What Stage of Perimenopause Are You In?

‍Perimenopause is usually divided into two stages: early and late. The biggest clue to where you are isn’t a single symptom or hormone result, it’s how your menstrual cycle is changing over time.

In early perimenopause, cycle length typically starts becoming less predictable. In late perimenopause, skipped periods and gaps of 60 days or more become more common as ovulation becomes increasingly inconsistent.

Hormones can fluctuate significantly throughout both stages, which is why you may have a month where you feel relatively normal followed by one that feels completely different.

Here’s how the two stages differ, what symptoms you may notice, and what your cycle patterns can tell you about where you are in the transition.

These stages are defined primarily by menstrual-cycle patterns, not by reaching one specific hormone level.

>>MORE: Perimenopause vs. Menopause: What's the Difference?

Stages of perimenopause: early stage

The first of the stages of perimenopause is called the early stage, marked by the beginning of irregular cycles. 

What’s happening in your body during this time? Your ovarian reserve is low, meaning you have fewer eggs left to be released into your fallopian tubes. Your ovaries start to slow down their production of estrogen, and a domino effect sets in:

• Estrogen becomes more unpredictable. Estrogen may rise unusually high in some cycles and fall sharply in others. That volatility can contribute to changes in bleeding, sleep, mood, temperature regulation, and other symptoms.
• Ovulation becomes less consistent. You may still ovulate regularly at first, but some cycles may become delayed or anovulatory.
• Progesterone may become less consistent. Because progesterone rises after ovulation, cycles where ovulation is delayed or does not occur can produce very different progesterone patterns.
• FSH can rise and fluctuate. FSH may increase as the ovaries become less responsive, but one FSH measurement alone does not tell you what stage of perimenopause you are in.m

The hallmark of early perimenopause is increasing cycle variability. A commonly used marker is a persistent difference of seven days or more in cycle length between consecutive cycles. During this stage, some people may experience variation in their cycle of more than a week.

When does early stage perimenopause begin?

The first stage of perimenopause can begin as early as your mid-30s, but happens most commonly in your 40s. The first sign of perimenopause is typically irregular menstrual cycles; however, you may also experience a range of physical and emotional symptoms that accompany this irregularity. 

Early stage perimenopause symptoms

As many as 90% of women will go to healthcare professionals to get advice about perimenopause symptoms, so what kinds of symptoms should you expect? Some of the most common perimenopause symptoms during early stage perimenopause include:

• Hot flashes: A sudden feeling of intense heat, often accompanied by sweating, chills, and a rapid heartbeat
• Night sweats: Similar to hot flashes, these bursts of heat occur during sleep, which can lead to disrupted sleep schedules and fatigue.
• Vaginal dryness: As estrogen decreases, vaginal tissues become thinner and less lubricated. This can cause discomfort during intercourse.
• Mood swings: You may feel irritable or have sudden changes in your emotions.
• Joint pain: Seven in ten women experience perimenopause joint pain, often caused by a decline in estrogen that helps regulate inflamation and promote joint health.
• Brain fog: Because estrogen plays a large role in memory and executive function, when estrogen decreases, you may feel groggy, confused, or have difficulty concentrating.

Remember, everyone experiences perimenopause differently. Some people may experience a range of symptoms at a high intensity, while others may only experience a few symptoms at a lower intensity.

Regardless of what you’re feeling, there are a variety of perimenopause treatment options to manage these symptoms:

• Lifestyle changes: Adapting your routine to include regular exercise, stress management, better sleep hygiene, and a nutritious diet can help improve your well-being and decrease symptom intensity. 
• Dietary adjustments: In addition to eating a nutritious diet, limiting processed foods, caffeine, and alcohol and increase soy-based products and flaxseeds can offer relief from hot flashes.
• Natural remedies: Certain vitamins and minerals can help promote hormonal balance and target specific symptom areas; for example, calcium can support bone health and help alleviate joint health, while omega-3 fatty acids can help with mood stability. Be sure to consult with a professional to determine what perimenopause vitamins or supplements are right for you. 
• Hormone replacement therapy (HRT): This medical intervention involves supplementing your body with hormones that are declining (typically estrogen and progesterone). Because lower hormone levels often cause perimenopause symptoms, balancing out hormones can help alleviate discomfort you might be experiencing. Again, be sure to discuss risks and outcomes with a healthcare professional as you consider when to start.

→ Learn more: Perimenopause treatment options

Stages of perimenopause: late stage

The second of the two stages of perimenopause is the late stage. In late stage perimenopause, irregular cycles are highly irregular and periods are scarce. 

What’s happening in your body now? Late perimenopause is defined less by a steadily falling hormone level and more by increasingly irregular ovarian activity. Ovulation becomes less frequent, progesterone production becomes less consistent, and estrogen can continue to swing significantly from cycle to cycle. As estrogen drops, other hormones respond:

• Progesterone continues to decline. Progesterone levels plummet by the second stage of perimenopause, leading to further irregular bleeding.
• FSH rises: In an attempt to encourage the ovaries to produce more estrogen, FSH increases, but has little impact.

The key marker of the late stage of perimenopause is the length between your periods. During the late stage, the clearest clinical marker is a gap of 60 days or more without a period.

When does late stage perimenopause begin?

The late stage of perimenopause tends to occur in your late 40s to early 50s. The average age for late stage perimenopause is 49, two years after the average age of the early stage (47). Remember, there’s a lot of variability between when perimenopause begins, and this variability carries over to each stage, too.

Late stage perimenopause symptoms

What symptoms can you expect during the second stage of perimenopause? Symptoms are similar, if not the same as the early stage of perimenopause; however, you might find that symptoms intensify or arise more frequently. 

Late stage perimenopause symptoms include:

• Hot flashes and night sweats
• Vaginal dryness
• Sleep disturbances
• Mood swings
• Joint pain
• Brain fog

You can continue using the same strategies from early stage perimenopause to manage and alleviate these symptoms. Depending on symptom intensity, you can try natural remedies like lifestyle changes or vitamins, or medical interventions like HRT. When treating perimenopause symptoms, be sure to consult a healthcare professional. 

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Stages of perimenopause: the bottom line

There are two main stages of perimenopause. Early perimenopause is usually marked by increasing cycle variability; late perimenopause is marked by gaps of 60 days or more between periods.

Symptoms alone can’t reliably tell you which stage you’re in, because hot flashes, sleep changes, mood shifts, brain fog, and other symptoms can occur throughout the transition. Your cycle pattern over time provides much more useful context.

And because hormones can fluctuate dramatically during perimenopause, looking at your pattern across multiple days and cycles can be more informative than relying on a single measurement.