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Stages of menopause
Menopause doesn't happen overnight. These are the stages doctors use, from the first changes to the years after your last period.
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The three stages
These are the common terms used to describe the stages of menopause.
-
PerimenopauseAlso called the menopausal transition
The time before the menopause when the body starts going through changes. These changes may start 5 to 7 years before menopause.
Until 1 year after the last period -
Menopause
A woman is considered to be in the menopause when she has not had her periods for one full year.
No period for 12 months -
Postmenopause
The period of time from the last menstrual period until the end of her lifespan.
The rest of life
What happens in the perimenopause
During the perimenopause, a woman may experience irregular periods, hot flushes, night sweats, tiredness, sleep disturbances, mood swings and brain fog.
A woman is in the perimenopause until one year after her last period. She is then in her menopause. See the full range of perimenopause symptoms.
- Irregular periods
- Hot flushes
- Night sweats
- Tiredness
- Sleep disturbances
- Mood swings
- Brain fog
When menopause comes earlier, later or suddenly
Premature ovarian insufficiency (POI)
When menopause occurs before the age of 40. This may happen naturally, surgically (when both ovaries are removed) or be induced (by chemotherapy or radiotherapy for cancer). Other factors can also cause POI.
About POIEarly menopause
When menopause occurs between 40 and 44 years of age.
What affects the age of menopauseLate menopause
When periods go on beyond the age of 55. Women who reach menopause late may have an increased risk of breast and uterine problems.
Surgical menopause
When both ovaries are removed by surgery before menopause. Symptoms of surgical menopause can be abrupt and more severe.
About surgical menopauseThe STRAW+10 classification
Doctors and researchers use the STRAW+10 system (Stages of Reproductive Aging Workshop + 10) to describe each stage of a woman's reproductive life in more detail. The stages are based mainly on changes in the menstrual cycle, supported by hormone levels and ultrasound findings. Stage 0 is the final menstrual period (FMP).
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| Menarche (first period) | Final menstrual period (FMP, stage 0) | |||||||||
| Stage | −5 | −4 | −3b | −3a | −2 | −1 | +1a | +1b | +1c | +2 |
|---|---|---|---|---|---|---|---|---|---|---|
| Terminology | Reproductive | Menopausal transition | Postmenopause | |||||||
| Phase | Early | Peak | Late | Early | Late | Early | Late | |||
| Perimenopause | Perimenopause | |||||||||
| Duration | Variable | Variable | 1–3 years | 2 years (1+1) | 3–6 years | Remaining lifespan | ||||
| Principal criteria | ||||||||||
| Menstrual cycle | Variable to regular | Regular | Regular | Subtle changes in flow or length | Variable length: persistent difference of 7 days or more in the length of consecutive cycles | Interval of amenorrhoea (no periods) of 60 days or more | ||||
| Supportive criteria | ||||||||||
| FSH (hormone) | Variable* | ↑ Variable* | ↑ >25 IU/L** | ↑ Variable | Stabilises | |||||
| AMH | Low | Low | Low | Low | Low | Very low | ||||
| Inhibin B | Low | Low | Low | Low | Low | Very low | ||||
| Antral follicle count | Low | Low | Low | Low | Very low | Very low | ||||
| Descriptive characteristics | ||||||||||
| Symptoms | Vasomotor symptoms likely | Vasomotor symptoms most likely | Increasing symptoms of urogenital atrophy | |||||||
* Blood test taken on cycle days 2 to 5. ↑ = raised. ** Approximate level based on assays using the current international pituitary standard. Stage 0, the final menstrual period (FMP), falls between stages −1 and +1a. FSH = follicle-stimulating hormone. AMH = anti-Müllerian hormone. Vasomotor symptoms = hot flushes and night sweats.
Sources
- Adapted from: Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(4):387–395. doi:10.1097/gme.0b013e31824d8f40
Keep learning
Signs & symptoms
From hot flushes and irregular periods to brain fog and joint pains.
Read morePremature ovarian insufficiency
When menopause happens before the age of 40.
Read moreSurgical menopause
When both ovaries are removed before menopause.
Read moreWorried about your symptoms?
Your doctor can help you work out what is going on and talk you through your options.