The stages of perimenopause, in order

What are the stages of perimenopause, in order?

Here is the full staged model researchers use, in the order your body moves through it.

• Early perimenopause: the length of your cycle starts varying by seven days or more from one cycle to the next, and it keeps happening.
• Late perimenopause: periods start skipping, with gaps of 60 days or more between them.
• Menopause: a single point in time, not a stage. It's the date of your final period, confirmed looking back once 12 months pass with no period.
• Early postmenopause: the first several years after that final period, while hormone levels are still settling.
• Late postmenopause: everything after that settling, for the rest of life.

Notice what does the defining at every step: cycle length and bleeding, not how tired you feel or how bad a hot flash was. That's deliberate. Symptoms are real and worth tracking, but they vary too much from woman to woman to define a stage. Your calendar is the more reliable tool. That's good news, because you don't need a lab visit to make a reasonable guess.

Is STRAW+10 the same thing as the "seven stages of perimenopause"?

Not quite, and the mismatch causes real confusion. The model clinicians use is STRAW+10, short for the Stages of Reproductive Aging Workshop. The "+10" means it's the update made 10 years after the 2001 original. Experts agreed on it in 2011 and published it in 2012. It is the standard staging framework in menopause research and care.

STRAW+10 covers your whole reproductive life, not just perimenopause. It has seven numbered stages. Three cover the reproductive years, two cover perimenopause, and two cover postmenopause. Your final period sits between them as a single point. That count of seven is almost certainly where the popular "seven stages of perimenopause" came from.

But seven describes the whole model, from your 20s through late life. Perimenopause itself is only two of those stages: early and late. The rest of the "seven stages" describes the years before perimenopause starts, or the decades after it ends.

Stage one: early perimenopause, defined by your cycle, not your symptoms

Early perimenopause has a specific, almost unglamorous definition. The lengths of back-to-back cycles differ by seven days or more, and that happens again within your next 10 cycles. One odd month doesn't count. Say your cycle ran a steady 28 days for years. Now it lands anywhere from 24 to 33 days, cycle after cycle. That variability is the marker itself.

Hormonally, this is when FSH starts climbing and swinging. FSH, or follicle-stimulating hormone, is the signal that prompts the ovaries. It's still too erratic to pin down with one blood test. You may skip an occasional period here too, but you haven't reached the 60-day gaps of the next stage. Many women spend most of their transition in this stage. Our guide to how long perimenopause lasts covers the timeline.

Stage two: late perimenopause, once periods start skipping for real

Late perimenopause has its own clean threshold: a gap of 60 days or more with no period at all. That is the line between early and late. It isn't "periods are more irregular than before." It's a specific gap of about two months with nothing. Our guide to a late or missed period in perimenopause helps you read a single gap.

FSH runs higher here, often above 25 IU/L on a random blood test. Even that isn't reliable enough on its own to name your stage, because levels can swing hard from week to week. This stage is shorter than the first, lasting about one to three years on average. It's also, unhelpfully, when hot flashes and poor sleep tend to peak for many women.

How do you know which stage you're in right now?

It comes down to a question you can answer yourself. Is your period still coming, just at unpredictable times? Or has it been gone for two months or longer? If it's the first, you're most likely in early perimenopause. If it's the second, you're most likely in late perimenopause, nearer the end than the beginning.

A few stray irregular cycles with no real pattern aren't enough to call it early perimenopause. What matters is the pattern repeating across cycles. If you're unsure, track two or three cycles on a calendar or period app instead of relying on memory. That usually settles it.

What actually happens at the menopause stage itself?

In this model, menopause isn't really a stage. It's a single point that closes late perimenopause and opens postmenopause. You don't feel it arrive. You only know you've reached it by counting back once 12 months pass without bleeding. The date of your last period then becomes official. Any bleeding after that 12-month mark is a separate concern, and it deserves a prompt call to a doctor.

That boundary, and what shifts hormonally once you cross it, is covered in our perimenopause vs. menopause guide.

Postmenopause has its own early and late stages, too

Postmenopause isn't one flat stage that never changes. STRAW+10 splits it into early and late. Early postmenopause starts at your final period and usually lasts five to eight years. Researchers divide it into three parts.

• The first year: the 12 months with no period that confirm menopause
• The second year: FSH and estradiol are still changing fast
• The next three to six years: hormone levels settle into a low, steady baseline

Hot flashes are most likely in the first two of those years. Late postmenopause begins once hormones have settled, and it lasts for the rest of life. Changes in this stage come more from general aging, like bone density and heart health, than from hormone swings. Vaginal dryness and other genital and urinary symptoms become more common here. Most everyday guidance simply says early and late postmenopause, which is enough detail for daily life.

Can a hormone test tell you your exact stage?

Not reliably, which surprises many women. FSH and estradiol swing too much within the same week for one blood test to set a stage. The same woman can show a late-stage number one week and an early-stage number the next. That's why the staging model relies on your cycle pattern, not a lab value.

Testing still has a real role. It can back up what your cycle is telling you, and it can rule out look-alikes such as thyroid disease. Our breakdown of perimenopause tests covers what each one can and can't tell you, and when a hormone panel is worth ordering.

Does any of this apply after a hysterectomy or on hormonal birth control?

Not cleanly. STRAW+10's criteria are built entirely on menstrual bleeding. Anything that removes periods as a signal breaks the model's main tool.

• Hysterectomy with ovaries kept: your ovaries go through the same transition on roughly the usual schedule. But with no periods to track, the cycle criteria can't apply.
• Hormonal IUD: periods are often lighter, irregular or gone by design. That can hide the very changes the stages rely on.
• Combined birth control, meaning the pill, patch or ring: these create their own regular bleeding pattern. So a normal-looking cycle doesn't rule perimenopause in or out.
• Both ovaries removed: there's no gradual transition. Postmenopause starts right away, from the date of surgery.
• PCOS, or polycystic ovary syndrome: STRAW+10 says its cycle criteria don't apply, because cycles were irregular to begin with. See perimenopause vs. PCOS.

In these cases, symptoms like hot flashes, poor sleep and mood changes become more useful signals. So do your age and hormone results tracked over time, rather than a single test.