What Are the Stages of Perimenopause?
Perimenopause, the menopausal transition, occurs for years before the final period. While the experience and timeline vary significantly between women, most women (almost 90%) will experience some degree of bothersome symptoms, affecting quality of life.
Today’s article will explore the stages of perimenopause and associated symptoms. We’ll leave you with some action steps to support you through this time and set the foundation for a lifetime of health. Keep reading to discover:
- Stages of perimenopause
- Early perimenopause
- Late-stage perimenopause
- What to expect (i.e., how your body is changing)
- Nutrition and lifestyle support
Stages of Perimenopause
We’re sure you have a lot of questions! What is perimenopause? When does perimenopause start? How long does perimenopause last? What are the first signs of perimenopause? These are some of the most common questions we hear.
Perimenopause is the natural life stage when the body is moving its resources away from reproduction, like puberty in reverse. It’s a transition to menopause, the one-year mark without a period.
There is some debate in the medical world about when perimenopause starts and the associated stages. Some argue that it doesn’t start until the menstrual cycle becomes irregular, but many women begin to experience perimenopause symptoms while continuing to have regular cycles.
No matter how you count it, perimenopause can last a significant period of time, anywhere from a few years to 10 or more years. Natural perimenopause can start in your late 30s or early 40s.
For this article, we’ll divide perimenopause stages into two: early and late.
Early Perimenopause
In early perimenopause, the menstrual cycle remains fairly regular. You may notice some cycles that are longer or shorter by a few days. However, under the surface, hormones are starting to change. You’ll begin to experience some fluctuations in estrogen levels, and estrogen may be higher at some times than it was previously. Additionally, progesterone begins to decrease.
Because of the hormonal changes, early signs of perimenopause can include symptoms like changes in sleep, PMS, and mood.
Mood Swings
Perimenopause depression, anxiety, mood swings, and other mental health challenges can arise in perimenopause (as they do during other hormonal transitions like postpartum). Previous depressive episodes increase the risk in perimenopause, but symptoms can also be new during this time triggered by hormonal changes.
Sleep Disruptions
Researchers estimate 16 to 47% of women experience clinical sleep disorders in perimenopause. Even those without a diagnosis may notice difficulty falling asleep and, perhaps more significantly, falling back to sleep after waking.
Progesterone is a calming hormone that relaxes the nervous system and promotes sleep. With declining progesterone in perimenopause, sleep issues commonly arise. A decreased tolerance to stress, anxiety, and other factors also contributes.
Breast Tenderness
Breast tenderness can be part of a collection of early perimenopause symptoms, which may have to do with excess estrogen relative to progesterone. Other PMS-type symptoms, especially in the one or two weeks leading up to the period, are also common. You may notice:
- Increase irritability
- Increased hunger and cravings
- Water retention
- Bloating
- Poor sleep
- Perimenopause headaches
- Heavy and painful periods
Hot Flashes and Night Sweats
Hot flashes and night sweats are the classic symptoms of perimenopause. They are more associated with low estrogen later in the transition, but many women experience them in the early stages of perimenopause, especially right before and during the period when estrogen declines.
Late Perimenopause
As perimenopause progresses, more symptoms tend to arise as estrogen and progesterone levels continue to decline.
Increased Menstrual Irregularity
Perimenopause period changes become more significant. Typically, women will skip periods and the cycles will become longer in later perimenopause. Sometimes, this is proceeded by shorter heavier cycles, but as the cycles extend to 60 days or longer, you know you’re in the later stage.
More Intense Hot Flashes and Night Sweats
Hot flashes and night sweats can become more frequent and intense. About 85% of women will experience them to some degree. You may notice them all cycle long and become more sensitive to triggers like alcohol, hot weather, spicy foods, and stress.
Vaginal Dryness and Discomfort
Vaginal health and lubrication have a lot to do with the vaginal microbiome and the beneficial lactobacillus bacteria, which keep the vaginal pH acidic. Low estrogen levels lead to changes in vaginal health, including dryness, discomfort, increased infections, and changes in libido. Talk with your healthcare provider about localized estrogen support, as it can be very beneficial for improving vaginal skin health, microbiome balance, and lubrication.
Changes in Libido
Around 40-55% of women experience low sexual desire in menopause but can start in perimenopause. Declining sex hormones, including estrogen and testosterone, contribute to symptoms. While previous generations tended not to discuss sexual health and suffer in silence, the paradigm is really changing, and there are many options to support women in sexual wellness.
Urinary Issues
Along with vaginal dryness can come increased urinary tract infections and vaginal infections related to low estrogen and microbiome changes. These symptoms are so common that they’re collectively called the genitourinary syndrome of menopause.
What to Expect During Your Menopause Transition
Think of perimenopause as a system reboot, a recalibration of the brain, or neurological transition. Since puberty, the brain has been wired for reproduction, but now it’s rewiring for life without this need. The good news is that after the transition is complete (a couple of years into post-menopause), many of the perimenopausal systems naturally resolve. But that doesn’t mean you have to suffer through it for years!
