What stage of menopause am I in?

Why you get a different answer everywhere you look

Search for what stage of menopause you are in and you will be told there are three stages. Elsewhere, five. Elsewhere again, seven. None of these is wrong exactly, but none of them is the standard either — they are different simplifications of the same underlying system.

That system is STRAW+10, short for the Stages of Reproductive Aging Workshop, updated in 2011. It divides reproductive ageing into ten stages, and it is what sits behind the staging language your clinician uses.^[1] Understanding two things about it makes the whole picture clearer.

Everything is anchored on one moment

STRAW+10 treats the final menstrual period as the zero point. Stages before it are counted backwards (−1, −2 and so on); stages after it are counted forwards (+1a, +1b, +1c, +2).

This has a consequence people find genuinely frustrating: the anchor can only be identified in hindsight. Your final period is only confirmed as final once twelve months have passed without another one. Nobody can tell you on the day. That is not evasiveness on your doctor’s part — it is how the definition works.

The criteria are about pattern, not age

The main criteria are menstrual: how much your cycle length varies, and whether you have had a long gap. Hormone levels are treated as supporting evidence, and symptoms — including hot flashes — as descriptivefeatures rather than staging criteria. Age is not a criterion at all — the system was explicitly designed to apply regardless of a woman’s age, ethnicity, body size or lifestyle.^[1]

The stages, in plain terms

Late reproductive stage (−3)

Cycles are still regular, but something has shifted — often they are a little shorter than they used to be, or flow has changed. Fertility is declining. Most people would not call this perimenopause, and it is not yet the transition proper.

Early menopause transition (−2)

The defining change is persistent variability: consecutive cycles differing by seven days or more, happening repeatedly rather than once.^[1] This is the stage most people mean when they say perimenopause. Hormone levels are not gliding downwards; they are swinging, which is exactly why symptoms come and go and why a blood test taken on the wrong week can look entirely normal.

Late menopause transition (−1)

Marked by the first gap of 60 days or more without a period. This stage typically runs one to three years,^[1] and it is when vasomotor symptoms are most often at their peak.^[3] Gaps get longer until they stop.

The final menstrual period (0)

A single point in time, confirmed only after twelve months of no bleeding.

Early postmenopause (+1a, +1b, +1c)

The first couple of years are when hormone levels are still settling, and when hot flashes and night sweats often remain at their most frequent — a fact that surprises people who expected periods stopping to mean symptoms stopping.^[3] Over the following years the pattern stabilises, flushes ease for many, and genitourinary symptoms such as dryness tend to become more noticeable.

Late postmenopause (+2)

Hormonally stable. Attention shifts towards the longer-term effects of low oestrogen — bone, cardiovascular and genitourinary health.

When staging by cycles does not work

This part is routinely left out of symptom checklists, and it matters. The authors of STRAW+10 were explicit that the criteria cannot be applied in the usual way to everyone, because they depend on there being a menstrual pattern to read at all.^[1] The system does not apply straightforwardly if you:

• have had a hysterectomy with your ovaries left in place — the hormonal transition still happens, but silently
• have had an endometrial ablation
• use hormonal contraception — the pill, hormonal coil, implant or injection impose their own bleeding pattern over whatever your body is doing
• have had both ovaries removed — this causes menopause immediately rather than gradually, and is a different clinical situation
• have PCOS or another condition that makes cycles irregular for reasons unrelated to menopause

If you are in one of these groups, the absence of an answer is not a failure on your part. It is a limitation of a system built on menstrual patterns. Symptoms become the practical guide, and this is one of the few situations where hormone testing may genuinely add something.

Why a blood test usually will not settle it

It seems like it should be simple: measure FSH, read off the answer. The problem is that during the transition FSH fluctuates enormously from week to week. A single measurement can be reassuringly normal in one cycle and unambiguously menopausal a few weeks later, with nothing having changed. For that reason, guidelines generally discourage relying on it to diagnose perimenopause in women over 45 who have typical symptoms — the history is more informative than the blood.^[2]

Testing has a clearer role at younger ages, where early menopause is a possibility that changes management, and in people who have no cycle to read.

What to do with the answer

Knowing what stage of menopause you are in is not a diagnosis and it does not prescribe anything. What it gives you is a frame — and, more practically, a way of walking into an appointment with something more specific than “I think I might be perimenopausal”.

It is worth saying plainly that you do not need to have reached a particular stage to be offered help. Treatment decisions are driven by how much your symptoms are affecting you, not by where you sit on a chart.

One thing does need naming rather than checking: any bleeding that occurs after twelve months without a period should always be reported to a doctor. It usually turns out to be nothing serious, but it is never something to stage at home.