What Phase Of Perimenopause Am I In?
I tend to break perimenopause into early, mid, and late.
I, personally, am somewhere between early and middle perimenopause and here’s why.
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 ≥3 months of amenorrhea (no period) are highly likely (about 95%) to become postmenopausal within the next 4 years.
In early perimenopause, cycles tend to become more variable in length. Most women report that they shorten at first. This means going from 28 days to 24 days. Or going from 30 days to 26 days. Technically, this phase is defined as cycle changes by 7 days. If you did testing, you might find your follicle stimulating hormone (FSH) is likely in range or maybe starting to creep up to above 10mIU/mL). Estradiol is also probably in an expected range when you test although I know it’s starting to swing around off its track meaning some days are higher or lower than expected. Progesterone is probably starting to drop more consistently. As a result, you are noticing symptoms here (hopefully you’re actively addressing them).
In what I call middle perimenopause (after a few years of early perimenopause), I notice women start to transition into a skipped period here and there thus ushering in panic of “Am I pregnant?” They are noticing MORE perimenopausal symptoms. Their hormones don’t feel as stable.
In late perimenopause, you might be skipping cycles pretty regularly. The technical definition is to go 60 days without a cycle. But, you might go 2 months with no period, then get a random period at the most inconvenient time. Then you go 5 months with no period then get 2 in the same month (awesome). You’re still having symptoms that might feel worse as you’re going longer without the levels of estradiol and progesterone you’re used 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.
FSH starts to rise about 6 years before your last menstrual period. This means if you tested your FSH in blood on day 3 of your period once a year starting at 35 or 40 years old, you can look for the trends. If you watch it go from 5mIU/mL a few years to 9mIU/mL to 15mIU/ML to 26mIU/mL it becomes obvious.
There is no test to determine WHEN a woman goes jumps through the hoop of menopause (no cycle x 12 months) but we use this information to guide us.
This 2022 article states the top 10 signs and symptoms women tend to report:
Irregular menstruation and ovulation cycles
Loss of sexual urge
Vasomotor Symptoms (hot flashes and night sweats)
Insomnia
Increase in abdominal fat ("belly fat")
Changes in the breast size and shape (increased fat accumulation)
Heart palpitations
Loss of memory and difficulties in concentration
Mood changes (depression, irritability, easier anger, mood fluctuations)
Fatigue
Pinkerton, J. Knowledge gaps and challenges in care for menopausal women OBG Manag. 2022 June;34(6):21-26, 28-29 | doi: 10.12788/obgm.0203
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 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 assessed (for example) as those signs and symptoms overlap.
Back to me, as of the time of writing this article in May 2024 I am ALMOST 47 years old. I am pretty consistently getting my period every 25 days (down from 28 days a few years ago). I do have some symptoms (hello itchy ears, slower brain recall, and more moodiness). I do ovulate (release the egg) but my progesterone production is not that ideal so I’m on progesterone in the luteal phase (see this article). I am not on estrogen or testosterone as I don’t need them yet.
Understanding where you are in perimenopause gives you more information and feedback about you and the journey you’re on. Even though it feels like you’re herding cats, you got this.
Citations:
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