Almost everybody claims to know what the term menopause stands for. Upon further inquiry, it becomes clear, however, that people, quite often, are talking about different things when they refer to menopause. The principle reason for this confusion in terminology lies in the fact that menopause is not a sudden event. As we already mentioned before, the process of ovarian senescence is gradual. Menopause, usually occurring at age 51 to 52 years, is characterized by the cessation of menstrual cycles and by highly elevated levels of the hormone FSH, is only the end stage of this gradual process. Long before that stage is reached, ovarian function, however, can be perceived as abnormal.

The first ovarian function to go is fertility. Almost 10 years before true menopause, most women reach the so-called functional menopause. There is a widely held perception, often even amongst health care providers, that, as long as a woman is menstruating, she can conceive. While in theory this may be correct, in clinical practice it is not. For all practical purposes, most women loose the ability to conceive 8 to 10 years prior to menopause and are, at that point, considered to have reached functional menopause. Another terminology, widely used, involves the term perimenopause. Perimenopause is the time period between the onset of clinical symptoms, related to the senescence of ovarian function, and final menopause. This period is usually characterized by menstrual irregularities, vasomotor symptoms (i.e., hot flashes), due to decreasing hormone levels, and relatively rapidly progressing osteoporosis.

It is paradoxically this period of perimenopause which requires most clinical attention because it is during these years that most women seek medical help for the management of their symptomatology. By the time women have reached true menopause, their bodies usually have already fully adjusted to the changes in hormone levels and most clinical symptoms have disappeared. Consequently, when most women seek out postmenopausal treatment, they, in reality, are asking for perimenopausal help to cope with the often very intense changes in hormonal activity long before true menopause is reached.