Understanding what stage of perimenopause you are in provides you with valuable information about you and the journey you’re on.
I like to breakdown perimenopause into 3 stages – early, middle, and late.
I, personally, am somewhere between early and middle perimenopause and here’s the reason why I think this.
If you still get your period and have your ovaries, research says approximately 50% of women will experience menstrual abnormalities by age 45.5 years. Women who have experienced over 3 months of amenorrhea (no period) are highly likely (about 95%) to become postmenopausal within the next 4 years.
Early Perimenopause
During early perimenopause, menstrual cycles can become more variable in length. Most women experience a shortening of their cycles initially. This may involve a transition from a 28-day cycle to a 24-day cycle or from a 30-day cycle to a 26-day cycle. If you were to undergo testing, you might find that your follicle-stimulating hormone (FSH) is likely within the normal range or may be starting to increase to above 10mIU/mL. Estradiol levels are also probably within the expected range when tested, although they may be starting to fluctuate, with most days showing higher levels and occasionally dropping lower than expected. Progesterone is starting to drop more consistently. HOWEVER – note that many women including me did not have any changes to their menstrual cycle length. It is often the case that most of the early symptoms are more brain related such as anxiety, poor sleep, less resilience to stress. Or maybe it’s just some night sweats. DUTCH cycle mapping test is very useful in this stage.
Middle Perimenopause
In middle perimenopause (after a few years of early perimenopause), I notice women start to transition into a skipped period here and there. They are noticing more perimenopausal symptoms and their hormones don’t feel as stable.
Late Perimenopause
In late perimenopause, you might experience irregular menstrual cycles. For example, you might have no period for 3 months, then get a period unexpectedly. After that, you could go 5 months without a period, and then have 2 periods in the same month. During this time, you might still have symptoms that feel more intense as your body adjusts to lower levels of estradiol and progesterone compared to when you were younger. FSH is likely above 10mIU/mL and might even be above 20mIU/mL indicating the follicles in your ovaries are really not listening or available anymore. Estradiol and progesterone are likely more consistently in the post-menopausal range.
Follicle-stimulating hormone (FSH) levels begin to rise about 6 years before your last menstrual period. To track this, you can test your FSH levels in blood on day 3 of your period once a year, starting at 35 or 40 years old. By monitoring the trend, if you notice your FSH levels going from 5mIU/mL to 9mIU/mL to 15mIU/mL and then to 26mIU/mL, it becomes evident.
Menopause is typically diagnosed based on the absence of menstrual periods for 12 consecutive months, rather than relying on a single blood test to predict the menopausal transition in women.
Common Signs and Symptoms
This 2022 article states the top 10 signs and symptoms women tend to report:
• Irregular cycles
• Loss of libido
• Hot flushes and night sweats
• Insomnia
• Increase in abdominal fat (“belly fat”)
• Changes in the breast size and shape (increased fat accumulation)
• Heart palpitations
• Brain fog
• Mood changes (depression, irritability, easier anger, anxiety, mood fluctuations)
• Low energy/fatigue
If you don’t have ovaries due to a hysterectomy, you’re considered surgical menopause and skipped the process of perimenopause.
If you’re using a hormonal IUD or on the birth control pill, you’re likely not able to tell what’s going on due to the mechanism of action of the IUD and pill.
Perimenopausal symptoms can start as early as in the mid-late 30’s. However, it’s important to note that many other aspects of health can cause similar symptoms. If you’re skipping periods and feeling tired at 35 years old, make sure you get your thyroid checked (for example) as those signs and symptoms overlap.
The Peri Grey Zone
It’s important to remember that not all GPs are well-informed about perimenopause. Even those who are may not recognise that women can experience symptoms before their periods change. Many patients have visited their GP about their symptoms only to have perimenopause overlooked or dismissed.
This happened to me when I visited my gynaecologist before experiencing any changes in my menstrual cycle. Despite my symptoms – anxiety, heart palpitations, restless nights, and breast pain – I was told that I couldn’t be in perimenopause because I was still having regular periods.
I’ve named this pre-menstrual symptom period the “Peri Grey Zone”. It’s called a grey zone because it can be uncertain whether the symptoms are due to perimenopause or other factors, but also because you simply don’t feel right.
This can be a confusing time. For instance, many people are unaware that heart palpitations, a common symptom, can be caused by the decrease in progesterone, one of the first changes in perimenopause. Some patients have even been sent to be tested for heart problems, only to find out that their results were negative. Their GPs then attributed the palpitations to stress. (Note: If you experience heart palpitations, be sure to get them checked out).
Even when symptoms become more obviously perimenopausal, such as changes in menstrual cycle or experiencing hot flashes, women still struggle to get a proper diagnosis. Furthermore, many GPs are hesitant to prescribe HRT, despite its proven safety for most women. And even when patients start HRT, it’s not a guaranteed solution for making all symptoms disappear.
What You Can Do
To help get the the root cause of symptoms, in clinic we recommend our clients take the DUTCH test for an accurate hormone profile over time, rather than a snapshot as you would get in a blood test. This will give you a clear picture of your hormone levels and approximately where you are in your transition.
Consider trying my new PCH Peri-Balance supplement – A truly unique blend of traditionally used plant extracts, a key mineral and vitamin for hormonal metabolism and singular glandular, all designed to smooth the journey of hormonal change for all women over the age of 35.
If you are suffering from menopause symptoms such as poor sleep, anxiety, brain fog, heavy periods, low libido, fatigue, bloating and weight gain, then don’t miss Pippa’s Menopause Workshop on Tuesday 25th March. The workshop will cover how diet, lifestyle and supplements can help.
References:
- Bradley LD. Chapter 14 – Abnormal Uterine Bleeding. ScienceDirect. Published January 1, 2007. Accessed February 8, 2024. https://www.sciencedirect.com/science/article/abs/pii/B9780323032476100140
- Santoro N. The menopausal transition. The American Journal of Medicine. 2005;118(12):8-13. doi:https://doi.org/10.1016/j.amjmed.2005.09.008
