Missed Periods: When Do They Mean Menopause?by Toni Hurst Patient Expert
By far the most frequent question I get about menopause is "WHEN does it start?" Women between the ages of 36 and 55 ask the same thing: "I've missed X number of periods. Is it menopause?"
I can tell you that technically, menopause begins after you have missed periods for 12 months, but of course that technical answer doesn't help much because by the time you've missed 12 periods, you KNOW you're in menopause. What women really want to know is whether they are starting menopause.
Missed periods can be caused by a lot of things, the two most frequent being pregnancy and menopause. To even see those two words together strikes fear in many women's hearts. I have a good friend who started missing her periods and hoped it was because she was pregnant, but alas, it was menopause. Only your hormones know for sure.
So a 47-year-old who is asking me about two missed periods (and even in her email I can sense the panic in her question) could be facing two very different futures. Of course, if you have had tubal ligation or other sterilization techniques to avoid pregnancy, then it is much more likely that two missed periods are the beginning of menopause.
A typical woman has about 500 menstrual cycles in her lifetime. So each of us knows pretty much what we're like (our moods and our bodies) just prior to, during and right after a period. If you've been listening during the past 500 cycles, you can tell when your body is changing and you're about to enter menopause. But most of us don't listen all that carefully, do we? It comes, we deal with it, it goes away, and we move on. There are physicians and psychologists who say that entering menopause has an entirely different "feel" to it than the typical menstrual cycle; that your inner wisdom will let you know the difference. Maybe so, but I still get a lot of questions saying, "I missed two periods, am I in menopause?" and they don't want me to answer: "Listen to your body. It's trying to tell you something."
Other factors can cause you to miss a period or two. Stress, medical conditions such as diabetes and tuberculosis, and eating disorders all play havoc with our periods, as does travel.
My advice is this: If you have missed a period or two and you could be pregnant, then take a simple home pregnancy test. If you are sure you're not pregnant, then try to relax about the missed period or two. If you are entering menopause, the only sure way to know is a blood test that shows hormone levels, but the test won't/can't change anything. If you think you have an eating disorder or another medical issue that you've been ignoring, then see a doctor. Yes, a couple of missed periods at age 47 could be the start of menopause. You may or may not get the concurrent hot flashes and other negative symptoms, not everyone does. Your attitude going forward about this new phase of your life can alter your symptoms and your view toward those symptoms a lot. Just as you need to listen to your body, your body will be listening to your head.