Reference
The 7 stages of menopause, and what replaced them
The original 2001 staging system divided adult female life into seven stages centred on the final menstrual period. Its 2012 update, STRAW+10, subdivided three of them, so the current reference has ten stages plus the final period itself. Both stage you by your bleeding pattern, not by your age and not by your symptoms.
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Where the number seven comes from
In 2001 the Stages of Reproductive Aging Workshop, usually shortened to STRAW, proposed a common vocabulary for something clinicians had been describing loosely. It divided adult female life into three phases, reproductive, the menopausal transition, and postmenopause, and cut those into seven stages numbered relative to the final menstrual period, which sits at the centre as Stage 0.
Counting outward: Stages -5, -4 and -3 are the reproductive years, early, peak and late. Stage -2 and Stage -1 are the early and late menopausal transition. Stages +1 and +2 are early and late postmenopause. Seven stages, one reference point, and the pages that say the 7 stages of menopause are describing this 2001 version.
It became the standard quickly. The paper's own comparison is to the Marshall and Tanner stages of puberty: a shared scale that lets two clinicians, or two studies, mean the same thing by the same word.
What STRAW+10 changed in 2012
Ten years of population data later, a follow-up workshop met in Washington DC in September 2011 to revise the criteria. It was sponsored by the National Institute on Aging and the Office of Research on Women's Health at the NIH, the North American Menopause Society, the American Society for Reproductive Medicine, the International Menopause Society, and the Endocrine Society. The result, published in 2012, is STRAW+10, and it is what clinicians and researchers use now.
- It split the late reproductive stage in twoStage -3 became -3b and -3a, because measurable ovarian changes begin before anything visible happens to your cycle.
- It split early postmenopause in threeStage +1 became +1a, +1b and +1c, because FSH and estradiol keep moving for roughly two years after the final period and only then settle.
- It made the bleeding criteria preciseVague descriptions of variability became specific, countable rules: seven days, ten cycles, sixty days.
- It put a number on FSH in late transitionBetter assay standardisation allowed a quantitative threshold where 2001 had only said elevated.
So the honest answer to how many stages of menopause there are is that it depends which version you mean. Seven in the 2001 system. Ten plus the final period in the current one.
Every stage, and what defines it
The stages that matter to anyone asking where am I are the four around the transition, from -3a through +1a. The table gives all of them from late reproductive onward.
| Stage | Phase | What defines it | Typical duration |
|---|---|---|---|
| -3b | Late reproductive | Cycles stay regular and keep their length. AMH and antral follicle count are already low. | Variable |
| -3a | Late reproductive | Subtle cycle change begins, characteristically shorter cycles. Early follicular FSH rises and becomes more variable. | Variable |
| -2 | Early menopausal transition | A persistent difference of seven days or more between the lengths of consecutive cycles. Persistent means it recurs within ten cycles of the first variable one. | Variable |
| -1 | Late menopausal transition | A gap of sixty days or more with no period. Hormone levels swing hard, and FSH above 25 IU/L on a random draw is characteristic. Vasomotor symptoms are likely here. | 1 to 3 years |
| 0 | Final menstrual period | The last period you ever have. It can only be identified in retrospect, twelve months later. | A single day |
| +1a | Early postmenopause | The end of the twelve months without a period that confirm the final one. Perimenopause ends here. | 1 year |
| +1b | Early postmenopause | The remainder of the rapid change in FSH and estradiol. Vasomotor symptoms are most likely during this stage. | 1 year |
| +1c | Early postmenopause | High FSH and low estradiol stabilise. | 3 to 6 years |
| +2 | Late postmenopause | Levels are stable. Further specification of this stage awaits more data. | Remainder of life |
Stages -5 and -4, the early and peak reproductive years, complete the system but have no bearing on the transition. Durations are population averages from the STRAW+10 paper, not predictions for an individual.
Where perimenopause starts and ends
This is the part almost nothing written for a general audience states plainly, and STRAW+10 is explicit about it. Perimenopause, meaning the time around menopause, begins at Stage -2 and ends twelve months after the final menstrual period, which is the end of Stage +1a.
Two things follow that surprise people. The first is that perimenopause has a definite beginning you can identify while it is happening: the first persistent seven-day swing in your cycle length. The second is that it continues for a full year after your periods have stopped altogether. The year of silence is not after perimenopause. It is the last part of it.
Because Stage 0 is only identifiable in retrospect, nobody knows they have had their final period at the time. You learn the date twelve months after the fact, by counting backwards. This is why no test and no tool can tell you when your last period will be.
Why the system ignores your age
One of the principles STRAW+10 set for itself is that the criteria are independent of age, of symptoms, and of pathology. Staging is done on bleeding pattern, with hormone levels as supporting evidence. Your birthday is not an input.
The reasoning is that no universal menopausal syndrome has been established across ethnic groups, so symptoms cannot carry the definition. The workshop also recommended the criteria be applied regardless of a woman's age, ethnicity, body size, or lifestyle. Two people the same age can sit three stages apart, and the system is built to say so.