Hormonal Changes
In perimenopause, you transition from a regular monthly menstrual cycle and ovulation to no more ovulation or periods. Many women are thrilled not to have to deal with monthly hormonal changes and periods. They feel more grounded and stable as hormones even out.
Emotional and Psychological Changes
As monthly hormonal swings go away, many women discover a new beginning and a new way of being in the world. It’s common to care less about what other people think and naturally let go of people-pleasing tendencies.
Physical Symptoms
We’ve discussed many of the physical symptoms in early and late perimenopause, which can significantly disrupt quality of life. Nutrition and lifestyle changes can counteract many symptoms, including perimenopause weight gain. You can also discuss hormone replacement therapy (HRT) with a menopause-literate healthcare provider. The growing body of research in this area supports increased safety and benefit for many women.
Sleep Disruptions
While hormonal changes can cause sleep disruption, poor sleep can make perimenopause symptoms (and life) much more challenging. Now is the time to establish good sleep habits and prioritize nightly relaxation and quality sleep.
Bone and Heart Health
In addition to the symptoms of perimenopause, the other downside is the long-term effects of low estrogen (and progesterone) levels on all aspects of the body, including bones, heart, brain, and muscles. After menopause, women’s risk for metabolic diseases and diseases of frailty increases significantly. Perimenopause is a window of opportunity for building lifestyle habits to offset these disease risks.
Sexual Health Changes
The end of fertility doesn’t mean the end of a healthy sex life if that’s important to you. Many women discover they are having the best sex of their lives in their 40s, 50s, and beyond!
Coping Strategies
Lizzy Swick Nutrition offers personalized nutrition and lifestyle protocols to address your perimenopause concerns. The first step is understanding the signs of perimenopause and what to expect. This way, you won’t be caught off guard and waste time seeing practitioners who don’t understand perimenopause or tell you your symptoms are “in your head.” Instead, you can advocate for the care and support you desire.
Lifestyle
As we work with more and more perimenopausal women, it’s clear these lifestyle strategies are critical:
- Regular exercise and movement, including strength training. It doesn’t have to be a generic exercise routine for perimenopausal women, but it is very personalized and enjoyable.
- Regular stress management – Therapy, yoga, time in nature, meditation, breathing exercises, saying no, scheduling downtime, etc.
- Sleep hygiene – Creating a relaxing bedtime routine, getting daytime sun exposure, limiting screen use and blue lights before bed, sleep supplements, etc.
- Social connection – Going through perimenopause with your girlfriends makes it more manageable (and fun)!
Nutrition
The perimenopause hormonal changes make it harder to get away with bad habits while maintaining your health. Building new food habits is a commitment, but one that is worth it and can help prevent symptoms and chronic disease down the line. Some critical strategies include:
- Eating enough protein
- Increasing fiber from plant foods
- Balancing blood sugar
- Decreasing ultra-processed foods
- Prioritizing cooking at home
- Optimizing nutrient status
- Focusing on food quality
- Building a loving relationship with food
- Finding ways to get pleasure from food without sacrificing your goals
While you can’t stop perimenopause, you don’t have to suffer; there are so many integrative tools to support you on your journey. If you’re ready to feel better and get to the root of perimenopause symptoms, or if you just don’t feel like yourself anymore, Lizzy Swick Nutrition can help you through the stages of perimenopause.
References
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- Bromberger, J. T., & Epperson, C. N. (2018). Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstetrics and gynecology clinics of North America, 45(4), 663–678.
- Tandon, V. R., Sharma, S., Mahajan, A., Mahajan, A., & Tandon, A. (2022). Menopause and Sleep Disorders. Journal of mid-life health, 13(1), 26–33.
- Ziv-Gal, A., Smith, R. L., Gallicchio, L., Miller, S. R., Zacur, H. A., & Flaws, J. A. (2017). The Midlife Women’s Health Study – a study protocol of a longitudinal prospective study on predictors of menopausal hot flashes. Women’s midlife health, 3, 4.
- Szymański, J. K., Słabuszewska-Jóźwiak, A., & Jakiel, G. (2021). Vaginal Aging-What We Know and What We Do Not Know. International journal of environmental research and public health, 18(9), 4935.
- Scavello, I., Maseroli, E., Di Stasi, V., & Vignozzi, L. (2019). Sexual Health in Menopause. Medicina (Kaunas, Lithuania), 55(9), 559.
- Nappi, R. E., Martini, E., Cucinella, L., Martella, S., Tiranini, L., Inzoli, A., Brambilla, E., Bosoni, D., Cassani, C., & Gardella, B. (2019). Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Frontiers in endocrinology, 10, 561. ]
- Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature reviews. Endocrinology, 11(7), 393–405.
