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Written by
Stacy Miller
Perimenopause can be a confusing time if you’re unsure of what to expect. While a lot of attention is brought to menopause, the time leading up to it is equally impactful. As you transition away from your peak reproductive years, knowing what to expect can make the shift easier. In this article, we’ll discuss the three stages of perimenopause, including when they typically start, how long they last, how hormones behave and how to identify which one you’re in. With this information, you can better understand the changes your body is going through and take control of your health.
As women, our menstrual cycle plays a large role in our lives. During our peak reproductive years, our ovaries release an egg every month, which is either fertilized, resulting in pregnancy, or disintegrated in the uterus, causing a period. However, as we age, our progesterone and estrogen levels begin to drop, causing ovulation to become infrequent. This stage is the perimenopause or menopause transition and typically starts around age 46. It is possible to experience early perimenopause between ages 40 and 45, but this only occurs in around 5% of women.
Perimenopause can last 4 to 10 years. During this time, your periods will become irregular until they stop completely. You’ll know you’ve entered the final stage of perimenopause—menopause when you’ve gone twelve consecutive months without a period.
If you ever wondered “what are the 7 stages of perimenopause?” or “what are the 4 phases of perimenopause?”, we want to tell you that the number of stages is different: based on the latest research, there are three. One small addition to that is talking about stages, but not phases of perimenopause.
The three stages of perimenopause are early, late, and menopause. Each one is defined by its effects on menstruation and has corresponding symptoms.
During early perimenopause, your periods are regular, but you may notice a difference in their length or flow. Early perimenopause generally starts at age 46 and can last around three years. You may not notice a lot of symptoms as you enter into early perimenopause, but as time goes on, it’s common to experience mood swings, increased stress or anxiety, weight gain, and vaginal dryness.
Changes in your sex hormone levels, estrogen and progesterone, cause these symptoms. Although your FSH levels begin to rise, estrogen and progesterone can remain normal in cycles that include ovulation.
Around age 49, women enter into late perimenopause. During this stage, your periods become irregular, with cycles of 60+ days and missed periods. Late perimenopause can last around 2.5 years and is when you may notice your symptoms becoming more pronounced. Hot flashes and night sweats are some of the most common signs of late perimenopause, along with depression, UTIs, and trouble sleeping.
Many women experience pain, bleeding, or discomfort during sex due to worsening vaginal dryness, leading to a decreased libido. Weight gain is also common, as we tend to exercise less and adopt a less nutrient-dense diet. Following late perimenopause, you enter into the third stage of perimenopause—menopause.
Your hormones behave in an entirely unpredictable manner. You may have cycles with normal FSH levels, while at other times it increases significantly. Estrogen levels can be higher or lower than during your reproductive years, and progesterone tends to decline. However, one to two years before the final period, your estrogen and progesterone levels drop to nearly undetectable levels. These drastic changes in your hormones can worsen your symptoms.
Menopause is the last stage of perimenopause and is marked by twelve consecutive months without a period, and typically begins around age 52. During menopause, you generally experience the same symptoms as late perimenopause, with some, like hot flashes and night sweats, worsening.
During these 12 months your FSH remains high, while estrogen and progesterone levels are low.
Knowing which stage of perimenopause you’re in can be tricky, but there are ways you can tell. If you’re between the ages of 40 and 45 and begin experiencing perimenopausal symptoms, your doctor can test your hormone levels to see if you’ve entered early perimenopause. Your reproductive hormones, such as FSH and estrogen, can help determine whether the changes are related to aging or to other causes. In addition to checking your reproductive hormones, your doctor may order thyroid function tests and check your prolactin levels.
For women 46 and older, symptoms and menstruation frequency are used to determine perimenopausal stages. If your periods are completely irregular, with 60+ days between periods, you’re in late perimenopause. If you’ve gone twelve consecutive months without a period, you’ve entered menopause, which is the final stage of perimenopause. Although these changes can still be related to other causes, such cases are rare, which is why your FSH and estrogen levels are not routinely checked.
Although the perimenopausal transition can be challenging, there are ways you can support yourself through it and make symptom management easier.
If your symptoms are interfering with your daily life, you can talk to your doctor, who can create a treatment plan that may include prescription medication like HRT or vaginal estrogen. Typically, estrogen HRT is taken to alleviate symptoms, while progesterone is necessary for women with a uterus to protect the endometrial lining. For mental health issues, therapy is extremely helpful, whereas estrogen HRT alone may not be sufficient to address them.
A nutritious diet can support hormone health, which can lessen perimenopausal symptoms, but it won’t restore your estrogen levels to those seen during the reproductive years. Removing sugary and processed foods and excessive caffeine and alcohol while adding fruits, vegetables, lean protein, and whole grains can help you feel your best.
Due to the drop in estrogen levels, perimenopause puts you at a higher risk of conditions like heart disease, so it’s important to take care of your body. Daily exercise, like walking, is a great way to stay active and support your mental health. It also guards against weight gain. Getting enough sleep is also vital for hormonal health, and you should try for 7 to 9 hours each night. Incorporating positive lifestyle changes can help you feel good throughout the menopausal transition.
Stress can wreak havoc on your body, so learning how to manage it during perimenopause is very helpful. Using relaxation techniques like mindfulness, journaling, meditation, and more can help reduce cortisol levels, which lead to anxiety, depression, and weight gain.
When going through perimenopause, it’s common to experience symptoms like the ones listed above. However, if they become severe, interfere with your life, or cause suicidal thoughts, you should speak with your doctor.
Knowing which stage of perimenopause you’re in can take the fear out of this normal life transition. Hormona is proud to offer cutting-edge hormonal support through the award-winning Hormona app. This premium hormone tracker gives you the tools and insights to help you understand your body and feel your best throughout every stage.
If you’re between the ages of 40 and 45 and have perimenopause symptoms, your doctor will perform a hormone test to determine if you’re in perimenopause. It can be as simple as testing your FSH and estrogen levels, but it may also involve measuring LH, TSH, and prolactin—and, depending on your symptoms, other hormones. Women 45 and above use symptoms and menstruation regularity to determine if they’re perimenopausal.
Perimenopausal symptoms tend to worsen during later perimenopause and menopause, which can last 3 to 7 years. Although symptom severity isn’t entirely tied to specific estrogen levels, the rapid drop in estrogen before the final period may be one of the possible reasons.
Yes, due to lowered estrogen levels, decreased activity, and poor diet choices, many women gain weight during perimenopause.
There are a few conditions that have similar symptoms, such as in perimenopause, including thyroid and pituitary problems, mood disorders, autoimmune disorders, early pregnancy, and chronic fatigue syndrome.
While you can use at-home hormone tests that indicate FSH levels, they may not give you a definitive answer if you’re in perimenopause or menopause. Symptom identification is used for women over age 46, while those between the ages of 40 and 45 can have hormone tests performed by their doctors to identify perimenopause.
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Dr Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the myriad of sleep.
What are menopause hormone levels? Menopause is 12 consecutive months without a period. It’s the final stage of perimenopause, which begins around age 46 and can last ten or more years. During perimenopause, your ovaries release eggs less frequently, and
At what age does perimenopause start? Perimenopause is a normal part of a woman’s reproductive cycle, where you transition out of your peak reproductive years into menopause. It is caused by ovarian aging, during which the number of follicles decreases
What is the last stage of perimenopause? The last stage of perimenopause is menopause and is marked by 12 consecutive months without a period. During perimenopause, your sex hormone levels like estrogen and progesterone start to decrease, causing ovulation to
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