Stage 1 of 7 · The 7 stages

Premenopause: the baseline decade, and what to record now

Premenopause is the baseline reproductive stage before the menopause transition — your cycles are still regular and ovulatory, and there is no menopausal change yet. In clinical staging it covers the late reproductive years, and the very thing that says you are here is that your periods are still broadly predictable. That is not nothing to do; it is the window in which what you record now — your cycle, your sleep, your baseline bloods — becomes the evidence that protects the next thirty years.

Last verified: 10 July 2026 · staged against STRAW+10 and NICE NG23 · re-verified quarterly

What is premenopause?

Premenopause is the run-up before perimenopause begins. Your ovaries are still doing their job — you are releasing an egg most months, and your oestrogen and progesterone are still cycling in the steady rhythm they have kept for two decades. In the STRAW+10 staging system that clinicians use, this is the late reproductive stage; the only thing quietly changing in the background is your ovarian reserve, the number of eggs left, which does not show on a standard blood panel and does not change a single decision today.

It matters to name the stage plainly, because "premenopause" is often used loosely to mean "anything before menopause". Here it means something specific: regular cycles, no menopausal change, before the transition. The moment your cycle length starts to swing persistently, you have moved into early perimenopause — a different stage with a different marker.

What are the signs I'm still in premenopause?

• Your cycles are still regular. A broadly predictable gap between periods, without a persistent swing of seven days or more in cycle length from one month to the next. That persistent seven-day swing is the cardinal marker of the next stage under NICE NG23 (a UK menopause guideline Maltese gynaecologists recognise) — and by that marker, you are not there yet.
• No blood test stages you here. FSH (follicle-stimulating hormone) swings too much at this point to mean anything, and AMH (anti-Müllerian hormone) speaks to fertility planning, not to dating menopause. If a clinician offers to "check your hormones" to see whether menopause is coming, a single reading cannot answer that — your cycle record can.
• Age, roughly 35 to 43. That is the usual span for this run-up, though it varies. Under 40 with cycles that have genuinely changed is a different, more pressing conversation — see the note below.

What should I record now?

This is the real work of the stage, and it is quiet. While everything is still normal, you are building your own baseline — the reference point you will measure every future change against.

Record, month to month:

• Cycle length and flow — the gap between periods and whether it is starting to shift, plus your typical bleed. A cycle you have tracked for a year is the single most useful thing you can bring to a future appointment.
• Sleep, mood and energy — a rough baseline now makes a real change obvious later, instead of something you argue about from memory.
• Your family timing — when your mother and sisters went through menopause. It is a genuine clue to your own likely window.

None of this is about worrying early. It is about arriving to the next stage with a record, rather than a hunch. For what those future appointments and tests look like, see menopause blood tests in Malta and when periods change in your 40s.

When does premenopause end?

It ends when perimenopause begins — clinically, when your cycle length starts to vary persistently by seven days or more from one month to the next. For most women that happens somewhere in the early-to-mid forties, but the range is wide and normal. There is no test that announces the change; it is your cycle pattern that marks it, which is exactly why the record you keep now does the work later.

How this shows up in Malta

Here is the Malta-specific reason to start recording now, rather than waiting until something is wrong. Malta has no dedicated public menopause clinic — not at Mater Dei Hospital, not at Gozo General — and no published peer-reviewed Maltese cohort on menopause exists at all. There is no local dataset a doctor can measure you against, and no clinic set up to catch you early. In that gap, your own record is the closest thing to a baseline anyone will have.

The public system's first women's-health touch-points are the Well Woman Clinics run by Primary Health Care (in Floriana, Qormi, Gżira, Birkirkara and Kirkop; phone 25680239) — useful to know exists, though they are a general screening service, not a menopause clinic. And because HRT is private-pay in Malta when the time comes, the women who navigate the transition most smoothly are almost always the ones who walked in already knowing their own pattern.