis and monitoring your response to treatment options. Listen to your body and find a healthcare provider who will listen to you and help you to live well through the menopause transition and beyond.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Association of Reproductive Medicine. Menopausal transition (perimenopause): What is it?

  2. National Institute on Aging. What is menopause?

  3. The North American Menopause Society. Menopause 101: A primer for the perimenopausal.

  4. The North American Menopause Society. How do I know when I'm in menopause?

  5. Sander B, Gordon JL. Premenstrual mood symptoms in the perimenopauseCurr Psychiatry Rep. 2021;23(11):73. doi:10.1007/s11920-021-01285-1

  6. Infurna FJ, Staben OE, Lachman ME, Gerstorf D. Historical change in midlife health, well-being, and despair: Cross-cultural and socioeconomic comparisonsAmerican Psychologist. 2021;76(6):870-887. doi:10.1037/amp0000817

  7. NHS. Migraine: Causes.

Additional Reading
  • The North American Menopause Society (NAMS). Menopause Practice: A Clinician’s Guide. 6th ed. NAMS; 2019.

By Andrea Chisholm, MD
Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School.