Clinicians describe the menopausal transition in stages, most often using the STRAW+10 framework.[1] The early transition is marked by a persistent change in cycle length and the late transition by skipped periods. Menopause is recognized after 12 months without a period.[2] Symptoms can begin before cycles change, even while periods look regular.
Key Facts
- STRAW+10 is a staging system updated in 2011 from cohort studies of midlife women. It simplified the bleeding criteria for the early and late transition.[1]
- A study of 1,559 Korean women applying STRAW+10 defined the early transition as a persistent difference of seven or more days between consecutive cycles. It defined the late transition as 60 or more days without a period.[2]
- In SWAN (3,302 women), frequent hot flashes or night sweats lasted longest in women who first reported them while premenopausal or early perimenopausal.[3]
- The stage describes bleeding patterns. Symptoms are not part of the stage definition, so they can show up earlier or later than the stage suggests.[1]
What are the stages of perimenopause?
The table is an educational map of how researchers classify bleeding patterns into stages. Only a clinician can place you in a stage.
| Stage | Bleeding pattern used to define it |
|---|---|
| Late reproductive (Stage -3) | Regular menstrual cycles, not meeting the criteria below (this study grouped all earlier stages together).[2] |
| Early menopausal transition | Cycle length becomes variable: a persistent difference of seven days or more between consecutive cycles.[2] |
| Late menopausal transition (Stage -1) | An interval of 60 days or more without a period.[2] |
| Early postmenopause (Stage +1) | 12 or more months since the last period.[2] |
Menopause itself is a point in time, recognized in hindsight once 12 months have passed without a period. For the full range of how long each phase can last, see our guide on how long perimenopause lasts.
How was the staging system built?
STRAW stands for Stages of Reproductive Aging Workshop. The 2011 update, STRAW+10, revised the original 2001 criteria. Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women. They looked at markers such as antimüllerian hormone, inhibin-B, follicle-stimulating hormone and antral follicle count, and adopted modifications by consensus.[1] The update simplified the bleeding criteria for the early and late transition. It also adjusted the criteria for two other stages and added information on how long the late transition and early postmenopause last.[1] The authors recommended the system for all women regardless of age, ethnicity, body size or lifestyle.[1] The authors also named seven research priorities, a sign that staging is still being refined.[1]
Can symptoms start before the stage changes?
Yes, for some women. The stage describes your bleeding pattern, while sleep changes, mood changes, hot flashes and brain fog are not part of the definition. In SWAN, a multiracial cohort of 3,302 women, those who first reported frequent hot flashes or night sweats while premenopausal or early perimenopausal had them longest. The median duration was above 11.8 years.[3] That is observational data about hot flashes and night sweats specifically. Still, it shows why a woman can have symptoms while her periods still look regular. It is also why a doctor may tell you your cycle looks normal while you know something has changed. What you notice is still worth raising. Our guide to early perimenopause signs lists what women commonly report.
What else can change your periods?
Not every change in your cycle is perimenopause. In the SWAN menstrual calendar substudy of 1,320 midlife women, prolonged bleeding, spotting and heavy bleeding were associated with transition stage. They were also associated with uterine fibroids, hormone use and ethnicity, and body mass index was associated with heavy bleeding.[4] About 34.5% of women reported at least three occurrences of heavy bleeding lasting three days or more. That makes it common, but still worth discussing with a clinician.[4] A clinician looks at the whole picture before deciding what a change means. Hormone blood work is one input some clinicians consider, and our guide to blood tests in perimenopause explains when it comes up.
What can you do with this information?
Use the stages as a map, not a verdict. Many women find it useful to keep a dated record of cycle changes and symptoms, note when each began, and bring it to an appointment. Useful details include the first day of each period, how long it lasted, how heavy it was, and any skipped months. Add symptoms such as sleep, mood, hot flashes and focus, with dates. Treatment decisions, including hormone therapy, belong with you and your clinician. If you are wondering whether your own changes fit, start with am I in perimenopause. For the other end of the transition, see the signs perimenopause is ending.
When to See a Doctor
- Emergency, call 911: very heavy bleeding together with dizziness, fainting, or chest pain.
- Soon: very heavy bleeding that soaks through protection quickly, bleeding between periods that is new for you, or any bleeding after 12 months without a period.
- At your next appointment: cycle changes, skipped periods, or symptoms such as poor sleep, mood changes or brain fog that are affecting daily life, even if your periods are still regular.
What Peritale Maps
Peritale gives you an objective, comprehensive picture of how the hormonal transition is affecting you, with no blood tests and nothing invasive at home. Using AI and a simple seven-minute process on a standard smartphone, it maps the effects on your cognitive performance (reaction speed, word retrieval, attention), your hearing and vision, and dozens of markers that computer vision reads across your skin, hair, and eyes, all alongside comprehensive symptom mapping. You get a complete snapshot that becomes your baseline, so you can talk to your doctor about what is really bothering you, take charge of your care, and start to feel like yourself again. Your first mapping is free.
Stages describe bleeding patterns. The mapping records other signals: cognitive tasks for reaction speed, word retrieval and attention, hearing and vision tasks, and skin, hair and eye markers, alongside comprehensive symptom mapping. Repeating it over time builds a dated record of how those signals move through the hormonal transition. You can bring that record to the clinician who works out where you are in the transition.
Map it, track it, bring it to your doctor
What you are noticing is real and worth taking seriously. Map your cognitive, hearing and vision signals alongside comprehensive symptom mapping, follow your hormonal transition pattern over time, and walk into your appointment ready to ask for the care you deserve. Your first mapping is free.
Start My Free MappingThe Bottom Line
Perimenopause has recognized stages, defined mainly by changes in your bleeding pattern: variable cycles in the early transition, skipped periods in the late transition, and menopause after 12 months without one. The stages are a map that clinicians use, and symptoms do not follow them neatly. If something has changed for you, even with regular periods, it is worth a conversation with your clinician, and a dated record of what you notice makes that conversation easier.
This content is for educational purposes only. Peritale is a general wellness product, not a medical device. It is not intended to diagnose, treat, cure, or prevent any disease. Always consult a qualified healthcare provider for medical advice.
Sources
- Harlow SD, Gass M, Hall JE, et al; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Journal of Clinical Endocrinology and Metabolism. 2012;97(4):1159-1168. PubMed
- Ryu S, Suh BS, Chang Y, et al. Menopausal stages and non-alcoholic fatty liver disease in middle-aged women. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2015;190:65-70. PubMed
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531-539. PubMed
- Paramsothy P, Harlow SD, Greendale GA, et al. Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women's Health Across the Nation (SWAN): a prospective cohort study. BJOG. 2014;121(12):1564-1573. PubMed
Citations are provided so you can read the primary science yourself. This list is a starting point, not a complete review, and does not constitute medical advice.