Stages
Where you might be.
Doctors use a staging system called STRAW+10 to describe what usually changes, and in what order.1 The ages overlap on purpose. Bodies don’t follow a schedule.
Age in years. The line is an illustration, not a measurement. Most people fall inside the shaded ranges; some don’t.
01 · Usually late 30s to mid 40s
Late reproductive years
Periods are still regular. Cycles may get a few days shorter. PMS, breast tenderness or sleep can shift in ways that are hard to pin down. Fertility is falling.
Many notice nothing here. Some notice plenty and are told they’re too young.
02 · Often starts in your 40s, sometimes late 30s
Early perimenopause
The marker: your cycle length changes by seven days or more, again and again.1 Periods may get heavier. Sleep, mood, anxiety and memory can change here, often before any hot flush.
Symptoms can start months or years before periods stop.2
03 · Usually the last one to three years before your final period
Late perimenopause
The marker: gaps of 60 days or more between periods.1 Estrogen swings are at their widest. Hot flushes and night sweats are most likely now, and sleep is often at its hardest.
Symptoms can peak here. Useful to know when they seem to come from nowhere.
04 · Usually between 45 and 55
Your final period
Menopause is technically one day: 12 months after your last period. You only know it in hindsight. Before 45 is called early menopause. Before 40 is premature ovarian insufficiency, which needs a proper medical assessment.3
On hormonal contraception, or after a hysterectomy, you may not be able to tell. Symptoms, and sometimes blood tests, are used instead.
05 · Roughly the first five to eight years after
Early postmenopause
Hot flushes can carry on for years. Bone density falls fastest in the first few years, and heart risk starts to rise. This is when bone and heart health are worth a direct conversation.
In one large US study, hot flushes and night sweats lasted a median of 7.4 years in total.4
06 · The rest of your life
Late postmenopause
Hormones settle at a new, lower level and many symptoms ease. Vaginal dryness and bladder symptoms are the exception: they tend to continue or worsen without treatment, and they are very treatable.5
It’s never too late to raise these.
Not sure which stage fits?
Your cycle dates tell you more than a single blood test can in perimenopause. Two or three months of notes is a good start.
Sources
- Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10). Menopause, 2012.
- NHS. Menopause and perimenopause.
- NICE. Menopause: identification and management (NG23).
- Avis NE et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Internal Medicine, 2015.
- The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement. Menopause, 2020.