Stages of menopause: perimenopause vs menopause vs postmenopause

Name: Stages of menopause: perimenopause vs menopause vs postmenopause
Creator: MenoWoman

The three stages of menopause are perimenopause (the transition, when periods become irregular), menopause (your final period, confirmed after 12 months without one) and postmenopause (every year after). Perimenopause vs menopause comes down to this: in perimenopause you still have periods, however irregular.^1,2

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor about very heavy bleeding, bleeding between periods or after sex, or periods less than 21 days apart.⁶ Any bleeding after 12 months without a period needs checking soon.⁹ Irregular periods in your early 40s or younger should also be assessed.¹

What is menopause? The 12-month rule

Menopause is the end of your periods, caused by the ovaries losing their egg-producing follicles and making less estrogen.² It is a single point in time, not a long phase.

You can only know it happened looking back. Doctors confirm menopause after 12 months in a row with no period, when nothing else, such as a medicine or illness, explains it.^2,1 The average age is about 51 to 52.^3,4 See average age of menopause.

Natural menopause usually happens between 45 and 55 worldwide.² It can also be brought on at any age by removing both ovaries, or by chemotherapy or radiation. This is called induced menopause.^2,3

The three stages in plain terms

Perimenopause: starts when cycle length begins to change and ends one year after the final period.³ It lasts about four years on average, but up to eight or more.^1,3
Menopause: the final period, confirmed after 12 months.¹
Postmenopause: the rest of life after that point.⁷

People often say "menopause" for the whole process, or "going through menopause" for perimenopause. That is fine in everyday speech, but doctors use the narrower meaning.

The STRAW+10 staging system

Doctors and researchers use a more detailed system called STRAW+10, published in 2012. It is based mainly on bleeding patterns, with hormone tests as support.⁵

Late reproductive (stage -3): periods still regular; subtle shortening of cycles may begin.⁵
Early menopausal transition (stage -2): cycle length varies by 7 days or more, again and again.^5,6
Late menopausal transition (stage -1): gaps of 60 days or more between periods. This stage lasts about 1 to 3 years.⁵
Final menstrual period (stage 0).⁵
Early postmenopause (stage +1): hormones change fast for about two years, then settle. This stage lasts about 5 to 8 years in all.⁵
Late postmenopause (stage +2): few further hormone changes; general aging matters more.⁵

The authors say STRAW+10 applies regardless of age, ethnicity or body size. It works less well after a hysterectomy or endometrial ablation, with polycystic ovary syndrome (PCOS), or with premature ovarian insufficiency.⁵

Menopause vs postmenopause

Menopause is the moment; postmenopause is everything after it. In practice, once you pass the 12-month mark you are both "through menopause" and postmenopausal.^1,7

STRAW+10 counts the first 12 months after the final period as part of perimenopause as well as early postmenopause. That is why perimenopause is said to end one year after the last period.^5,3

Pregnancy is no longer possible naturally after menopause.⁴ UK NHS guidance still advises contraception until 2 years after the last period if you are under 50, or 1 year if over 50.¹⁰ Most symptoms ease in postmenopause, but risks to bones and heart rise.¹

Hormone changes and special cases

Through the stages, FSH rises and becomes more variable, while AMH falls until it cannot be measured.⁵ Estradiol keeps falling for about two years after the final period, then levels settle.⁵

Some women do not follow the usual path. Removing both ovaries causes an immediate menopause.⁴ After a hysterectomy, periods stop, so stage cannot be judged by bleeding; STRAW+10 suggests using symptoms and blood tests instead.⁵ Menopause before 40 is a separate condition; see early menopause and POI.

Symptoms by stage

In early perimenopause, periods may still be fairly regular. Some women notice occasional hot flashes around a period, poor sleep or weight gain.¹ In late perimenopause, periods may be skipped for months and then return heavy.¹

Hot flashes and night sweats are most likely in the late transition and the first two years after the final period.⁵ Mood changes, brain fog and fatigue are common across the transition.⁴

Later in postmenopause, vaginal dryness and urinary symptoms become more common.⁵ Bone loss and heart risk rise after menopause.⁷ See bone loss, and for treatment by symptom, the hormone therapy and vaginal estrogen pages.

How do I know which stage I am in?

Track your periods. If you still have periods, even irregular ones, you are likely in perimenopause. If you have gone 12 months without one, you have reached menopause and are now postmenopausal.¹

For women over 45, NICE says diagnosis can be based on symptoms and periods alone, without blood tests.⁸ Hormone levels swing in perimenopause, so tests can mislead; see are at-home menopause tests accurate?.

Staging is harder if you use hormonal contraception, have had a hysterectomy, or have a hormonal coil.^8,5 A doctor can help. Pregnancy is still possible in perimenopause, even when periods are irregular. If you do not want to become pregnant, keep using contraception until a doctor advises you it is safe to stop.⁶ UK NHS guidance notes that HRT is not a contraceptive.¹⁰

Cleveland Clinic advises talking to a doctor about irregular periods if you are in your early 40s or younger, as this can be a sign of early menopause or premature ovarian insufficiency.¹

Common myths about the stages:

Myth: menopause lasts for years. Fact: menopause is a single point, your final period. The years of change around it are perimenopause and postmenopause.^1,2
Myth: once periods become irregular, you cannot get pregnant. Fact: pregnancy is still possible until menopause is confirmed.^6,10
Myth: a blood test can tell you your stage. Fact: for women over 45, NICE bases diagnosis on symptoms and periods, not tests.⁸

Questions you may want to ask your doctor:

Which stage do you think I am in, and why?
Do my symptoms need treatment now, or tests to rule out other causes?
When can I safely stop contraception?

What it is used for: evidence rated

Option	Evidence	What the research shows
Hormone therapy for hot flashes (perimenopause and early postmenopause)	Strong evidence	Usually considered within 10 years of menopause or before 60.⁷
Vaginal estrogen for later vaginal and bladder symptoms	Strong evidence	NICE advises offering it for as long as symptoms need relief.⁸
Period diary to identify your stage	Some evidence	Rated some: STRAW+10 and NICE both base staging mainly on bleeding patterns, not tests, though diaries themselves are rarely studied.^5,8
Strength and weight-bearing exercise after menopause	Some evidence	Advised to support bone density as bone loss speeds up after menopause.⁷
At-home FSH tests	Weak evidence	FSH swings in perimenopause, and NICE does not use it for women over 45.⁸

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.