Signs Perimenopause Is Ending: What to Expect in the Final Stages

What Is the Final Stage of Perimenopause?

Perimenopause is the transition leading up to menopause, typically lasting 4–10 years. During this time, oestrogen and progesterone levels fluctuate more erratically than in the premenopause, causing a range of symptoms including irregular periods, hot flushes, and mood swings.

The perimenopause can be thought of in 2 stages – the early stage and the late stage.

The early stage of the perimenopause marks the beginning of the menopause transition when hormone levels start to fluctuate more erratically than previously.

The late perimenopause can be thought of as the final stage of the perimenopause. This is when periods usually (but not always) become less frequent and hormone levels drop more consistently. The biggest sign that perimenopause is ending? Your periods stop altogether. 

A woman is officially in menopause when she has gone 12 consecutive months without a period. So you are in the perimenopause officially until you have gone for 365 days with no period.

If you do not have periods because of the use of progesterone-only contraception – for example, you may be taking the progesterone-only pill, or you may have a Mirena (or equivalent) coil fit, or you may not have periods because you have had a hysterectomy – you won’t know when you have transitioned from the late perimenopause into the menopause. It does not necessarily matter that you don’t know when the actual menopause itself occurred, as symptom management is important when it comes to treatment.

Symptoms of the menopause are usually related to the fluctuating and decreasing oestrogen levels. Symptoms can start in the early perimenopause and continue into the postmenopause as your body then adapts to the new state of having very low oestrogen levels. Symptoms usually worsen as the perimenopause progresses and then improve in the postmenopause.

The National Institute for Health and Care Excellence does not recommend testing hormones from the age of 45 years to diagnose the menopause transition (you can read more here). Hormone levels fluctuate hour by hour and day by day in the perimenopause. As a result, you may have severe symptoms of the menopause transition, but your hormone levels may actually be normal at the point in time when they are measured.

In the postmenopause, the oestrogen level is very low – too low to measure by conventional means – and is not related to symptoms or their duration. Blood tests are therefore unhelpful in working out where you are in the menopause transition and if you have transitioned into the postmenopause.

It is better to talk to a healthcare professional about your symptoms to help determine if and where you could be in the menopause transition, or take our Menopause Questionnaire.

Key Signs Perimenopause Is Ending

While every woman’s experience is unique, here are the most common signs that perimenopause is coming to an end:

1. Longer Gaps Between Periods

In the early perimenopause, you may skip the odd cycle, but periods can become heavier and closer together or may become less frequent. One of the biggest clues that you are entering the later perimenopause is that your periods become even more sporadic. Instead of missing a period here and there, you might go several months without one. When they do return, they are often lighter and shorter than before.

If you’ve gone 12 months without a period, you’ve officially reached menopause.

If you have any bleeding after you have gone 12 months without a bleed, this is classed as postmenopausal bleeding and needs investigating – please see your GP if this happens to you.

For more information on changes to periods and bleeding, see here.

2. Hot Flushes and Night Sweats May Worsen … or May Start to Ease

For some, hot flushes and night sweats – vasomotor symptoms – worsen as the oestrogen continues to decline as they progress through the menopause. Some women experience sweats in the daytime as well as at night. Vasomotor symptoms may become more frequent or more intense in the longer gaps between periods. For others, hot flushes and night sweats start to improve as menopause itself approaches.

It’s unpredictable and varies from woman to woman, but generally, as your hormone levels stabilise in the postmenopause, these symptoms tend to fade over time.

For more information on hot flushes and night sweats and ways to manage them, see here.

3. Mood Swings Become Less Severe

Perimenopause is known for its emotional rollercoaster, thanks to fluctuating hormones. But as oestrogen and progesterone levels continue their downward trend and the more erratic and dramatic fluctuations start to settle, you might notice fewer mood swings and less emotional instability.

However, for some women, low oestrogen can contribute to persistent anxiety or low mood, so it’s important to monitor your mental health and seek support if needed. The key is to talk about your symptoms and seek support, particularly if they are becoming more severe and difficult to cope with.

(For more on mood swings in the menopause transition, and ways to manage them, see here. To read about anxiety, head here, and here to read about depression.)

4. Migraine May Improve

If you suffer from migraine related to hormonal change (for example, migraine before a period), the more erratic fluctuation of the early perimenopause may result in worsening migraine. As periods become less frequent and the erratic fluctuations start to settle in the later perimenopause, migraine related to hormone changes may start to settle. However, there are some women for whom migraine worsen in the menopause.

It’s important to monitor migraine and please seek medical support if they become more frequent or severe, or if they are not responding to usual medication. See here for more on headaches and migraine in the menopause transition.

