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Is this perimenopause, menopause, or postmenopause?

Or a different pathSurgery or treatmentMenopause that arrived all at onceRead more Not sure? Try the checklist

If you're in perimenopause, just past it, or years into postmenopause, including after surgery, chemo, or cancer treatment, a lot of these symptoms share the same driver. Here's how to map where you are.

Hormonal IUD, ablation, or no period to go by

When your period can't tell you where you are

The usual timeline counts from your final period. If a hormonal IUD (like Mirena), an endometrial ablation, or a hysterectomy that kept your ovaries means you rarely or never bleed, that marker is gone, sometimes for years. You still go through the same change. Your ovaries keep their own schedule, you just can't see it on a calendar.

Symptoms become the guide. NICE guidance says that from 45, perimenopause and menopause can be recognized from symptoms like hot flashes, night sweats, sleep and mood changes, without a blood test. For people with no periods to track, the pattern of symptoms over time is the signal, which is why logging them helps.
A blood test can help in some cases. A hormonal IUD works mostly inside the uterus, so an FSH test still reads, but levels swing a lot in perimenopause and one result rarely settles it. NICE advises against using FSH to diagnose menopause in people on combined hormonal contraception or high-dose progestogen. Under 45, testing is more often worth asking about.
A hormonal IUD can become part of HRT. A 52 mg levonorgestrel IUD can provide the progestogen that protects the uterus lining if estrogen is added later. UK sexual health guidance says one fitted at 45 or older can stay in for contraception until 55.
After an ablation, the uterus is still there. Some lining can remain after an ablation, so if you use estrogen, a progestogen is still usually needed to protect it. Worth saying out loud at the appointment.

Research on this group is thin. Most menopause studies define stages by bleeding, so people without periods are often left out or counted separately.

Track symptoms instead of periods Contraception in perimenopause

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