How do you know if you're menopausal ? Symptoms, age, and tests to find out for sure

To know whether you are menopausal, it is essential to combine clinical observation of your cycles and symptoms with, if necessary, hormonal testing. Menopause is officially defined as 12 consecutive months without menstruation, in the absence of any other cause (pregnancy, illness, hormone treatment, etc.). This definition, validated by the World Health Organization (WHO) and the French High Authority for Health (HAS), allows a reliable diagnosis to be made. In practice, for middle-aged women, it is often the prolonged absence of periods, combined with transition symptoms, that confirms the onset of menopause.

Well before this definitive stop, several signs may appear:

• cycle disorders (irregularity, lengthening or shortening of cycles);
• hot flushes and night sweats (80% of women in perimenopause report these symptoms according to the SWAN study, n = 3,302);
• sleep disorders (39% of women report insomnia according to a 2022 meta-analysis);
• vaginal dryness (around 60% according to a study published in Menopause, 2023);
• mood changes (20 to 30% prevalence of mild to moderate depressive symptoms during the transition, according to the Journal of Women's Health review, 2021).

In the presence of these signs and in cases of doubt, a blood test can measure FSH (follicle-stimulating hormone) and oestradiol: an FSH level above 25 IU/L, accompanied by low oestradiol levels, points toward a decline in ovarian function. These measurements, combined with age and clinical context, provide a precise picture of your hormonal status.

Menopause corresponds to the definitive end of periods and the cessation of fertility. According to the WHO, it is declared "after 12 consecutive months without menstruation, without any other apparent physiological or pathological cause" (WHO, Menopause fact sheet, October 2024). In France, the HAS uses the same definition to standardise diagnosis and monitoring.

A woman's hormonal journey is divided into three phases:

• Premenopause: the period of regular cycles, from puberty until the first signs of hormonal transition.
• Perimenopause: the transition phase during which cycles become irregular, accompanied by marked hormonal fluctuations; it lasts on average 4 to 8 years (Maturitas, 2022).
• Menopause: the point at which periods have been absent for 12 consecutive months. This is followed by post-menopause, an adaptive period at lower oestrogen levels.

In France, the average age of spontaneous menopause is 51 years (± 3 years), according to HAS/Ameli data. This normal range extends from 45 to 55 years:

• Around 68% of women reach menopause between the ages of 50 and 52 (EPIDOS study, 2020);
• 5% enter menopause before age 45;
• 1% before age 40, known as premature ovarian insufficiency (POI).

• Genetics: the average age of menopause of the mother or sisters is a good predictor (Journal of Clinical Endocrinology & Metabolism, 2021).
• Smoking: smokers reach menopause on average 1.5 years earlier than non-smokers (Cochrane Review, 2022).
• Medical treatments or trauma (chemotherapy, ovarian surgery) accelerate the depletion of follicular reserve.
• Autoimmune conditions or genetic abnormalities are identified in 10–15% of POI cases.
• Higher BMI appears to slightly delay menopause (modest effect, +0.3 years on average).
• Overall lifestyle (diet, physical activity, stress levels).

Menopause before age 40, or premature ovarian insufficiency, affects around 1% of women. It can be sporadic or linked to genetic, autoimmune or iatrogenic causes (chemotherapy, radiotherapy). Diagnosis is based on an absence of periods for 4 months combined with two elevated FSH measurements (≥ 25 IU/L) taken three weeks apart.

Well before the definitive end of periods, several warning signs may appear. Symptoms vary considerably from one woman to another in intensity and duration.

• Hot flushes and night sweats: median duration 7.4 years (SWAN study, 2023).
• Abdominal weight gain, decrease in muscle mass.
• Joint and muscle pain, decrease in bone density (risk of osteoporosis doubled after age 50).
• Cycle disorders: irregular periods, longer or shorter cycles, altered flow. This is often the first observable sign of perimenopause.

• Mood swings, irritability, anxiety (20–30% according to The Lancet Psychiatry, 2022).
• Increased risk of depression with personal or family history.

