"Am I in menopause or not?" I get that question more often than any other, usually from women around 45 who notice their cycle going haywire but have no idea where they stand. The honest answer: menopause is not an on-off button, but a journey lasting years and unfolding in recognisable stages.
The beauty of knowing those stages is that you can place your own body better. Not to put yourself in a box, but to understand that what you feel is logical and belongs to a phase.
Why thinking in stages helps
Internationally, doctors use the so-called STRAW staging to describe the transition. It divides the reproductive lifespan into stages, based on your cycle and your hormones. You do not need to know those terms, but the idea behind them is useful: menopause unfolds gradually, and what is normal in one phase need not be in another. Thuisarts describes the transition as a process that lasts on average around four to seven years.
The five stages at a glance
| Stage | What happens | What you may notice |
|---|---|---|
| 1. Premenopause | Regular cycle, hormones still in balance | Usually little to nothing |
| 2. Early perimenopause | Cycle becomes irregular, oestrogen fluctuates | Variable periods, first hot flushes, poorer sleep |
| 3. Late perimenopause | Cycle skips more often, hormones fall | Long gaps, fiercer hot flushes, mood swings |
| 4. Menopause | The moment, confirmed in hindsight after 12 months without a period | Only recognised retrospectively |
| 5. Post-menopause | Oestrogen stays low and stable | Hot flushes often ease; focus on bones and heart |
Stage 1: premenopause
Your cycle is still regular and your hormones do their work as always. Some women notice subtle changes in mood or energy in the lead-up, but there are no real menopausal complaints yet.
Stages 2 and 3: perimenopause
This is the phase most women mean when they say "the change". Your oestradiol starts to fluctuate, your cycle becomes erratic, and complaints like hot flushes, sleep problems and irritability can appear. Those very fluctuations make testing tricky: one measurement says little, because tomorrow the value may be different. To go deeper into this period, read our comprehensive guide to perimenopause.
Stage 4: menopause itself
Strictly speaking, menopause is a single day: your very last period. The tricky part is that you only know for sure once twelve months have passed without bleeding. Until then, you cannot know whether another period is coming.
Stage 5: post-menopause
After this, your hormones stay at a low, calm level. The fiercest complaints ease for many women, but attention shifts to your bones and cardiovascular health, which become more vulnerable without oestrogen.
When does a test really add something?
In fluctuating perimenopause, a hormone test is usually not a reliable gauge. The NHG guideline for GPs states that the diagnosis of menopause rests mainly on complaints and cycle, not on a blood test. A test becomes more interesting when:
- you are younger than 40 and your periods stop (possible early menopause, where FSH and oestradiol are relevant);
- you have complaints that also fit a thyroid problem, such as fatigue (consider TSH);
- you want a broader picture of your hormonal and metabolic health, for example with a women's hormone panel.
Always discuss a test result with your GP. A number is a snapshot; your story is the whole picture.
Frequently asked questions about the stages
Can I skip stages?
No, the order is fixed, but the pace varies enormously. One woman spends years in late perimenopause, another moves through it relatively fast. Sometimes it seems a stage is skipped because the complaints are so mild you barely notice them.
Can I still get pregnant in perimenopause?
Yes. As long as you occasionally still ovulate, pregnancy is possible, even with an erratic cycle. Only after twelve months without a period are you officially post-menopausal. Discuss with your GP what this means for contraception.
Does the start of menopause differ per woman?
Greatly. Genetics play a role: women often reach menopause around the same age as their mother. Smoking, certain surgeries and some conditions can also bring the moment forward. If it begins before 40, discuss that with your doctor.
What changes physically in each stage?
Behind the complaints lies a hormonal logic. In premenopause, your eggs still mature regularly and your cycle is predictable. In perimenopause, the egg supply runs down, your ovaries respond less, and your oestradiol starts to fluctuate. Your FSH, the hormone that drives your ovaries, rises to compensate for that declining response. In post-menopause, FSH stays structurally high and your oestradiol low. That explains why testing hormones in stable post-menopause is more reliable than in fluctuating perimenopause.
Knowing where you stand brings calm
You do not have to label every stage precisely to feel better. But realising that menopause is a process with stages helps you be patient with yourself. What you feel today belongs to where you are now, and that will change again. If you suspect your thyroid as a cause of your complaints, read our guide to thyroid symptoms in women.
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Lunarahealth
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