Yesterday I sat down to read the new ISO standard on menstruation, menstrual health and menopause with genuine interest.

My curiosity quickly turned to disappointment.

One of my biggest concerns is something that might sound like semantics, but isn't: the definition of menopause and the menopause transition.

Menopause and the menopause transition are not the same thing

Menopause has a specific meaning.

It is the point at which menstruation has ceased permanently, established retrospectively after 12 consecutive months without a period. When I teach this, I often use the phrase Menopause Day because it makes clear that we are talking about a particular point on the ovarian ageing timeline.

For typical menopause, this most often happens between the ages of 45 and 55.

The existing British Standard, BS 30416:2023, makes the distinction particularly clearly. It defines menopause as a “moment in time”, traditionally defined as 12 months after the final period. It also acknowledges that the word menopause is often used conversationally to describe the much wider experience around it, while distinguishing this from the medical definition.

That distinction matters.

The new ISO appears to reframe menopause as the menopause transition and to define that transition in relation to when symptoms start.

And that's where I have a problem.

Symptoms don't define the menopause transition

Symptoms may appear during Late Reproductive, which is already part of the ovarian ageing process, before the clinical menopause transition begins.

Entry into the clinical menopause transition is identified by a persistent change in menstrual-cycle length of seven days or more — whether symptoms are present or not.

And that's important, because ovarian ageing is biology; clinical stages are how we describe where someone is within that process; and symptoms are experiences that may need support wherever they occur.

Symptoms are important. They can affect someone's health, wellbeing, relationships and ability to work. And they absolutely deserve recognition and support.

But symptoms are not the biological boundary between Late Reproductive and the menopause transition.

We don't have to change the science to provide support

There is no need to make somebody fit a particular clinical stage before taking their symptoms seriously.

Someone experiencing symptoms during Late Reproductive deserves support.

Someone in the clinical menopause transition who has few or no symptoms is still in the menopause transition.

And someone experiencing symptoms after Menopause Day deserves support too.

These are different questions:

What is happening biologically?

How do we clinically describe where someone is within the ovarian ageing process?

What is this individual experiencing, and what support do they need?

We can — and should — answer all three.

Absolutely — support the symptoms. But don't alter the science to do it.

That's why I'm particularly interested to hear from people who contributed to the development of these standards, as well as those working in menstrual and menopause health.

Was there a deliberate reason for changing the terminology and definitions used in BS 30416? And if so, what problem was the change intended to solve?

Read the standards

BS 30416:2023 — Menstruation, menstrual health and menopause in the workplace

ISO — Menstruation, menstrual health and menopause in the workplace