The Stages of Menopause Explained: Premenopause to Postmenopause

Menopause is usually described in three stages. Perimenopause is the transition, when hormones fluctuate and periods change. Menopause is the single point 12 months after your final period. Postmenopause is everything after that. Perimenopause and postmenopause are each split into earlier and later phases, with different symptoms and health priorities.

What are the stages of menopause?

The most widely used framework for describing reproductive ageing is STRAW+10, from the Stages of Reproductive Aging Workshop. It divides adult life into three phases: the reproductive years, the menopausal transition and postmenopause. These are split into stages centered on the final menstrual period.

In everyday language, most people and health services use four terms:

For a full overview, see what menopause is.

Stage 1: Premenopause (the reproductive years)

"Premenopause" usually means the years before perimenopause begins. Cycles are typically regular, although fertility starts falling from around 30 and more steeply after the mid-30s.

Late in this stage, subtle changes begin. Follicle-stimulating hormone (FSH) starts to creep up and cycles may shorten slightly, often before anything obvious is noticed.

Stage 2: Perimenopause (the menopausal transition)

Perimenopause usually begins in the mid-to-late 40s and lasts about four years on average before periods stop. It can be much shorter or longer. STRAW+10 divides it into two stages.

Early perimenopause

• Cycle pattern: Cycle length changes by seven days or more compared with your usual pattern, and this happens again within 10 cycles.
• Hormones: Estrogen swings, sometimes higher than usual, and ovulation becomes less reliable.
• What you might notice: Periods arriving earlier or later, changes in flow, worse premenstrual symptoms, sleep or mood changes.

See the early signs of perimenopause.

Late perimenopause

• Cycle pattern: At least one gap of 60 days or more without a period.
• Typical length: One to three years.
• Hormones: Ovulation becomes uncommon and estrogen begins a sustained fall.
• What you might notice: More skipped periods, and hot flashes (called hot flushes in the UK) and night sweats becoming more likely.

You can still get pregnant throughout perimenopause. See pregnancy during perimenopause. For the full timeline, see how long perimenopause lasts and our perimenopause guide.

Stage 3: Menopause

Menopause is a single point: the date 12 months after your final period, when there is no other cause for periods stopping. The WHO notes this generally happens between 45 and 55 worldwide.

Because it can only be recognized looking back, many people don’t know exactly when they reached it. Hormonal contraception, a hormonal IUD, hormone therapy or a hysterectomy can all make it harder to tell. See how to know when menopause has started.

Stage 4: Postmenopause

Postmenopause lasts the rest of your life. STRAW+10 splits it into early and late phases.

Early postmenopause

This covers roughly the first five to eight years after the final period.

• Hormones: FSH continues to rise and estrogen falls further, reaching its lowest levels about one to two years after the final period.
• Symptoms: Hot flashes and night sweats are often most noticeable in the years around the final period. In the SWAN study, frequent hot flashes continued for a median of 4.5 years after the final period.
• Bones: SWAN found bone density falls fastest in a roughly three-year window around the final period, by about 2% a year.
• Body composition: Fat gain accelerates and lean muscle declines until about two years after the final period, then levels off.

Late postmenopause

This is the rest of life after early postmenopause.

• Hormones: Hormone levels settle at their new, stable levels.
• Symptoms: Hot flashes usually fade for most people, although some have them for many years.
• Genitourinary changes: Vaginal dryness, discomfort during sex and urinary symptoms often persist or become more noticeable, because they tend not to improve without treatment. See vaginal dryness and urinary changes.
• Long-term health: Bone density, heart health and muscle strength become increasingly important.

For how long individual symptoms tend to last, see how long menopause symptoms last.

How do the stages compare?

These stages come from research frameworks. They describe typical patterns, not rules. Many people do not fit neatly into any one stage.

What if you skip stages?

