The STRAW+10 stages

STRAW+10 is the clinical staging system endocrinologists use to describe a woman's reproductive transition. It runs from peak reproductive years through late postmenopause. Knowing your stage helps frame what symptoms are typical and what treatments tend to fit.

Reference: Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop +10. Menopause. 2012;19(4):387–95.

• Late reproductive

  STRAW minus3b · age late 30s–early 40s

  The final stage of full reproductive function. Cycles are regular but fertility is declining and subtle hormonal shifts can begin.

• Early perimenopause

  STRAW minus2 · age 40–46

  Cycles become more variable — at least 7 days difference between consecutive cycles. Hot flashes and sleep changes can start here.

• Late perimenopause

  STRAW minus1 · age 45–55

  Cycles become highly irregular with intervals of 60+ days between periods. Hot flashes are usually frequent. Most women in this stage are within 1–3 years of their final menstrual period.

• First year postmenopause

  STRAW plus1a · age 48–56

  The 12 months following your final menstrual period. Vasomotor symptoms typically peak in this window.

• Early postmenopause

  STRAW plus1b · age 49–60

  The first several years after menopause. Vasomotor symptoms gradually decline for most women, though some persist for a decade or more.

• Late postmenopause

  STRAW plus2 · age 60+

  More than 6 years past the final menstrual period. Vasomotor symptoms typically have resolved or are markedly reduced; concerns shift toward bone, cardiovascular, and genitourinary health.