The menopause and what changes in your health

The definition is simple and it is the same across Europe: a woman is postmenopausal from one year after her last period. Twelve consecutive months — which is why the right clinical question is not "what stage are you in?" but "when was your last period?".

Before that comes the transition, which many people call perimenopause: irregular cycles, further apart or closer together, that can last years. There too the useful information is the date, not a label.

This is the part almost nobody says. In a healthy woman aged 45 or over, the menopause is diagnosed from the history — twelve months without a period, with no hormonal contraception — and the NICE guideline is explicit in not requiring blood tests for it.

The European Society of Endocrinology says the same in other words: biochemical testing to diagnose or manage the menopause in women older than 45 is not necessary. An FSH or an oestradiol ordered in that context tends to return a number that swings widely and that changes nothing about what happens next.

There are exceptions, and your doctor knows them: symptoms before 45, a question about another cause for the periods stopping, or a clinical situation that calls for a different reading.

With the menopause, two topics gain weight in the consultation. Bone, because falling oestrogen speeds up the loss of bone mass. And the heart, because a woman's cardiovascular risk rises with age and the menopause is part of that context.

Gaining weight in the conversation is not the same as gaining a test. In the international guidelines, the menopause on its own triggers no new screening — it is one piece of information that helps your doctor decide, alongside your age, your family history and the rest of your profile.

It is worth saying what stays the same too, because that is where most of the confusion sits: