What does STRAW+10 stand for?

Stages of Reproductive Aging Workshop, updated in 2011. It is the standard framework for describing reproductive ageing from the reproductive years through postmenopause.

How are the stages defined?

Primarily by menstrual-cycle regularity, supported by hormone markers such as FSH and AMH. The final menstrual period is stage 0, with negative stages before and positive stages after.

When do hot flushes typically begin?

They typically begin during the menopausal transition and often peak around early postmenopause, while urogenital symptoms such as vaginal dryness tend to come later and persist.

STRAW+10: The Stages of Reproductive Ageing

STRAW+10 — the Stages of Reproductive Aging Workshop criteria, updated in 2011 — is the standard framework clinicians and researchers use to describe where a woman is in the reproductive ageing process. It divides life from the reproductive years through postmenopause into stages, defined mainly by menstrual-cycle regularity and, where relevant, hormone markers. This guide explains the stages in plain terms. Educational information only, not medical advice.

The core idea: reproductive ageing is a continuous process, and its clearest outward sign is the menstrual cycle. STRAW+10 names the stages so symptoms and findings can be discussed precisely.

The stages

STRAW+10 numbers stages from negative to positive, with zero at the final menstrual period (FMP):

Reproductive years (negative stages)

Stage -5 (early reproductive): regular cycles; peak fertility in the earlier years.
Stage -4: regular cycles, with fertility beginning to decline through the later reproductive years.
Stage -3 (late reproductive): cycles remain regular, but hormone markers begin to shift — notably a falling anti-Müllerian hormone (AMH) and, in some women, a rising follicle-stimulating hormone (FSH) in the early follicular phase. Fertility is reduced.

Menopausal transition (negative stages)

Stage -2 (early transition): cycle length varies by seven days or more from the woman's norm; FSH is typically elevated. Symptoms such as hot flushes can begin.
Stage -1 (late transition): the hallmark is skipped cycles — an interval of 60 days or more between periods — with more pronounced symptoms and higher FSH.

Postmenopause (positive stages)

Stage 0: the final menstrual period (FMP), identified in hindsight after twelve months without bleeding.
Stage +1 (early postmenopause): the first years after the FMP; vasomotor symptoms are often most intense, and bone loss accelerates.
Stage +2 (late postmenopause): further years on; symptoms such as vaginal dryness and bladder changes typically persist or worsen, while hot flushes may settle in some women.

What defines each stage

Marker	What it shows
Menstrual cycle	The primary outward marker — regularity, then variability, then skipped cycles, then absence.
FSH	Rises as ovarian reserve falls; used to support staging, though it fluctuates in the transition.
AMH	Falls steadily across the reproductive years; a marker of ovarian reserve.
Antral follicle count	Declines with ovarian reserve, assessed on ultrasound where indicated.

How it helps in practice

It explains the timing of symptoms. Hot flushes typically begin in the transition and peak around early postmenopause; urogenital symptoms come later and persist.
It frames fertility. Fertility declines through the late reproductive years and is markedly reduced by the late transition.
It guides bone health. Bone loss accelerates around the FMP, so the early postmenopausal years are when protection matters most.
It gives a shared language for conversations with clinicians.

Educational information only — not medical advice. Staging is a descriptive framework; symptoms and treatment decisions are individual. Consult a qualified clinician.

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