Perimenopause can be a confusing period, but understanding the stages of this transition can help you manage symptoms and navigate this time with confidence and clarity.
Perimenopause is the elusive transition to menopause, which can last anywhere from a few years to a decade and cause a range of physical, mental, and emotional symptoms. This transitional period, culminating in the end of periods, can be confusing and turbulent — but it doesn’t have to be. Understanding the stages of perimenopause, including what’s happening to your body when and why, can help navigate this period with greater awareness and control.
>>MORE: Perimenopause vs. Menopause: What's the Difference?
So, what are the stages of perimenopause, what happens during them, and how can you tell when you’ve reached each stage? Here’s everything you need to know to confidently manage the transition.
Stages of perimenopause: early stage The first of the stages of perimenopause is called the early stage, marked by the beginning of irregular cycles .
What’s happening in your body during this time? Your ovarian reserve is low, meaning you have fewer eggs left to be released into your fallopian tubes. Your ovaries start to slow down their production of estrogen, and a domino effect sets in:
Follicle-stimulating hormone (FSH) starts to rise. The pituitary gland, a pea-sized structure at the base of your brain, starts to pump out more FSH to try and stimulate the ovaries and ramp up the production of estrogen. Estrogen fluctuates. As FSH tries to stimulate the ovaries — and the ovaries don’t respond — there are fluctuations in estrogen levels. The dips and peaks of estrogen can lead to irregular periods with shorter cycles, spotting, or missed periods all together.Progesterone declines. As estrogen declines, so does progesterone, which can contribute to irregular cycles.The key marker of the early stage of perimenopause is the first missed period or irregular cycle. During this stage, some people may experience variation in their cycle of more than a week .
When does early stage perimenopause begin? The first stage of perimenopause can begin as early as your mid-30s, but happens most commonly in your 40s. The first sign of perimenopause is typically irregular menstrual cycles; however, you may also experience a range of physical and emotional symptoms that accompany this irregularity.
Early stage perimenopause symptoms As many as 90% of women will go to healthcare professionals to get advice about perimenopause symptoms, so what kinds of symptoms should you expect? Some of the most common perimenopause symptoms during early stage perimenopause include:
Hot flashes : A sudden feeling of intense heat, often accompanied by sweating, chills, and a rapid heartbeatNight sweats: Similar to hot flashes, these bursts of heat occur during sleep, which can lead to disrupted sleep schedules and fatigue.Vaginal dryness: As estrogen decreases, vaginal tissues become thinner and less lubricated. This can cause discomfort during intercourse.Mood swings : You may feel irritable or have sudden changes in your emotions.Joint pain : Seven in ten women experience perimenopause joint pain, often caused by a decline in estrogen that helps regulate inflamation and promote joint health.Brain fog : Because estrogen plays a large role in memory and executive function, when estrogen decreases, you may feel groggy, confused, or have difficulty concentrating.Remember, everyone experiences perimenopause differently. Some people may experience a range of symptoms at a high intensity, while others may only experience a few symptoms at a lower intensity.
Regardless of what you’re feeling, there are a variety of perimenopause treatment options to manage these symptoms:
Lifestyle changes: Adapting your routine to include regular exercise, stress management, better sleep hygiene, and a nutritious diet can help improve your well-being and decrease symptom intensity. Dietary adjustments: In addition to eating a nutritious diet, limiting processed foods, caffeine, and alcohol and increase soy-based products and flaxseeds can offer relief from hot flashes.Natural remedies: Certain vitamins and minerals can help promote hormonal balance and target specific symptom areas; for example, calcium can support bone health and help alleviate joint health, while omega-3 fatty acids can help with mood stability. Be sure to consult with a professional to determine what perimenopause vitamins or supplements are right for you. Hormone replacement therapy (HRT): This medical intervention involves supplementing your body with hormones that are declining (typically estrogen and progesterone). Because lower hormone levels often cause perimenopause symptoms, balancing out hormones can help alleviate discomfort you might be experiencing. Again, be sure to discuss risks and outcomes with a healthcare professional. Stages of perimenopause: late stage The second of the two stages of perimenopause is the late stage. In late stage perimenopause, irregular cycles are highly irregular and periods are scarce.
What’s happening in your body now? The ovaries have decreased estrogen production more so than in the beginning of perimenopause; this is what leads to the frequent missed periods, or no periods for months at a time. As estrogen drops, other hormones respond:
Progesterone continues to decline. Progesterone levels plummet by the second stage of perimenopause, leading to further irregular bleeding.FSH rises: In an attempt to encourage the ovaries to produce more estrogen, FSH increases, but has little impact.The key marker of the late stage of perimenopause is the length between your periods. During the late stage, periods tend to be more than 60 days apart.
When does late stage perimenopause begin? The late stage of perimenopause tends to occur in your late 40s to early 50s. The average age for late stage perimenopause is 49, two years after the average age of the early stage (47). Remember, there’s a lot of variability between when perimenopause begins, and this variability carries over to each stage, too.
Late stage perimenopause symptoms What symptoms can you expect during the second stage of perimenopause? Symptoms are similar, if not the same as the early stage of perimenopause; however, you might find that symptoms intensify or arise more frequently.
Late stage perimenopause symptoms include:
Hot flashes and night sweats Vaginal dryness Sleep disturbances Mood swings Joint pain Brain fog You can continue using the same strategies from early stage perimenopause to manage and alleviate these symptoms. Depending on symptom intensity, you can try natural remedies like lifestyle changes or vitamins, or medical interventions like HRT. When treating perimenopause symptoms, be sure to consult a healthcare professional.
Stages of perimenopause: the bottom line It’s no secret that perimenopause can be a challenging transition. Understanding perimenopause stages — the early and late stage — can arm you with the knowledge to navigate this transition with greater self-care and confidence.
