If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting. The average age of the onset of menopause is 51 years, and it is most commonly occurs from age 47 to 53. Perimenopause is the period immediately before and after the onset of menopause, and averages 4 years. Although some women may abruptly stop having menstrual periods, many women will notice that their periods space out for months to years before bleeding stops permanently. Although pregnancy is unlikely in this age group, it is essential to do a pregnancy test to be absolutely sure.
Regular periods are the result of a precise hormone balance causing regular ovulation.
In perimenopause changes in hormone levels interfere with ovulation. If ovulation does not occur, the ovary will continue making estrogen, causing the endometrium to keep thickening. This often leads to a late menstrual period followed by irregular bleeding and spotting. It is not unusual to have irregular bleeding for up to 6 months before menstrual periods stop completely. Unless the bleeding is excessive, or a woman it at high risk for uterine cancer, this is generally not of concern.