Which stage of perimenopause am I in?

The stages come from the STRAW+10 staging system, which researchers and menopause societies drew up in 2011 and which most studies still use. It deliberately rests on bleeding patterns, because periods are something you can record yourself, while hormone tests vary from lab to lab. The finder asks what your periods have done lately and places you at the furthest stage your answers reach. It gives an estimate from what you tell it and cannot diagnose anything.

The stages, and the marker for each

STRAW+10 counts stages backwards and forwards from the final period, which it calls stage 0. These are the ones that matter in your late 30s, 40s and early 50s.

In everyday speech, "early perimenopause" means stage −2 and "late perimenopause" means stage −1. The −3a changes come before the transition officially starts, though many people notice them as the first sign. Our article on when perimenopause starts covers the ages each stage tends to arrive and how long the whole span lasts.

How the finder decides

It works down from the latest stage and stops at the first marker you meet. Twelve months or more since your last period puts you after the final period. Otherwise, a 60-day gap in the past year, or a current gap that is already that long, puts you at stage −1. If neither applies, a swing of a week or more that has happened more than once places you at stage −2. One swing on its own sits on the line between the late reproductive stage and the early transition, because STRAW+10 asks for a second swing within 10 cycles before it calls the change persistent. Shorter cycles with no swing match stage −3a. If none of these apply, your periods show no stage marker yet.

Hot flashes and night sweats do not move you between stages. STRAW+10 treats symptoms as supporting detail, since not everyone has them, though it notes vasomotor symptoms are most likely in the late transition. The finder mentions them in your result and leaves the stage to your periods. Your age is used the same way: it changes the advice, never the stage.

A worked example

Take someone aged 46 whose last period was five weeks ago. She has never gone two months without one. Over the past six months her cycles ran 27, 36, 25 and 33 days, and they used to be a steady 28. That is two jumps of 7 days or more (27 to 36, then 25 to 33) within four cycles, so the finder places her in the early transition, stage −2. Her shorter cycles also match −3a, but the finder reports the furthest stage reached. If her next period were 65 days away, she would move on to stage −1.

Not sure how much your cycles vary? The cycle length calculator takes your period start dates and counts every swing and gap for you, so your answers to questions 3 and 4 rest on real numbers.

When the stage cannot be read

Everything here depends on bleeding you can count. A combined pill, patch or ring sets your bleeds by the packet, and a hormonal coil or implant can make them light or stop them, which is why the NHS says hormonal contraception can hide the signs of perimenopause. After a hysterectomy or an endometrial ablation, or while you take HRT, there are no natural periods to count. Pregnancy and breastfeeding stop or change periods for their own reasons, and a missed period at 40-something can still be a pregnancy, as our page on pregnancy in perimenopause explains.

In any of those cases a doctor goes by symptoms and age. For people over 45, NICE guidance says perimenopause is recognised from symptoms and cycle changes without hormone tests, and an FSH test is kept for younger patients. The symptom checklist looks at the changes beyond your periods.

What the stage does not tell you

A stage describes timing. It says nothing about whether a particular bleed is normal. Bleeding between periods, after sex, a period lasting longer than a week, flooding, or any bleeding after 12 months without a period should be checked whatever stage you are in, according to ACOG. The bleeding checker sorts those signs by how soon to act.

My take

I'd start with the dates before the finder, and I'd judge the result by question 3 above all, because a two-month wait for a period is the easiest marker to recall. I'd treat the stage as an opening for a conversation with your doctor and bring dates rather than impressions. Question 4 is the hard one to answer from memory, and six months of start dates settle it. The printable symptom diary has a row for them, and Her Good Days, a free app, keeps your period dates and works out each cycle length and any gap of 60 days or more as you go. Then I'd run the finder again in three months, paying most attention to the first 60-day gap, since that move into the late transition is the one STRAW+10 links with hot flashes and night sweats.