Where are you in the menopause transition?
Most women find out they have reached menopause about a year after it happened, because the definition is retrospective. Before that point you are somewhere in a transition that clinicians break into stages, each one with its own cycle pattern and its own rough timetable. Tell the form your age, when you last bled and how your cycles have shifted, and you will see which stage fits and roughly how much of it is left to run. This assessment on Find The Norm uses the STRAW+10 clinical staging system (Harlow et al. 2012, Journal of Clinical Endocrinology and Metabolism) to classify your menopause stage relative to the five-stage clinical framework.
Querying population data…
Are you in perimenopause?
Rate your symptoms on the MRS scale.
What is the STRAW+10 staging system?
STRAW+10 is the staging system clinicians and researchers use to describe where a woman sits in reproductive ageing, published by the Stages of Reproductive Aging Workshop in 2012 and built on seven stages, five in the reproductive period and two after it, defined mainly by what your cycles are doing. Hormonal markers such as FSH and AMH support the staging and do not drive it. The 2012 revision widened the criteria to cover women with irregular cycles and conditions such as PCOS, who the earlier version could not place at all. What the system is for is decisions about contraception and about whether HRT is appropriate, which is why a clinician wants your stage before anything else.
What are the typical ages for each stage?
SWAN, the multi-ethnic US cohort of 3,302 women, puts the median onset of early perimenopause at about 47.5 years, late perimenopause at 49.4 years and the final menstrual period at 51.4 years, and those three medians are the spine of every stage boundary here. Those medians hide a wide spread, because the normal range for menopause runs from 44 to 58 years, so a woman who finishes at 45 and a woman still cycling in her mid fifties are both ordinary. Below 40 the label changes to premature ovarian insufficiency, and between 40 and 45 to early menopause, and both of those warrant investigation rather than reassurance. Ethnicity moves the timing as well, with Black and Hispanic women in SWAN reaching menopause slightly earlier than white and Asian women, and the age-stratified onset figures sit on the health statistics page. Your menstrual cycle length is the input the staging leans on hardest.
How long does perimenopause last?
Perimenopause usually runs 4 to 8 years, with SWAN reporting a median symptomatic duration of about 4 years, though the full stretch from the first hormonal change to a confirmed final period can be longer than either figure on its own suggests. Early perimenopause can span 2 to 6 years and often passes unnoticed, since a cycle that turns up a week early reads as ordinary life rather than as a stage change. Late perimenopause, the skipped-period phase where symptoms sharpen, tends to last 1 to 3 years, and the perimenopause quiz puts a number on symptom burden using the validated MRS scale. Starting before 45 tends to mean a longer transition overall. One thing worth tracking throughout is blood pressure, which commonly climbs in late perimenopause and early postmenopause.
Frequently asked questions
Menopause itself lasts a day. It is the point 12 months after your last period, dated backwards once the year has passed. What people mean by the question is the whole transition, and SWAN puts its median at 7.4 years with a range from under 2 years to more than 14. Hot flushes and night sweats run a median 7.4 years too, and 29% of women get them for 10 years or more.
Five stages carry the useful detail. Early perimenopause (stage -2) starts when your cycles begin shifting by 7 or more days. Late perimenopause (stage -1) arrives with a gap of 60 or more days. The final menstrual period (stage 0) can only be confirmed 12 months later. Early postmenopause (stage +1) covers roughly the first 6 years after that date, and late postmenopause (stage +2) runs from there on.
The median final period falls at 51 years in the UK (NHS and BMS figures) and 51.4 years in the US (SWAN), with the 5th to 95th percentile range running from 44 to 58 years. Before 40 it counts as premature ovarian insufficiency, affecting around 1% of women, and between 40 and 45 it is early menopause, at roughly 5%. Smoking pulls the date forward by 1 to 2 years. Population figures sit on the health statistics page.
Both supply hormones, which means your bleeding pattern stops reporting what your ovaries are doing. STRAW+10 stages you on cycle behaviour, so a withdrawal bleed on the pill or on cyclical HRT says nothing about where you actually are. Blood tests do not rescue it, because FSH only ever supports a stage rather than settling one. Most clinicians fall back on your age and on the symptoms you had before you started.
Yes, right up until menopause is confirmed by 12 consecutive months without a period. Ovulation gets erratic rather than stopping, and natural conception in the mid-40s is estimated at under 5% per cycle, which is low and is still above zero. The Royal College of Obstetricians and Gynaecologists advises carrying on with contraception until 55, or for 2 years after the last period if you are under 50 and 1 year if you are over. HRT does nothing to prevent pregnancy.
Clinicians read your cycles first. Regular cycles mean premenopause. Once they start shifting by 7 or more days you are in early perimenopause, and a gap of 60 or more days moves you to late perimenopause. Bloods come second and never settle it alone. FSH above 25 IU/L points to late perimenopause, and consistently above 30 to 40 IU/L points to postmenopause. In the UK most GPs diagnose women over 45 on age and symptoms without testing at all.
Yes, and SWAN found the gaps are wide. Black and African American women reach menopause about 1.5 years earlier on average and carry hot flushes and night sweats for a median 10.1 years, longer than any other group in the study. Japanese American women finish later, at a median 52.0 years, with shorter symptom duration. Chinese American women match white women on age while reporting fewer vasomotor symptoms. Income, BMI and smoking do not account for the gaps.
Perimenopause is the run-up, with hormones swinging, cycles changing and symptoms such as hot flushes and broken sleep. Menopause is one retrospective date, the day 12 months have passed since the last period, and everything after it is postmenopause. Someone who says they are going through menopause almost always means perimenopause or early postmenopause. The wording matters because what helps, and what a clinician will offer, differs by stage.
- Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop +10. Journal of Clinical Endocrinology & Metabolism. 2012;97(4):1159-68. DOI: 10.1210/jc.2011-3362
- Study of Women's Health Across the Nation (SWAN). Longitudinal multi-ethnic cohort, N=3,302. swanstudy.org.
- Avis NE et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531-539. DOI: 10.1001/jamainternmed.2014.8063
- North American Menopause Society. Clinical practice guidelines. menopause.org.
- NHS. Menopause: overview and treatment options. nhs.uk/conditions/menopause.
- British Menopause Society. Staging of the menopause. thebms.org.uk.