The stages of perimenopause (STRAW+10), explained simply
Doctors split perimenopause into two stages using the STRAW+10 system. In early perimenopause, the length of your cycles starts to vary — consecutive cycles differ by seven days or more. In late perimenopause, you start skipping periods — gaps of 60 days or more. Menopause is reached 12 months after the last period. Your stage depends on your cycles, not on a blood test.
What STRAW+10 is
STRAW+10 (Stages of Reproductive Aging Workshop + 10) is the reference system researchers and clinicians use to describe where a woman is in reproductive ageing. It was updated in 2011 and published in 2012. Its main criterion is the menstrual cycle, because hormone tests swing too much in perimenopause to be reliable on their own.
The stages around the transition
| STRAW+10 stage | Name | Main criterion | Typical experience |
|---|---|---|---|
| −3a | Late reproductive | Cycles still regular, subtle changes in flow or length | Slightly shorter cycles, PMS may worsen |
| −2 | Early menopausal transition (early perimenopause) | Persistent difference of 7+ days in length of consecutive cycles | Cycles become unpredictable; sleep and mood changes common |
| −1 | Late menopausal transition (late perimenopause) | 60+ days without a period | Skipped periods, hot flushes become frequent |
| +1a | Early postmenopause (first year) | 12 months since final period | Menopause confirmed; hot flushes often still strong |
| +1b/+1c | Early postmenopause | 1–2 years, then 3–6 years after | Hormones settle; flushes fade for many |
| +2 | Late postmenopause | 6+ years after | Vaginal and bone health become the focus |
"Persistent" in stage −2 means the variation happens again within 10 cycles — one odd cycle does not change your stage.
How long each stage lasts
There is a lot of variation. Early perimenopause can last a few years; late perimenopause is usually shorter — commonly one to three years. Overall perimenopause lasts about four years on average. Smoking tends to bring menopause earlier, and your mother's age at menopause is one of the strongest predictors of yours.
Working out your own stage
You need three facts:
- Age — the transition usually starts in the 40s.
- Date of your last period.
- How your cycles have behaved over the past year — about the same length, varying by a week or more, or with gaps of two months or more.
| Your answers | Likely stage |
|---|---|
| Regular cycles, under 45, few symptoms | Reproductive / late reproductive |
| Cycles vary by a week or more | Early perimenopause |
| A gap of 60+ days in the last year | Late perimenopause |
| No period for 12+ months | Postmenopause |
MenoShift turns these three answers into your stage on the first screen, tells you how confident the estimate is, and updates it as you log periods.
When staging by cycles doesn't work
Cycle-based staging doesn't apply if you've had a hysterectomy or endometrial ablation, use a hormonal IUD, or take combined hormonal contraception. Then age and symptoms are the guide, and clinicians sometimes use FSH tests (most useful under 45). STRAW+10 also notes that conditions like polycystic ovary syndrome, very low body weight or chemotherapy can change the picture.
MenoShift turns a 20-second daily check-in, your cycle and your Apple Watch nights into a plain explanation of the day — with the source. No account; nothing leaves your phone.
Download MenoShift on the App StoreFAQ
What's the difference between early and late perimenopause?
Early perimenopause is defined by cycle lengths that vary by seven days or more; late perimenopause by gaps of 60 days or more between periods. Hot flushes are typically more frequent in the late stage.
Can I go back from late to early perimenopause?
Cycles can become more regular for a while, but staging follows the overall direction of change. A gap of 60+ days places you in late perimenopause even if the next few cycles look normal.
Is there a test for my perimenopause stage?
Not a single reliable one. Hormone levels fluctuate daily. The validated approach is the cycle-based STRAW+10 criteria together with age and symptoms.
Does my stage tell me when menopause will happen?
Only roughly. Late perimenopause usually means menopause within a few years. Your mother's age at menopause and smoking also shift the timing.
Sources: Harlow SD et al., Executive summary of STRAW+10, Menopause 2012; NICE guideline NG23; SWAN (Study of Women's Health Across the Nation).
Related
This guide is general information, not medical advice. If symptoms worry you — especially bleeding after 12 months without a period, very heavy bleeding, or chest pain — see a clinician.