The 4 stages of perimenopause explained
Early, Mid, Late, and Postmenopause Transitions
Perimenopause is a complex hormonal journey that unfolds over many years. By understanding its stages, you can better track your symptoms, seek the right support, and make informed decisions about your body.
1. Early perimenopause (mid-to-late 30s or early 40s)
This stage is often missed or misdiagnosed, even though hormonal shifts have begun. Progesterone typically drops first, while estrogen fluctuates.
Symptoms You Might Notice:
Shorter or irregular cycles
PMS intensifying
Breast tenderness
Anxiety or mood swings
Trouble sleeping
Though subtle, these are signs your body is starting the transition.
According to the North American Menopause Society (NAMS), early perimenopause is marked by “menstrual cycle variability” and can last 2–5 years before more obvious symptoms appear.
Try tracking your cycle changes using my Symptom Tracker tool or explore the Stages of Menopause PDF to understand where you might be.
2. Mid perimenopause (early to mid-40s)
Here, hormone levels, especially estrogen start to rise and fall more unpredictably. You may still get regular periods, but symptoms become harder to ignore.
Common Symptoms:
Heavy or erratic periods
Heightened anxiety
Sleep disturbances
Migraines or headaches
Hot flashes starting
Gut issues or bloating
Studies from the Endocrine Society show that increased variability in estrogen and progesterone levels during this stage is directly linked to mood disorders and sleep problems.
If you’re here, understanding the estrogen rollercoaster is key. My Estrogen High vs Low Symptoms PDF explains why some days you feel euphoric… and others, like you're falling apart.
3. Late perimenopause (typically mid-to-late 40s)
This is when things really change. Your periods may go months without appearing, only to return suddenly. The hormonal drop becomes more dramatic.
What you might feel:
Months without a period (but not yet 12 months)
Hot flashes, night sweats intensifying
Palpitations or panic-like episodes
Profound fatigue
Depression or apathy
Vaginal dryness or low libido
A 2022 review in the Journal of Women's Health noted that women in late perimenopause often report the most severe symptoms, particularly vasomotor and psychological ones.
Many women start or adjust MHT (menopausal hormone therapy) at this stage, but it's crucial to know what your hormones are doing first. That’s why tools like the Symptom Tracker are so helpful before deciding.
4. Postmenopause (12 months after your final period)
You’re officially in postmenopause when you’ve gone 12 consecutive months without a period. For most women, this happens around age 51, but the timing varies.
Symptoms that may continue:
Lingering hot flashes
Vaginal dryness or discomfort
Slower metabolism or weight gain
Changes in skin elasticity
Anxiety may persist if nervous system support is lacking
The Cleveland Clinic explains that after menopause, lower estrogen increases the risk of bone loss, cardiovascular disease, and metabolic shifts making lifestyle support more essential than ever.
This is where ongoing support matters. My Lifestyle Course helps you rebalance holistically and prevent long-term impacts of hormone loss.
Sources & references:
North American Menopause Society (NAMS): Understanding Perimenopause
Endocrine Society: Hormone Fluctuations in Perimenopause
Cleveland Clinic: The Stages of Menopause
Journal of Women’s Health: Symptom Severity in Late Perimenopause
Future Woman: Understanding the Four Stages of Perimenopause