Not everyone goes through the gradual transition:

• Surgical menopause: If both ovaries are removed before menopause, you move straight into postmenopause, with symptoms that often start within days. See surgical menopause.
• Medical menopause: Chemotherapy or pelvic radiotherapy can bring on menopause suddenly, sometimes temporarily.
• Early menopause and premature ovarian insufficiency: The stages happen much earlier than average, before 45 or before 40. See early menopause.
• Little cycle change: Research summarized by the US Centers for Disease Control and Prevention found 12% to 25% of women have little or no change in cycle length before their final period.

Which stage am I in?

A rough guide, if you are not using hormonal contraception or HRT:

• Regular cycles and no symptoms: probably still in your reproductive years
• Cycles varying by a week or more, or new symptoms in your 40s: possibly early perimenopause
• Gaps of two months or more between periods: possibly late perimenopause
• No period for 12 months: menopause has been reached; you are now postmenopausal

Hormone tests cannot reliably pinpoint your stage, because levels swing so much in perimenopause. A record of your periods and symptoms is more useful. If you use hormonal contraception, a hormonal IUD or HRT, ask your clinician how to judge your stage.

What care matters at each stage?

• Perimenopause: Contraception, managing bleeding changes, treating symptoms that affect your life, and noting anything unusual about bleeding.
• Early postmenopause: Symptom relief, bone health, blood pressure, cholesterol and diabetes checks, and deciding about treatment while benefit-risk profiles are most favorable. The Menopause Society notes hormone therapy’s benefits generally outweigh the risks for people under 60 or within 10 years of menopause without contraindications.
• Late postmenopause: Vaginal and urinary health, bone density, heart health, muscle strength, screening, and reviewing any ongoing treatment.

At any stage, get checked promptly for:

• Any vaginal bleeding 12 months or more after your final period
• Bleeding after sex or between periods
• Very heavy bleeding
• Periods that stop before age 40

Frequently asked questions

How many stages of menopause are there?

Most sources describe three: perimenopause, menopause and postmenopause. Some add premenopause as a fourth, and research frameworks divide perimenopause and postmenopause into early and late stages.

Which stage of menopause is the worst?

It varies. Many people find late perimenopause and early postmenopause hardest, as hot flashes and sleep problems often peak then. Others find the unpredictability of early perimenopause most difficult.

Can you go back to an earlier stage?

Periods can return after a long gap during perimenopause, which is why you need 12 full months without a period to confirm menopause. Once you are postmenopausal, you don’t return to earlier stages. New bleeding after menopause should always be checked.

Is postmenopause the same as menopause?

Not quite. Menopause is the single point 12 months after your final period; postmenopause is the time after that. In everyday language the terms are often used interchangeably.

Does my stage affect which HRT I’d be offered?

Often, yes. A cyclical regimen, which gives a monthly bleed, is commonly used during perimenopause or within about a year of your last period. A continuous regimen, designed to be bleed-free, is usually used once you are postmenopausal. Using the wrong regimen for your stage is a common cause of unexpected bleeding.

References

1. Harlow SD et al. Executive summary of STRAW+10 (2012), via ASRM
2. NEJM Journal Watch: Codifying the stages of reproductive aging (STRAW+10)
3. World Health Organization: Menopause fact sheet
4. US Office on Women’s Health: Menopause basics
5. ACOG: Having a baby after age 35: how aging affects fertility
6. Endocrinology of the menopause (review)
7. Avis NE et al. Duration of menopausal vasomotor symptoms. JAMA Internal Medicine, 2015
8. SWAN fact sheet: Bone health over the menopause transition
9. SWAN: Changes in body composition and weight during the menopause transition
10. CDC Stacks: Menstrual cycle changes as women approach the final menses
11. Prevalence of psychosomatic and genitourinary syndrome among menopausal women: systematic review
12. The 2022 hormone therapy position statement of The North American Menopause Society
13. NHS: Hysterectomy: considerations
14. Leeds Teaching Hospitals NHS Trust: HRT and unscheduled vaginal bleeding

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.