The stages of menopause, in plain words

"Which stage of menopause am I in?" is one of the most common questions women ask Google in the Philippines. It is a good question, because the stage changes what you can expect and what makes sense to try.

Doctors and researchers use a framework called STRAW+10 (Stages of Reproductive Aging Workshop, updated in 2012). Its big idea is simple: your bleeding pattern tells you more than a hormone test. The STRAW+10 authors recommended applying it regardless of age, ethnicity, body size or lifestyle, so it works for Filipinas too.

Below is our plain-language version. For a quick personal estimate, use the stage finder: enter your age and how your periods have changed, and it shows your likely stage on a timeline.

Your periods still come on schedule, but subtle things start to shift. In STRAW+10 the later part of the late reproductive stage is where cycles begin to change subtly, mainly by getting a little shorter, and early-cycle FSH starts to rise and vary, even though most women would still call themselves regular.

What you might notice: not much. Perhaps slightly shorter cycles, or premenstrual symptoms that hit harder than they used to.

This matters because it breaks a popular folk rule. Many people believe perimenopause only starts after a year of irregular periods. In fact the change can begin while you are still regular. We explain this on Menopause na ba ako?.

This is the start of the menopausal transition. In STRAW+10, early transition means a persistent difference of 7 days or more in the length of back-to-back cycles, happening again within 10 cycles. For example, 24 days, then 33, then 26.

Periods still come. They are just unpredictable. Flow can get heavier or lighter. FSH tends to rise, but it swings so much that a single test is not reliable, which is why NICE advises diagnosing perimenopause without blood tests in women over 45 with typical symptoms.

Common symptoms at this stage: poorer sleep, mood changes, the first hot flashes, brain fog. See perimenopause for the full picture.

In STRAW+10 the late transition starts when you go 60 days or more without a period. "Minsan 2 months wala," as one Filipina on r/kwarentahin described it.

This stage lasts on average 1 to 3 years, and STRAW+10 says it is when vasomotor symptoms (hot flashes and night sweats) become likely. Many women find this the hardest stretch: long gaps, then a sudden heavy period, plus poor sleep from night sweats.

You can still get pregnant in this stage. Keep using contraception until your doctor says you can stop. UK FSRH guidance counts women as possibly fertile for 2 years after the last period if under 50, and 1 year if 50 or over. Our sister site Birth Control Philippines covers options in your 40s.

Menopause is the moment 12 months have passed since your last period. WHO calls this natural menopause when there is no other cause, such as pregnancy, a medicine or surgery. You only know the date in hindsight.

Most women reach it between 45 and 55 (WHO). A 2012 study of Filipino women found an average of 48.9 years. More on timing on our menopause age page.

Postmenopause is every year after menopause. STRAW+10 splits the early years into substages: the first year after your final period (which also closes perimenopause), a further year when FSH and estradiol are still changing fast, and then about 3 to 6 more years when FSH stays high and estrogen stays low. Early postmenopause as a whole lasts about 5 to 8 years.

Hot flashes often continue in these early years. This is also when bone loss speeds up. WHO notes that loss of bone density at menopause is a major contributor to osteoporosis and fractures. A DXA scan may make sense; see bone density test.

The rest of life. Hot flashes fade for most women, though some keep them for years. Symptoms tied to low estrogen in the vagina and bladder (GSM: dryness, pain with sex, urgency, repeated urine infections) tend to slowly get worse rather than better.

The good news: low-dose vaginal estrogen works well, and The Menopause Society (2022) says it can be used at any age and long term. Bones and heart need ongoing attention. WHO notes that women's advantage over men in heart disease gradually disappears after menopause.

There is no single moment, but these are the usual signs that you are near the end of the transition:

• Longer gaps between periods. Skipping periods for 60 days or more is the marker of late perimenopause, and the final period is usually not far away.
• Lighter, shorter periods, though a surprise heavy one can still happen.
• Hot flashes peak. STRAW+10 says vasomotor symptoms are likely in late perimenopause and most likely in the first 2 years or so after the final period.
• 12 months with nothing. Once you pass a full year with no bleeding, perimenopause is over and you are postmenopausal.

One important rule: after 12 months without a period, any bleeding is not "one last period". It needs a check-up. Read bleeding after menopause.

Some women cannot use their bleeding pattern as a guide, for example after a hysterectomy, while using a hormonal IUD or pills, or with conditions such as PCOS that already make cycles irregular. In these cases your doctor will go by your age and symptoms, and may sometimes use blood tests.

If you are under 45 and your periods are changing, or under 40 and they have stopped, do not wait it out. See a doctor and read early menopause, or try our early menopause check. PCOS overlap is covered on our sister site PCOS Philippines.