The stages of the menopausal transition, explained

Perimenopause is the multi-year transition before the final menstrual period. It typically begins in the 40s (sometimes earlier) and lasts around 4 years on average, though the range is wide. Cycles change; vasomotor and other symptoms often appear.

Menopause itself is a point in time: the 12-month anniversary of the last menstrual period. The average age in the U.S. is around 51.

Postmenopause is every year after that anniversary. Some symptoms persist for years; others resolve. Long-term considerations — bone density, cardiovascular health, urogenital health — become more prominent.

STRAW+10 (Stages of Reproductive Aging Workshop) is the clinical framework that subdivides the transition into more granular stages based on cycle regularity, cycle length variability, and menstrual patterns. Late reproductive stages (–3b, –3a) show subtle cycle changes. Early menopausal transition (–2) shows cycle length variability of 7 days or more. Late menopausal transition (–1) includes intervals of amenorrhea of 60 days or more. Early postmenopause (+1a, +1b, +1c) is the first several years after the final period; late postmenopause (+2) is beyond.

Early menopause is between 40 and 45. Premature menopause (or primary ovarian insufficiency when spontaneous) is before 40 and carries different long-term considerations. Surgical menopause happens abruptly when both ovaries are removed.