The 4 Stages of Perimenopause
The onset of hormonal changes that begin (usually) in our forties can be a confusing time. And I've noticed there is not a lot of insight or guidance around this incredibly important time in a woman’s life – and more importantly, how to understand what is going on and supporting this process rather than trying to supress it, medicate it, or ignore it.
Here's What Actually Happens...
Our female hormones, oestrogen and progesterone, are beginning to wind down as we approach a perfectly normal and natural end to the fertile reproductive years. Both of these hormones play a key role in ovulation, which really is the main event that our hormones get excited about from our teen years to our mid-thirties (or thereabouts).
Perimenopause refers to the sequence of events that begin to occur in the lead up to menopause – and it can last between 2-12 years, with changes becoming noticeable anytime from age 35 onwards. But whilst our hormones are in decline, they certainly don't go quietly. This is the time when hormones are actually fluctuating up and down – and therefore symptoms are the most obvious (and potentially distressing). There are actually more hormonal fluctuations occurring during this time than there are at puberty! Which certainly explains why women in their forties often feel like they are on a hormonal roller-coaster. Up, down, up, down...with the occasional sideways jolt.
The term ‘menopause’ actually refers to the life phase that begins one year after the last period – and contrary to popular belief, hormonal fluctuations have mostly settled and symptoms usually subside during this stage.
It can be useful to view these changes as a natural occurrence that has been designed by nature as a way to provide support (in the form of helpful grandmothers) to the newer generations.
‘Women need to know that perimenopause ends in a kinder and calmer phase of life called menopause.’
Professor Jerilynn C Prior, Women’s Hormone Expert
Common Signs & Symptoms of Perimenopause
- Irregular periods – periods may arrive more frequently or you may start skipping periods
- Extremely heavy bleeds, often with clots or flooding
- Migraines – these may suddenly start occurring or become more frequent than previously
- Itchy skin
- Insomnia (particularly waking during the early hours of the morning)
- Night sweats, which can become worse/more frequent in the week before your period
- Lowered stress tolerance – you may find that things bug you more than they used to, or you become upset more easily
- Fluid retention
- Urinary tract infections or thrush
- Reduction in sex drive
- Niggly aches & pains, such as joint pain or cramps
- Weight gain, particularly around the midsection, that is difficult to shift (‘help, I’ve lost my waist!’)
Breaking It Down
It can be easier to understand the changes that occur (and therefore, where you may be on your perimenopausal journey) by breaking this period of time down into 4 phases.
- Phase 1: Very Early Perimenopause can last up to 5 years, and may be where you start to notice a few small changes in when your periods arrive, your flow, or your moods.
- Phase 2: Early Transition tends to see more irregularity happening in the cycle. For instance, you may find that your periods arrive more frequently (sometimes occurring only a couple of weeks apart) or they may only turn up every 5 or more weeks. It’s also pretty common to fluctuate between the two – you may have a couple of months of very frequent, heavy bleeds, followed by a few months of sparse, light bleeds.
- Phase 3: Late Transition is where periods become very infrequent – usually 2 months or more between periods. You may also find that this is the time that coincides with sleep difficulties, hot flushes and weight gain.
- Phase 4: Late Perimenopause refers to the year after the final period. Once you have gone 1 year without a period, you are deemed to have officially entered menopause.
Why I Don’t (Usually) Test Hormones
Often, when I speak to women who are struggling with perimenopausal symptoms, the first thing that they tell me is that they have had their hormones tested, and they have been told they are not in perimenopause or menopause.
The trouble with hormone testing during this time is that the fluctuations are normal – in other words, it’s almost impossible to accurately identify perimenopause with a test. You may have your blood test taken at a time when you are experiencing a perfectly typical perimenopausal hormonal surge or trough, and your hormones will be doing something different within a month or two.
With any hormonal issue (including PMS & period pain), the overall pattern of symptoms always gives us the best guidance as to what is actually going on.
How You Can Turn The Corner...And Feel Good Again!
- Reduce, or avoid, alcohol. As a lover of many a good wine, I hate to be the bearer of bad news, but this is it in a nutshell. Alcohol is not your friend during perimenopause. There’s no dressing that one up – alcohol interferes with our hormones, impairs detoxification, and robs us of important nutrients like magnesium. It will make your hot flushes more frequent and/or severe, worsen your sleep and make you feel more anxious or stressed. If you currently drink, consider looking at the ‘sober curious’ movement – it’s an area that is becoming incredibly popular with people all around the world who are recognising that alcohol does more harm than good – and there are plenty of resources, books, podcasts and (shock!) alcohol-free drink options that are quite enjoyable, available.
- Manage stress. Due to the loss of progesterone during the perimenopausal transition, your resilience to stress is lower than it used to be. This is the time to really prioritise self-care, and it may even be a cue to take a hard look at your commitments and the things in your life that are not serving you. Make sure you schedule time out for activities you enjoy, to spend with loved ones, and plenty of opportunities to rest and refresh.
- Nourish yourself. At this time, your body, mind (and hormones!) really need you to feed them well – so that you avoid nutrient deficiencies and blood sugar fluctuations that can make perimenopausal symptoms a whole lot worse. If you aren’t already, try to base most of your day around fresh whole foods like lean poultry, fish/seafood, legumes, nuts & seeds, veggies, fruits and healthy carbs like rye, pumpkin, sweet potato and oats to improve gut health.
If you’d like to really ramp up your nutrition and get serious about your hormonal health, our Metabolic Balance program is the perfect solution – by taking the guesswork out of what to eat, when to eat, and how much is right for your body. We’ve had some great feedback from our participants who have told us that not only have they been able to successfully lose weight (and keep it off!) they’ve noticed improvements in their hot flushes, aches & pains, sleep, moods and so much more.