How Do I Know If I’m in Menopause If I Don’t Get a Period?

If you’ve asked yourself this question, you’re not alone. Some of our own, Dawn & Naomi, have asked themselves the same question while navigating perimenopause and menopause. 

What are ‘normal’ period changes during perimenopause? 

There’s no one-size fits all answer. However, studies over the past 20 years have helped us understand what to expect: 

While this can be helpful for some, it won’t apply to everyone. There have been several studies showing how different it can be. Around 15-25% of people don’t notice any changes in their cycle before their periods stops altogether. Others may experience irregular cycles for years before their final period. In addition, other factors can influence the patterns of periods: 

What if I haven’t had a period for years? 

Menopause is officially defined as going 12 consecutive months without a period. It’s a simple, but helpful definition. But that definition doesn't work for everyone — especially if you've had a hysterectomy, use a hormonal IUD, or have had a uterine ablation. 

Does a hysterectomy cause menopause? 

It depends. The effect a hysterectomy has on menopause largely comes down to whether your ovaries were removed during the procedure.

Here's a quick breakdown of the most common types of hysterectomy: 

In both cases, the ovaries might be left in place. When the ovaries are left, they continue to produce hormones like estrogen and progesterone, which means your body will not go into menopause right away. If you have had a hysterectomy or are planning one, it's important to clarify with your doctor whether the ovaries will remain.

In fact, most hysterectomies done for benign reasons in pre-menopausal people should and do leave the ovaries in place to preserve hormone function. 

Want to learn more about menopause and hysterectomies? Check out this article. 

Regardless of whether your ovaries are removed, if you've had a hysterectomy, you'll stop getting your period. That's because menstruation (aka, your period) is the shedding of the endometrial lining (the lining inside of the uterus) each month if pregnancy doesn't occur. And without a uterus, there's no lining to shed.  

If you keep your ovaries, menopause is not expected to occur until closer to your body's natural time of menopause. That's because your ovaries are still releasing hormones. They don’t need the uterus to keep producing hormones.  

That said, your transition into menopause might look a little different than if you didn’t have a hysterectomy. Some premenopausal people may experience hot flashes immediately after a hysterectomy due to decreased blood flow to the ovaries. This is typically temporary, but you may also start natural menopause a few years earlier than you would have otherwise.   

If your ovaries are removed as part of a hysterectomy, you won't get a period anymore. You may also start experiencing menopause symptoms right away — regardless of your age. This is known as surgical menopause or induced menopause. Because your body stops receiving hormones abruptly, the symptoms of menopause can come on quickly and feel more intense than in natural menopause, where hormone levels decline gradually over many years. 

Hormonal IUD and bleeding 

Hormonal intrauterine devices (IUDs) are a popular form of long-acting reversible birth control. They're also used to very effectively help manage irregular or heavy menstrual bleeding. These small, T-shaped devices are placed in the uterus by a medical provider and can last anywhere from 3 to 8 years, depending on the type.  

Hormonal IUDs are among the most effective contraceptive options available, with a failure rate that has been reported to be just 0.02%. They can be an excellent tool for managing heavy or abnormal bleeding, especially in perimenopause. Some higher-dose IUDs are also used to protect your endometrium (uterine lining) if you’re taking menopause hormone therapy (MHT). If you're considering one, it's important to talk with your doctor about the risks and benefits. 

One of the most common side effects of hormonal IUDs is reduced bleeding — or no bleeding at all. Depending on the dosage, 12-20% of users may stop having periods after the first year of use. For those who continue to bleed, most have a significantly lighter period. 

Hormonal IUDs are safe and effective when used as directed, especially if you want to avoid pregnancy in your 40s. It’s safe (and normal) to not have a period while using a hormonal IUD. It simply means the device is keeping the uterine lining stable and thin. However, this can make it harder to tell where you are in the menopause transition, since you're not seeing monthly cycle changes.

Importantly, using the IUD doesn't affect when menopause beings. If you're not bleeding each month because of the IUD, talk to your doctor about your symptoms, hormone levels, and at what point it makes sense for you to remove the IUD. There are other ways to sort out your menopause stage with your clinician and treat symptoms effectively if needed.

What to expect after uterine ablation  

If you're not getting a period as you move through the menopause transition, one possible reason could be an endometrial ablation — also called a uterine ablation. This procedure removes or destroys a thin layer of the uterine lining (endometrium) to help treat abnormal heavy bleeding that's significantly affecting your quality of life.  

It can be a good option for those who are done having children and are in perimenopause. For those approaching or experiencing menopause, endometrial ablation can help manage their symptoms and improve their quality of life.

Many people at this stage of life may already be dealing with irregular or heavy periods due to shifting hormone levels. Ablation is one option that can help control bleeding that’s difficult to manage and may reduce the need for other medical interventions. 

After the procedure, some people may experience lighter periods or stop bleeding altogether within a few weeks. While ablation can significantly reduce bleeding, it doesn’t trigger menopause. It may temporarily reduce or stop menstrual bleeding, but it doesn’t affect the natural progression of menopause.

It's important to remember that menopause is a complex hormonal transition directed by the ovaries that affects the entire body, not just the uterus. Even if you're not bleeding, you may still experience symptoms like hot flashes, night sweats, mood swings, and vaginal dryness — all signs that your body is moving through menopause.   

So, what do I do if I’m not getting a period? 

If you're not sure where you are in the menopause transition, that's okay! Whether you're in perimenopause, menopause, or postmenopause, what matters most is how you feel and how you manage your symptoms, so you can have the best quality of life.

Dr. Jill Liss, Versalie Advisor, puts it this way: