Part 1 of 4 in the menopause series. Part 2 is how TCM reads this change; part 3 is when to see a doctor first; part 4 is daily life and what a consultation asks.

"The last six months I've just been off — hot flushes, poor sleep, shorter temper. Is this menopause?" It comes up often, usually asked with a little hesitation.

This part answers one thing: what is happening in the body.

The short version

• Menopause has a precise definition: 12 consecutive months without a period. That is the WHO's wording and the NHS's.
• It usually happens between 45 and 55 — the WHO, the NHS and the Malaysian Menopause Society all give that range.
• The years before it, when changes in the cycle are first observed, are perimenopause, and the WHO says they can last several years.
• Symptoms usually last 7 to 9 years, sometimes longer, and they change along the way — that is the NHS.
• What falls is ovarian follicular function and oestrogen — that is the WHO. The NHS adds that these hormones also keep your bones healthy, so the change is not only in the periods.
• TCM theory places this change with the "kidney": the WHO's TCM terminology standard says perimenopausal disorders often result from kidney qi failure and imbalance between yin and yang. The "kidney" here is a set of functions, not the organ of Western medicine. Part 2 sets that out in full.

First, the things that cannot wait

Any bleeding after menopause needs a doctor — even if it has only happened once, there is only a small amount, or it is only pink or brown discharge. The NHS states it can be a sign of cancer, which is why it is always checked. A lump you can feel in the breast or abdomen goes to a doctor too.

Chest pain or palpitations with breathlessness or a cold sweat — call 999 now, or go to the nearest hospital emergency department.

The full list is in part 3. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. A life stage, not a disease — and it has numbers

Menopause is not an illness. The WHO describes it as one point in a continuum of life stages for women, marking the end of the reproductive years; the Malaysian Menopause Society says the same — a natural life stage, not a disease.

Not an illness, but it has very specific numbers.

The definition: 12 consecutive months without a period. The WHO's version adds two conditions — no other obvious physiological or pathological cause, and no clinical intervention. The NHS puts it plainly: no period for 12 months, and you are not using hormonal contraception.

The age: between 45 and 55. Most women experience menopause in that range, the WHO says; the NHS and the Malaysian Menopause Society give the same one. The NHS states early menopause or premature ovarian insufficiency can happen before the age of 45 — and that goes to a doctor first.

The years before it are perimenopause. The WHO defines them as running from when changes in the cycle are first observed until one year after the final period; the transition can last several years. The Malaysian Menopause Society also states it can last several years.

Symptoms usually last 7 to 9 years, sometimes longer. The NHS also states they change — hot flushes and night sweats may improve for a while and be replaced by others, such as low mood and anxiety.

There is no routine test. The NHS states a doctor may diagnose it from your age and your symptoms; the WHO says it is not possible to predict when an individual woman will experience menopause. So "has it started?" is a question for a doctor, not for a checklist.

II. What falls in the body

Section I answers "when". This one answers "what happened".

What falls is ovarian follicular function and oestrogen in the blood. That is the WHO's account, which adds: the ovaries stop releasing eggs. The NHS version is shorter — menopause is caused by a fall in hormone levels. On its page about hormone therapy, the NHS names two of them: oestrogen and progesterone, which fall to low levels as you approach the menopause.

Those two hormones were not only running the periods. The NHS states they are an essential part of period cycles, ovulation and pregnancy, and that they also keep your bones healthy; as you get older, losing them can have a big effect on your body. Put simply, the same hormones had other work elsewhere — so menopause is not only "periods stopping".

What commonly follows. The WHO says these changes can affect physical, emotional, mental and social well-being, and among the symptoms it lists are hot flushes and night sweats, changes in the regularity and flow of the cycle until it stops, difficulty sleeping, and changes in mood. It also states the range is wide: from few if any symptoms to severe ones that affect daily activities and quality of life.

Two longer-term changes. The WHO is direct about both: women's advantage over men in terms of cardiovascular disease gradually disappears with the significant decline in oestrogen levels after menopause, and loss of bone density at menopause is a significant contributor to higher rates of osteoporosis and fractures. Read that with the line above — the NHS says these hormones keep bones healthy, the WHO says bone density is lost at menopause — and you have why part 3's everyday list includes weight-bearing exercise and calcium-rich food.

One step neither page takes. Both say what falls and what commonly follows; neither explains why a fall in hormones sets off a single hot flush. This article does not supply it either — when part 2 reads one flush, it uses only the description and the trigger list those pages state.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

The words in this part

• Perimenopause (围绝经期) — the transition from when changes in the cycle are first observed until one year after the final period; the WHO's definition.
• Early menopause, premature ovarian insufficiency (卵巢早衰) — the NHS states either can happen before the age of 45; if periods stop before 45, see a doctor first.
• Ovarian follicular function — the ovaries' work of releasing eggs; the WHO says menopause is caused by its loss plus falling oestrogen.
• Oestrogen and progesterone — the two hormones the NHS names: part of period cycles, ovulation and pregnancy, and they keep bones healthy.

