Perimenopause, menopause, postmenopause: what do the stages mean?

Summary

Menopause is a single moment. It is diagnosed looking backwards, once twelve months have passed since your last period. The years before it, when cycles become irregular and symptoms begin, are perimenopause; the years after are postmenopause. The stages are not a disease classification but a map for understanding where your body is. The stage Lumia shows you is an estimate, not a diagnosis.

What is happening?

The ovaries work with a limited reserve of eggs you are born with. When that reserve drops noticeably in your forties, ovulation becomes irregular and the production of estrogen and progesterone starts to fluctuate. The internationally accepted STRAW+10 staging system describes this process by looking at your menstrual pattern, not at hormone levels ¹:

• Late reproductive stage: Cycles are still regular, perhaps a little shorter. No symptoms, or very mild ones.

• Early perimenopause (the menopausal transition): A difference of 7 days or more starts to appear between consecutive cycle lengths (29 days, then 22, say). Hot flashes and changes in sleep and mood often begin here.

• Late perimenopause: Gaps of 60 days or more without a period appear. Symptoms are usually at their most intense during this stage and just after it.

• Menopause (the final period): Diagnosed in retrospect: if you have had no period for twelve months, the last bleed at the start of those twelve months was your "final period".

• Early postmenopause: The first five to eight years after the final period. Hormones settle at a new, lower level. Symptoms ease gradually in most women, but how long they last varies a great deal from person to person.

• Late postmenopause: Symptoms are largely behind you. What comes to the fore in this stage is bone, cardiovascular and genitourinary health.

In everyday language, "perimenopause" covers the early and late transition plus the first twelve months after the final period. So a woman only confirms she is in menopause twelve months later; until then she is, in theory, in perimenopause.

What do we know?

• Timing: Worldwide, natural menopause happens at around 51 on average, and the range of 45 to 55 is considered usual. Averages reported from Türkiye are a little earlier, around 47 (46–48); there is not yet a nationally representative cohort ^{6 7 8}. Menopause between 40 and 44 is called "early menopause", while under 40 it is a separate picture — premature ovarian insufficiency (POI) — which needs investigating in its own right ⁵.

• Duration: Perimenopause lasts around four years on average; it can be shorter than one year or run beyond eight. For hot flashes and night sweats, a large US cohort (SWAN) found a median duration of more than seven years. Women whose symptoms start early in perimenopause generally have them for longer ⁴.

• The stage is established from your history, not from a hormone test: NICE recommends that in women over 45 with typical symptoms, perimenopause and menopause be identified without blood tests, from the menstrual pattern and the symptoms. Measuring FSH may be considered between 40 and 45 in women with symptoms, and is necessary where POI is suspected under 40. The reason is simple: in perimenopause, hormones fluctuate so much from day to day that a single measurement can mislead ².

• Fertility doesn't end immediately: Ovulation in perimenopause is irregular, but possible. If pregnancy is not wanted, contraception is recommended for one year after the final period over the age of 50, and for two years under 50 ².

• The stages run differently for each woman: Smoking, some surgical and oncological treatments, and a family history of early menopause can all affect the timing. Two women at the same stage may have very different symptoms, duration and intensity. This is why tracking tells you more than averages do.

What does this give you?

Knowing your stage is useful not for choosing a treatment but for asking the right question.

• If you are in perimenopause: the real work is deciding, with your doctor, whether changes in your periods are "expected" or a pattern that needs looking into. Both hormonal and non-hormonal options for symptoms can be discussed at this stage ³.

• If you have recently reached menopause (early postmenopause): alongside managing symptoms, baseline assessments for bone and heart health come onto the agenda.

• If you are in late postmenopause: genitourinary symptoms such as vaginal dryness tend to increase over time, and they are treatable. There is no need to accept them as "normal for this stage".

The stage Lumia shows you is an estimate, derived from your answers during onboarding and from your tracking data. It is used to personalize the content and the flow. Only your doctor can assess your stage.

Sources

1. Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. Menopause. 2012;19(4):387-395.
2. NICE. Menopause: identification and management (NG23). 2015; updated November 2024.
3. The Menopause Society. The 2022 Hormone Therapy Position Statement. Menopause. 2022;29(7):767-794.
4. Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539.
5. ESHRE/ASRM/CREWHIRL/IMS Guideline Group on POI. Evidence-based guideline: premature ovarian insufficiency. Climacteric. 2024;27(6):510-520.
6. Neslihan Carda S, et al. The menopausal age, related factors and climacteric symptoms in Turkish women. Maturitas. 1998;30(1):37-40.
7. Özdemir O, Çöl M. The age at menopause and associated factors at the health center area in Ankara, Turkey. Maturitas. 2004;49(3):211-219.
8. Vehid S, et al. The prevalence and the age at the onset of menopause in Turkish women in rural area. Saudi Med J. 2006;27(9):1381-1386.

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