This is why being 38 does not rule the transition out and being 52 does not confirm it. It is also why the honest way to place yourself is to look at your cycles rather than at a chart of average ages. Onset before 40 is the one situation that changes the answer, because that is investigated as premature ovarian insufficiency and needs an in-person work-up rather than a staging exercise.
How to read your own cycle against this
You need two numbers and one gap. The numbers are the lengths of your recent consecutive cycles, counted from the first day of one period to the first day of the next. The gap is the longest stretch you have gone without a period in the past year.
- If consecutive cycles differ by seven days or more, and it keeps happeningThat is the Stage -2 criterion, the early menopausal transition, and the start of perimenopause.
- If you have had a gap of sixty days or moreThat is the Stage -1 criterion, the late menopausal transition, the stage that averages one to three years and carries the heaviest symptom load.
- If it has been twelve months with nothingThe final period was twelve months ago, and you are at the end of Stage +1a.
- If your cycles are regular but something feels differentLate reproductive stages -3b and -3a are real and are defined largely by things you cannot see. Symptoms without cycle change do not rule the transition out.
Our own check does this arithmetic for you and pairs it with a weighted symptom score, because a stage on its own does not tell you how much you are carrying. It asks for your age band and your cycle pattern, scores sixteen symptoms on an instrument built after the Menopause Rating Scale, and places you against these stages. If you have been offered a blood test to settle the question, what each perimenopause test actually measures explains why it usually cannot.
What staging cannot do
A stage is a description, not a prognosis. It cannot date your final period, it cannot tell you how long your own transition will run, and it carries no treatment threshold. The durations in the table are averages across populations, and individual variation around them is wide.
Staging also assumes a cycle to read. Hormonal contraception, an endometrial ablation, a hysterectomy that left the ovaries, and some treatments for heavy bleeding all remove or alter the bleeding pattern the criteria depend on. In those situations staging by cycle is not available, and the question belongs with a clinician who knows your history.
Sources
Every criterion, duration and threshold on this page comes from the STRAW+10 executive summary, which is open access and worth reading directly if you want the underlying data.
- Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012;19(4):387 to 395. Co-published in the Journal of Clinical Endocrinology and Metabolism 2012;97(4):1159 to 1168, Fertility and Sterility 2012;97(4):843 to 851, and Climacteric 2012;15(2):105 to 114.
- Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, Woods N. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Climacteric 2001;4(4):267 to 272. The original seven-stage system.
- National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23, published November 2015, last updated November 2024. Recommendation 1.7.2 on diagnosing premature ovarian insufficiency under 40.
Common questions
What are the 7 stages of menopause?
They come from the 2001 STRAW system, numbered around the final menstrual period: Stages -5, -4 and -3 are the early, peak and late reproductive years; Stage -2 is the early menopausal transition; Stage -1 is the late menopausal transition; and Stages +1 and +2 are early and late postmenopause. The 2012 update subdivided Stage -3 and Stage +1, giving ten stages plus the final period.
What are the stages of perimenopause?
Two. Early menopausal transition, Stage -2, is marked by a persistent difference of seven days or more between consecutive cycle lengths. Late menopausal transition, Stage -1, is marked by a gap of sixty days or more without a period and lasts one to three years on average. Perimenopause then runs on through Stage +1a, the twelve months after the final period.
How do I know what stage of perimenopause I am in?
By your bleeding pattern rather than your age. Compare the lengths of your recent consecutive cycles: a persistent difference of seven days or more places you in early transition. A gap of sixty days or more places you in late transition. Our two-minute check does this alongside a weighted symptom score, free and in your browser.
What is STRAW+10?
The Stages of Reproductive Aging Workshop +10, a 2011 expert workshop whose 2012 report is the current reference system for staging the menopausal transition. It was sponsored by the National Institute on Aging and the NIH Office of Research on Women's Health, the North American Menopause Society, the American Society for Reproductive Medicine, the International Menopause Society, and the Endocrine Society.
How long does late perimenopause last?
The late menopausal transition, Stage -1, is estimated to last one to three years on average, based on menstrual calendar studies and on changes in FSH and estradiol. It is the stage where vasomotor symptoms are likely to occur. Individual variation around that average is wide, and no tool can narrow it for you.
When does perimenopause officially end?
Twelve months after your final menstrual period, at the end of Stage +1a. STRAW+10 states this explicitly: perimenopause begins at Stage -2 and ends twelve months after the final period. The year without periods is the last part of perimenopause rather than something that follows it.
Does age determine your menopause stage?
No. STRAW+10 deliberately uses criteria independent of age, symptoms and pathology, and recommends applying them regardless of age, ethnicity, body size or lifestyle. Two people of the same age can be several stages apart. The exception is onset before 40, which is investigated as premature ovarian insufficiency rather than staged.
Can you tell when your last period will be?
No, and no test can. The final menstrual period is Stage 0, and it is identifiable only in retrospect, once twelve months have passed without another one. You learn the date by counting backwards a year after the fact, which is why any tool promising to predict it is overselling.
Find your own stage
The check asks for your cycle pattern and your age band, scores sixteen symptoms, and places you against the STRAW+10 stages on this page. It hands you a printable summary in the language a clinician recognises.
A stage is not a verdict. It is a place to start the conversation from.
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