Frequently asked questions

At what age does menopause start? Most women experience menopause between 45 and 55 — the WHO, the NHS and the Malaysian Menopause Society all give that range. "Menopause" means 12 consecutive months without a period; the years before, when changes in the cycle are first observed, are perimenopause, which can last several years. If periods stop before 45, see a doctor first.

Can you still get pregnant in perimenopause? Yes. The NHS states you still need contraception after your final period — for 1 year if you are 50 or over, 2 years if you are 40 to 49.

The other three parts

• Part 2: How TCM reads this change — the "kidney", the "liver", and the words behind them
• Part 3: When to see a doctor first, and what is generally done
• Part 4: Daily life in Malaysia, hormone therapy, and what a consultation asks

👉 If you are not sure "where to start setting out the changes of this stage for a practitioner", you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in "First, the things that cannot wait" above or in part 3 applies, see a doctor or a gynaecologist first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, Menopause fact sheet, 16 October 2024 — https://www.who.int/news-room/fact-sheets/detail/menopause
• NHS, What are menopause and perimenopause?, page last reviewed 19 May 2026 — https://www.nhs.uk/conditions/menopause-and-perimenopause/what-are-menopause-and-perimenopause/
• NHS, Symptoms of menopause and perimenopause, page last reviewed 19 May 2026 — https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
• NHS, About hormone replacement therapy (HRT), page last reviewed 7 February 2023 — https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/
• NHS, Postmenopausal bleeding, page last reviewed 24 September 2026 — https://www.nhs.uk/symptoms/post-menopausal-bleeding/
• Malaysian Menopause Society, What is Menopause?, 12 September 2023 — https://menopause.org.my/2023/09/12/what-is-menopause/
• Malaysian Menopause Society, Common Myths About Menopause, 12 September 2023 — https://menopause.org.my/2023/09/12/common-myths-about-menopause/
• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322

本文是「更年期」系列的第 1 篇，共 4 篇。第 2 篇讲中医怎么看这段变化，第 3 篇讲什么时候要先看医生，第 4 篇讲日常怎么安排、看诊会问什么。

「医师，我这半年整个人不太对劲——热潮、睡不好、脾气也变差，是不是更年期到了？」这是不少读者常问的一类问题，问的时候常带着一点犹豫。

这一篇只回答一件事：这段时间，身体里到底在发生什么。

一分钟看完

• 停经的定义很具体：连续 12 个月没有月经。世卫与 NHS 都是这么写的。
• 通常发生在 45 到 55 岁之间——世卫、NHS 与马来西亚更年期学会给的是同一个区间。
• 在那之前月经周期开始出现变化的那几年叫围绝经期——世卫的定义是可以持续数年。
• 症状一般持续 7 到 9 年，有时更久，而且中途会换样——这是 NHS 写明的。
• 下降的是卵巢卵泡功能与雌激素，这是世卫的说法。NHS 补一句：这两种荷尔蒙原本也维持骨骼健康，所以变化不只在月经。
• 中医理论把这段变化放在「肾」来看：世卫的中医术语标准说，「绝经前后诸证」常由肾气衰退、阴阳失衡所致。理论里的「肾」是一组功能，不是西医的肾脏。整段说明在第 2 篇。

先说不能等的几件事

停经之后出现任何出血，请务必就医——即使只有一次、量很少、只是粉色或褐色分泌物。NHS 写明它可能是癌症的征兆，所以一律要检查。摸到乳房或腹部的肿块，一样先看医生。

胸痛、心悸伴随气促或冒冷汗——请立刻拨打 999，或前往最近的医院急诊部。

完整的清单，见第 3 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、这是一个阶段，不是一个病——而且有数字

更年期不是病。世卫把它描述为女性生命阶段连续体上的一个点，标志生育年龄的结束；马来西亚更年期学会的说法一样：自然的生命阶段，不是疾病。

不是病，但有很具体的数字。

定义：连续 12 个月没有月经。 世卫的版本还加两个条件——没有其他明显的生理或病理原因，也没有临床介入。NHS 的版本更口语：12 个月没有月经，而且您没有在使用荷尔蒙避孕。

年龄：45 到 55 岁之间。 世卫说大多数女性在这个区间经历停经；NHS 与马来西亚更年期学会给的是同一个区间。NHS 写明，45 岁之前可能发生早发停经或卵巢早衰——那要先看医生。

