The STRAW (Stages of Reproductive Aging Workshop) classification is a widely accepted framework for understanding the different stages of menopause. Developed by a group of menopause experts, it helps to describe the changes that occur during a woman’s transition from reproductive to post-reproductive life. Menopause is the natural biological process marking the end of a woman’s menstrual cycles, defined as occurring 12 months after her last period.
The STRAW system is based on the changes in menstrual cycles, hormone levels, and overall health status that mark the progression through menopause. The system is divided into several stages, which can be grouped into three main categories: Pre-menopause, Perimenopause, and Postmenopause.
Reproductive (Pre-menopause)
The Reproductive Stage, or pre-menopause, refers to the years in a woman’s life when her menstrual cycle is regular and she is still fertile. During this time, the ovaries are producing estrogen and progesterone in adequate amounts to enable ovulation which for most, occurs regularly. This stage typically spans from menarche (the first menstrual period) to the early 40s, although it can vary from woman to woman.
Key characteristics of this stage include:
- Regular menstrual cycles
- Fertility and ovulation
- Steady hormone levels
Although menopause is not yet approaching, subtle changes may begin in the 40s, including a slight or significant shift in menstrual cycle regularity.
Perimenopause
Perimenopause is the transitional phase leading up to menopause and can begin as early as a woman’s mid-40s but may vary. The STRAW system divides perimenopause into early perimenopause transition and late perimenopause transition. The collective menopause transition can last anywhere from 4 to 10 years. During perimenopause, a woman’s hormone levels may fluctuate widely, which for some, leads to changes in menstrual cycles and the emergence of various symptoms. Estrogen production starts to decline, and the ovaries begin to work less efficiently.
Key features of perimenopause include:
- Irregular periods: Menstrual cycles become shorter or longer, and flow may vary. A woman may skip cycles or have heavier or lighter bleeding.
- Hot flashes: Sudden feelings of warmth, often accompanied by sweating, are a hallmark symptom.
- Sleep disturbances: Many women experience difficulty sleeping due to hormonal fluctuations, leading to insomnia or night sweats.
- Mood swings: Increased irritability, anxiety, or mild depression can occur as hormone levels fluctuate.
- Decreased fertility: While fertility declines, pregnancy is still possible until a woman reaches menopause.
Menopause (Postmenopause)
Menopause is officially reached when a woman has not had a menstrual period for 12 consecutive months. The ovaries stop releasing eggs, and estrogen and progesterone levels significantly decrease. The transition to menopause marks the end of a woman’s reproductive years.
There are two key stages in postmenopause:
- Early postmenopause (approximately1-5 years after the final period): During this stage, the symptoms of menopause, such as hot flashes and mood changes, may still be present, but hormone levels stabilize at lower levels.
- Late postmenopause (approximately after 5 – 7 years): By this time, most of the menopausal symptoms, such as hot flashes and night sweats, begin to subside. However, women may still experience long-term health effects due to the lower levels of estrogen, including ongoing hot flashes and sleep disturbances. Things to also discuss with a health care provider are you personal risks of osteoporosis and cardiovascular disease.
The STRAW system provides a comprehensive framework for understanding the stages of menopause. By recognizing these stages, women can better understand the physical and emotional changes that occur throughout their menopausal journey. Perimenopause, in particular, is a time of significant hormonal fluctuation, with irregular periods and symptoms like hot flashes and sleep disturbances. After menopause, women enter postmenopause, a stage that can span many years and requires ongoing attention to health and well-being.
For more see: https://menopause.org/
“Menopause is the ultimate reminder that we are never just one thing. We are constantly evolving, and this is a beautiful new chapter.”
— Unknown