• Brain fog: memory and concentration difficulties, often temporary.
• Possible relief after hormonal stabilisation or adoption of an appropriate lifestyle.

• Vaginal dryness, dyspareunia, decreased libido.
• Available solutions: lubricants, vaginal moisturisers.

The main criterion remains the absence of periods for 12 months, with no other explanation. Context (age, medical history, symptoms) is always taken into account.

Useful in cases of doubt: menopause suspected before age 45, atypical symptoms or history of ovarian treatment.

The tests include:

• FSH (follicle-stimulating hormone): a level above 25 IU/L (some laboratories indicate 30 IU/L) points toward a decline in ovarian function
• Oestradiol: low levels confirm the drop in oestrogen production
• Inhibin B (sometimes): a marker of residual ovarian reserve

These detect an increase in FSH in the urine. Such tests can be reassuring, but do not replace a medical diagnosis: their results are influenced by hydration, the time of day and hormonal variability.

This is one of the most common and most confusing situations. The pill masks menopausal symptoms: it artificially regulates cycles, suppresses hot flushes and maintains a stable hormonal environment. It is therefore impossible to know for certain whether you are menopausal while taking hormonal contraception.

The only way to find out is to stop the pill, in consultation with your doctor. This decision is assessed on a case-by-case basis:

• If you are over 50: the pill can generally be stopped, as the risk of pregnancy is very low. Hormonal monitoring can be carried out 6 weeks after stopping.
• If you are under 50: it is advisable to discuss with your doctor whether stopping is appropriate and, if so, to switch to non-hormonal contraception (copper IUD, condom) to allow observation of natural cycles.

Hysterectomy (total or partial removal of the uterus) eliminates periods, making the "12 months without menstruation" criterion impossible to apply. However, if the ovaries are preserved, they continue to function and produce hormones — you are therefore not menopausal in the hormonal sense of the term.

In this case, diagnosis relies exclusively on:

• A blood test (elevated FSH + low oestradiol)
• Observation of climacteric symptoms (hot flushes, sleep disorders, vaginal dryness)

If the ovaries were removed at the same time as the uterus (total hysterectomy with bilateral oophorectomy), menopause is immediate and surgical — often more abrupt than natural menopause.

Once menopause is confirmed (12 months without periods), post-menopause begins. Signs indicating that this transition is stabilising include:

• Hot flushes and night sweats gradually space out until they disappear
• Mood stabilises as hormone levels settle at their new low baseline
• Fatigue and irritability decrease
• The body gradually adapts to the absence of oestrogens

It is advisable to make an appointment if:

• you are under 40 and have had no periods for several months;
• menopause occurs before age 45 or after age 55;
• symptoms (hot flushes, sleep disorders, low mood) are severe or affecting your quality of life.

Your doctor may suggest hormone replacement therapy or non-hormonal approaches, as well as a menopause dietary supplement, which can support the body through hormonal changes. They may also recommend preventive measures for osteoporosis (bone density scan) and cardiovascular risks.

Between 45 and 55 years, with a median of 51 years. This figure covers a wide individual variability.

Yes, in around 1% of cases, this is referred to as premature ovarian insufficiency. Any prolonged absence of periods before age 40 warrants a medical assessment.

No, not for all women. It becomes useful in cases of suspected early menopause, atypical clinical presentation, or when symptoms are difficult to interpret.

Perimenopause can last 4 to 8 years, and some vasomotor symptoms persist on average 4 to 7 years after menopause (SWAN, 2023), sometimes longer.

Their reliability is limited by hormonal fluctuations and collection conditions. They can provide an initial indication, but do not replace a medical consultation.

• World Health Organization (WHO) - Menopause fact sheet, October 2024. who.int
• French High Authority for Health (HAS) - Menopause: management. has-sante.fr
• Ameli.fr / French Health Insurance - Menopause: symptoms and diagnosis. ameli.fr