之前那几年叫围绝经期。 世卫的定义是：从月经周期开始出现变化，到最后一次月经之后一年；这段过渡可以持续数年。马来西亚更年期学会也写它可以持续数年。

症状一般持续 7 到 9 年，有时更久。 NHS 还写明它会变——热潮与盗汗可能一阵子后减轻，被情绪低落、焦虑这些取代。

没有例行的检验。 NHS 写明，医生可能根据您的年龄与症状作出判断；世卫也说，无法预测个别女性何时停经。所以「是不是到了」，答案在医生那里，不在一张自测表上。

二、身体里什么在下降

第一节说的是「什么时候」，这一节说「发生了什么」。

下降的是卵巢卵泡功能与血液中的雌激素。 这是世卫的说法，它还补了一句：这意味着卵巢不再排出卵子。NHS 的版本更短——更年期由荷尔蒙水平下降引起；在讲荷尔蒙治疗的那一页，NHS 点名了其中两种：雌激素与孕酮，在接近更年期时降到低水平。

这两种荷尔蒙原本不只管月经。 NHS 写明：雌激素与孕酮是月经周期、排卵与怀孕的必要部分，也维持骨骼的健康；随着年纪增长，失去这两种荷尔蒙可能对身体有很大的影响。简单说，就是同一组荷尔蒙原本还在别处上班——所以停经不只是「月经停了」。

下降之后常见什么。 世卫说，这些荷尔蒙变化可能影响身体、情绪、精神与社交层面的健康；它列出的症状里有热潮与盗汗、月经规律与量的改变直到停止、入睡困难、情绪的改变。世卫也写明差异很大：可以少到几乎没有，也可以严重到影响日常活动与生活质量。

还有两项较长期的变化。 世卫写得很直接：女性在心血管疾病方面相对男性的优势，会随着停经后雌激素的显著下降而逐渐消失；停经时骨密度的流失，是骨质疏松与骨折比率较高的重要因素。把它和上面那句连起来读——NHS 说这两种荷尔蒙维持骨骼健康，世卫说停经时骨密度会流失——第 3 篇的日常清单里为什么有负重运动与含钙饮食，就是从这里来的。

有一步这两页都没有写。 它们说明了什么在下降、下降之后常见什么，但都没有解释荷尔蒙下降为什么会引发一次热潮。这篇不补这一步；第 2 篇读一次热潮时，用的也只是这两页写明的描述与诱因清单。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这篇出现的几个词

• 围绝经期——从月经周期开始出现变化，到最后一次月经之后一年的那段过渡；世卫的定义。
• 早发停经、卵巢早衰（premature ovarian insufficiency）——NHS 写明，45 岁之前可能发生早发停经或卵巢早衰；45 岁之前停经，先看医生。
• 卵巢卵泡功能——卵巢排出卵子的那部分功能；世卫说停经由它的丧失与雌激素下降引起。
• 雌激素、孕酮——NHS 点名的两种荷尔蒙：管月经周期、排卵与怀孕，也维持骨骼的健康。

常见问题

更年期几岁开始？ 世卫：大多数女性在 45 到 55 岁之间经历停经；NHS 与马来西亚更年期学会给的是同一个区间。「停经」指连续 12 个月没有月经；在那之前月经周期开始出现变化的几年叫围绝经期，可持续数年。45 岁之前就停的，先看医生。

围绝经期还会怀孕吗？ 会。NHS 写明，最后一次月经之后仍需避孕——50 岁或以上 1 年，40 到 49 岁 2 年。

这个系列的另外三篇

• 第 2 篇：中医怎么看这段变化——「肾」「肝」，和那几个词
• 第 3 篇：什么时候要先看医生，一般做法有哪些
• 第 4 篇：日常怎么安排，荷尔蒙治疗与看诊会问什么

👉 如果您不确定「这段时间的变化，该从哪里整理起来说给医师听」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若有本文「先说不能等的几件事」或第 3 篇列出的情况，请先看医生或妇产科。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 世界卫生组织，Menopause fact sheet，2024 年 10 月 16 日 — https://www.who.int/news-room/fact-sheets/detail/menopause
• NHS，What are menopause and perimenopause?，页面最后审阅 2026 年 5 月 19 日 — https://www.nhs.uk/conditions/menopause-and-perimenopause/what-are-menopause-and-perimenopause/
• NHS，Symptoms of menopause and perimenopause，页面最后审阅 2026 年 5 月 19 日 — https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
• NHS，About hormone replacement therapy (HRT)，页面最后审阅 2023 年 2 月 7 日 — https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/
• NHS，Postmenopausal bleeding，页面最后审阅 2026 年 9 月 24 日 — https://www.nhs.uk/symptoms/post-menopausal-bleeding/
• Malaysian Menopause Society，What is Menopause?，2023 年 9 月 12 日 — https://menopause.org.my/2023/09/12/what-is-menopause/
• Malaysian Menopause Society，Common Myths About Menopause，2023 年 9 月 12 日 — https://menopause.org.my/2023/09/12/common-myths-about-menopause/
• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022 — https://www.who.int/publications/i/item/9789240042322