What are the stages of reproductive aging in women?

Updated: Oct 16, 2018
  • Author: Janice L Bacon, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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In 2001, The Stages of Reproductive Aging Workshop (STRAW) defined 7 stages of adult women’s lives into 3 broad categories- reproductive, menopausal transition and post-menopause- with subcategories defined by menstrual cycle data and endocrine studies. In 2011, these criteria were updated and the staging system modified. [111]

In the late reproductive years, menstrual cycles are regular, but menstrual intervals decrease due to decreased luteal phase progesterone and a shorter follicular phase. Endocrine changes include decreased inhibin B and antimüllerian (AMH) levels and a lower antral follicle count in the ovary. While estradiol levels are generally preserved, follicle stimulating hormone levels (FSH) increase slightly. [111] These changes may begin in the early to mid-forties.

During the menopausal transition (perimenopause), menstrual intervals become more variable and FSH also varies or rises. AMH and inhibin B levels remain low. The late phase of menopausal transition occurs 1-3 years before the final menses and is characterized by increased menstrual intervals. FSH levels are greater than or equal to 25 IU/L and AMH, Inhibin-B and antral follicle counts are low.

Following the final menses, menopausal symptoms are most pronounced and coincide with elevated FSH, decreased AMH and inhibin B and antral follicle counts are very low. Estradiol levels decrease and FSH levels rise higher and then stabilize for the next 3-6 years. Menopausal symptoms most noted are hot flashes (hot flushes). Other symptoms often reported include insomnia, mood changes, and headache.

The first 1-6 years after the final menses is termed “early menopause.” Vasomotor symptoms may begin to decrease but urogenital symptoms and atrophy are more prominent and somatic aging more evident. [111]

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