5. Sleep Patterns May Improve

Many women struggle with insomnia or frequent night wakings during perimenopause, in both the early and late stages. As hormone fluctuations settle in the menopause and beyond into postmenopause, some women find their sleep improves, though others may continue to experience sleep issues into menopause. Sleep can be a debilitating symptom of the menopause transition.

If you don’t sleep well, there can be an impact on your mood and brain fog. To read more about what can cause sleep problems in the menopause transition, and ways to manage sleep issues, see here.

6. Vaginal Dryness and Bladder Issues Can Persist

While some symptoms, like mood swings and irregular periods, may ease, others—such as vaginal dryness and bladder weakness—can persist into menopause and postmenopause.

This is because oestrogen plays a key role in vaginal and bladder health. Lower levels can cause:

• Vaginal dryness or discomfort during intercourse
• Increased urinary tract infections (UTIs)
• Urinary urgency or leaks
• More nighttime trips to pass urine

If these symptoms bother you, treatments like vaginal oestrogens can help bladder symptoms related to the menopause transition. Vaginal oestrogens or DHEA can also help manage vaginal symptoms, as can non-hormonal lubricants and vaginal moisturisers.

To read more about vaginal symptoms and ways to manage them, see here and for more about bladder symptoms, read here.

7. Weight and Metabolism Changes

As perimenopause ends, many women notice weight gain, especially around the abdomen. This is due to hormonal shifts impacting metabolism, changing how the body stores fat and also impacting muscle mass. Changes to mood, anxiety and fatigue may affect our food choices and how much exercise we do.

Staying active, eating a balanced diet, and engaging in strength training can help maintain a healthy weight post-menopause. See here for more information.

8. Bone and Joint Changes Become More Noticeable

Oestrogen helps maintain bone density and joint health. As levels decline, some women may start to experience:

• More joint stiffness or discomfort
• Increased risk of osteoporosis (bone thinning)

Osteoporosis and the less severe form of loss of bone density (osteopenia) do not usually cause symptoms, unless presenting with a fracture. It’s so important to ensure you’re getting enough calcium, vitamin D, and weight-bearing exercise to protect bone health. For more on muscle aches and pains see here and to learn more about osteoporosis see here. Consider talking to your GP to ensure that the symptoms are menopause related and not due to other medical conditions or forms of arthritis.

What Happens After Perimenopause Ends?

Once you’ve gone 12 months without a period, you have officially entered menopause. From this point on, your body continues to adjust to lower oestrogen and progesterone levels, and your menstrual cycles have permanently stopped. The menopause itself is a point in time when you can look back and say that you have not had a period for 12 months, and you then enter into the postmenopause phase of your life. In the postmenopause your body and brain continue to adapt to the new low hormonal ‘norm’.

Many symptoms of the menopause transition ease after menopause for many women but some—like vaginal dryness and bone loss—may persist. This is why ongoing self-care and medical support remain important.

The risk of osteoporosis and heart disease increases as you transition through the menopause and into the postmenopause – these conditions don’t improve after the postmenopause. It is important to know about them so you can make appropriate lifestyle changes to help to reduce the risk.

When to See a Doctor

While perimenopause is a natural process, it’s a good idea to see your GP if:

• You experience very heavy or prolonged bleeding
• You have bleeding after menopause (this should always be checked)
• Your symptoms are impacting your quality of life
• You want advice on HRT (hormone replacement therapy) or symptom management

Conclusion

The end of perimenopause marks the beginning of a new phase of life. While some symptoms ease, others may require ongoing management. The key is to listen to your body, seek help if needed, and take proactive steps to support your health.

If you suspect perimenopause is ending but aren’t sure, keeping a symptom diary can be helpful. Tracking your cycle, symptoms, and overall well-being can give you valuable insights as you move towards menopause and postmenopausal life.

Perimenopause may be unpredictable, but you don’t have to navigate it alone. With the right knowledge and support, you can move forward feeling confident and prepared for what’s next.

If you’re struggling, don’t suffer in silence!

• Please reach out for support – see your GP or book an appointment to speak to one of the doctors in our menopause clinic.
• If you’d like to join our wonderful Facebook Group, just head here. We’re a warm and inclusive group to empower women through menopause… it’s your space to share stories about your menopause experience, ask questions, and find peer support and inspiration. We’ll share the latest news and evidence-based information on menopause from our experts and you’ll be the first to hear about new research and our regular expert-led live events. Knowledge is power and we look forward to welcoming you!
• If you think you may be experiencing symptoms of the menopause transition, you can learn more with our symptom checker or by taking our Menopause Questionnaire.