The stages of menopause, and how to tell which one you are in

Why staging exists at all

Staging is not academic tidiness. The stage you are in predicts which symptoms are likely, how long they are likely to last, and which risks become relevant, which is why it changes what a good consultation covers.

The system in use is STRAW+10, agreed by an international workshop and adopted by professional bodies. Its central decision was to anchor stages to menstrual pattern rather than to hormone levels, precisely because hormone levels are too erratic in this phase to define anything.

The stages

Working forwards through the transition:

• Late reproductive: cycles still regular, but subtly shorter; fertility declining; sometimes the first symptoms
• Early perimenopause: a persistent change in cycle length of seven days or more. Symptoms often begin or intensify here
• Late perimenopause: at least one gap of 60 days or more between periods. Hot flashes are typically most frequent and most severe in this stage and the two years after the final period
• Menopause: a single point in time, dated retrospectively as twelve consecutive months with no period
• Early postmenopause: roughly the first five to eight years after. Vasomotor symptoms usually peak early then decline; bone loss is fastest here
• Late postmenopause: symptoms of tissue change such as vaginal dryness and urinary problems tend to continue or worsen, unlike hot flashes

What the stages tell you about symptoms

The pattern worth internalising: mood and cycle chaos cluster in perimenopause, when hormones are swinging. Hot flashes peak around the final period. Tissue symptoms — vaginal dryness, urinary urgency, recurrent infections — are postmenopausal and get worse with time rather than better.

That last point is why waiting things out is a reasonable strategy for hot flashes and a poor one for genitourinary symptoms.

The limits of the system

STRAW+10 was designed around a natural transition with an intact uterus and ovaries, and it explicitly does not apply cleanly to several common situations: after hysterectomy with ovaries retained, with an intrauterine system or hormonal contraception suppressing bleeding, after ablation, or with PCOS.

If you have no periods to track, staging falls back on symptoms and, in some cases, on hormone testing — one of the few settings where FSH measurement genuinely adds something.

When to see someone

Bring a record of your cycles over the last year. It is the single piece of information that determines your stage, and it is almost never available at the appointment.

Any bleeding after twelve months without a period means the twelve-month clock has not simply restarted — it needs investigating.