Benjamin Franklin once wrote that nothing is certain in this world except death and taxes, but we’d like to add one more certainty for 50 percent of the population: menopause. Menopause is defined as one year from a person’s final menstrual period, and the average age is 51.5. There’s a lot more to it than a one-year anniversary of your last period, though; there’s perimenopause, which precedes menopause, and postmenopause, which succeeds it. To learn more about what signals the end of menopause (and what to expect leading up to it), we reached out to OB/GYN Dr. Mindy Goldman, MD, the Chief Clinical Officer at Midi Health.

Dr. Mindy Goldman, MD, is the Chief Clinical Officer at Midi Health and a Clinical Professor in the Department of Obstetrics and Gynecology and Director of the Gynecology Center for Cancer Survivors and At-Risk Women Program at the University of California, San Francisco. As Midi’s Chief Clinical Officer, Dr. Goldman brings her decades of experience as an OB/GYN to all patient care, but survivors of breast cancer and at-risk women are a special focus for her. Dr. Goldman is a nationally recognized expert in the menopausal symptoms that come with treatment for breast cancer, and how to improve them safely and effectively. She is on the survivorship panel for the National Comprehensive Cancer Network (NCCN) and is the Sub-committee Chair for the panels on sexual functioning and menopause and helped author the NCCN management guidelines in these areas.

Dr. Goldman tells us that we generally think of perimenopause and menopause when discussing the different stages of menopause. 

Clinically, perimenopause is the months or years preceding menopause. During this time, women can develop many of the same symptoms that we see in menopause, yet can still have their periods. Dr. Goldman explains that this stage tends to last an average of four to six years, but can go on as long as ten years. 

“Within the perimenopause stage there is what’s called the early transition stage and the late transition stage,” she tells us. “In the early part, periods may get closer together, or farther apart. The late transition is when you may skip cycles altogether, so the interval between periods gets much longer.” In addition to irregular periods, women in perimenopause can experience the onset of a variety of symptoms, including hot flashes and night sweats, insomnia, moodiness, anxiety, weight gain and brain fog. Dr. Goldman adds that you might also see skin changes—acne, dryness or both—and a host of other surprising symptoms. “All are related to estrogen levels in the body fluctuating and gradually declining,” she says. “It’s the same type of roller coaster we experience at puberty, only in reverse, with female hormone levels fluctuating on their way down, instead of on the way up.”

Dr. Goldman says menopause is defined as one year from the final menstrual period, and the average age is 51.5, though can happen earlier or later depending on the individual. “At menopause, estrogen reaches its lowest level and remains low for the rest of your life,” she explains, elaborating that this estrogen depletion can trigger symptoms throughout the body. “Once someone has gone through menopause, they are considered ‘postmenopausal’ for the rest of their lives.”