While each woman’s perimenopause journey is unique, the transition generally follows four main stages. Recognising these stages can help you understand what to expect and identify the first signs, even when they’re subtle. Often, early symptoms like sleep disturbances, mood swings, and anxiety appear before noticeable changes in the menstrual cycle, making perimenopause easy to overlook at first. Understanding how perimenopause unfolds—and the many symptoms you may experience—can be reassuring, helping you feel more prepared and proactive as you move towards menopause.

What are the stages of perimenopause?

Stage 1: Early perimenopause

Overview: Early perimenopause is often marked by subtle hormonal shifts. For some women, these changes are so mild they may not even notice perimenopause has begun. Menstrual cycles often stay regular, making it easy to overlook these initial changes.

Common Symptoms: Early signs may include sleep disturbances, mood changes, heightened anxiety, and occasional night sweats or hot flushes. Many women attribute these symptoms to daily stressors, not realising they could be related to early perimenopause.

Support Tips: Prioritising quality sleep, regular exercise, and managing stress levels can be helpful during this stage. Even small lifestyle adjustments, like focusing on balanced nutrition, can lay a strong foundation for managing symptoms in later stages.

Stage 2: Active perimenopause

Overview: In this stage, hormonal fluctuations become more noticeable, often amplifying physical and emotional symptoms. For many women, PMS symptoms can feel more intense, and changes in the menstrual cycle may start to appear—though this doesn’t happen for everyone, and your cycle may remain regular for some time.

Common Symptoms: Symptoms often intensify in Stage 2, with more pronounced hot flushes, night sweats, and increased sleep disturbances. Many women experience heightened mood swings, irritability, and feelings of prolonged tiredness or fatigue. Changes in menstrual flow may also begin, such as heavier or lighter periods.

Support Tips: Since symptoms in this phase can start to impact daily life, consulting with your doctor or a menopause specialist about symptom management can be very helpful. This is an important time to focus on your health and well-being—supportive supplements, regular exercise, and a balanced diet with hormone-supportive nutrients can make a noticeable difference, as can techniques like yoga or mindfulness to manage stress.

Getting good-quality sleep is essential for managing symptoms and balancing work and family commitments, though broken sleep and insomnia are common challenges in perimenopause. Creating a calming bedtime routine, limiting screen time before bed, and, if needed, considering a natural, non-habit-forming sleep aid, like our Sleep Complex, can provide extra support to get the rest you need. A symptom and period-tracking app on your phone can also be valuable for spotting patterns, identifying potential triggers, and sharing insights with your doctor.

 

Stage 3: Late perimenopause

Overview: Late perimenopause generally occurs within a few years of menopause and often brings more intense hormonal fluctuations. Estrogen levels decline more steadily, while testosterone levels may also shift, influencing energy, libido, brain fog, and mood. Menstrual cycles may become highly irregular, sometimes skipping several months at a time, though some women may still experience regular periods.

Common Symptoms: During this stage, symptoms may reach their peak or feel more intense. Hot flushes and night sweats often become more frequent, and menstrual cycles may skip for extended periods before returning unpredictably. Other common changes include increased “brain fog,” memory lapses, intensified mood changes, and sleep disturbances, which can lead to fatigue and anxiety. Some women also experience joint and muscle aches or inflammation, along with changes in libido, skin texture, and hair thinning as hormone levels fluctuate and decline.

Support Tips: This is a good time to build on supportive routines that can help manage these changes, along with monitoring bone health, as bone density may begin to decline with lower estrogen levels. Prioritise nutrient-rich foods, stay hydrated, and consider weight-bearing exercises, which are especially beneficial for bone strength. Certain supplements with hormone-supportive ingredients, such as our core product Foundation, along with targeted adaptogens and herbal extracts, can help with many symptoms, like lifting mood, boosting energy levels, and restoring sleep. If symptoms feel overwhelming, talk to your doctor about hormone treatment options—there are many effective choices available that may help bring relief.

Stage 4: The final stretch before menopause

Overview: This stage, often called “late-stage perimenopause,” typically spans the final year or months before menopause. At this point, hormonal changes start to stabilise at lower levels as the body prepares to transition. Once you’ve gone 12 consecutive months without a period, you’re considered to have reached menopause.

Common Symptoms: Symptoms can vary widely in this final stretch. For some, symptoms like hot flushes and night sweats may feel their most intense, while for others, they may start to ease. Estrogen decline can also lead to noticeable changes in libido, skin texture, hair, and an increased risk to bone density and heart health. Many women also notice shifts in muscle mass and fat distribution, with weight changes often appearing around the waistline.

Support Tips: This is a time to really nurture both mental and physical health. Aim for a diet rich in calcium, magnesium, and vitamin D—found in green leafy vegetables, eggs, nuts, and seeds—to support bone health and include heart-healthy foods like omega-3-rich fish. Quality proteins and fibre also offer excellent health benefits, which are important as we age. Regular physical activity and routine check-ins with healthcare providers for bone and cardiovascular health screenings are also important. Many women find that connecting with a support network or online community provides encouragement and shared understanding during this transition.

Transitioning to Menopause

Once 12 consecutive months have passed without menstruating, menopause is officially reached—marked as a single day that signals the end of this transition. After this, the body moves into post-menopause, where hormone levels settle at a new baseline. Symptoms may ease or continue for some, though they often become less intense over time. Menopause marks the beginning of a new life phase—post-menopause—where caring for your mind and body with awareness and support can greatly enhance your overall well-being, contributing to a healthy, vibrant later life.