If you’ve been wondering whether you’re in perimenopause—or just going slightly mad—this post is for you. The good (and annoying) news is that perimenopause doesn’t hit all at once. It unfolds in stages, each with its own quirks, challenges, and yes, surprises. Think of it less like a light switch and more like a dimmer—gradually shifting until you reach menopause (when your periods stop for good).

Let’s break down the stages so you can get a clearer picture of where you might be—and what’s coming next.

What Exactly Is Perimenopause?

Perimenopause means “around menopause,” and it refers to the years leading up to your final period. During this time, your ovaries start to wind down hormone production—particularly estrogen and progesterone—which leads to a wide range of symptoms, from irregular periods to night sweats to mood swings. According to the North American Menopause Society (NAMS), perimenopause typically starts in a woman’s 40s but can begin earlier. In fact, a study published in Nature, February 2025 revealed that women are beginning perimenopause as early as 30 years of age! 

The whole transition can last anywhere from 4 to 10 years. Yes, years. It’s not a quick stop—it’s a slow cruise.

The Four Stages of the Menopausal Transition

There are different ways to categorize the stages, but a commonly accepted framework comes from the STRAW+10 system (Stages of Reproductive Aging Workshop), which breaks it into clear phases. Here’s how it typically looks:

Early Perimenopause (a.k.a. “Wait, is this normal?”)

This is the sneaky stage. Your periods may still seem mostly regular, but subtle changes start creeping in:

– Your cycle length might shorten or vary slightly (from your usual 28 days to maybe 24 or 32).

– You might notice more intense PMS or mood swings.

– Sleep issues, anxiety, or brain fog start to surface.

– Ovulation becomes less predictable.

Hormones start fluctuating significantly, but not in a consistent pattern. Estrogen can be wildly high one day and drop suddenly the next. You might feel fantastic one week and totally off the next.

Mid to Late Perimenopause (“Okay, something’s definitely happening”)

This is when things get more obvious—and often more intense:

– Your periods become irregular or skip altogether.

– You might go months without a period, then have one that’s extra heavy.

– Hot flashes, night sweats, and sleep disturbances ramp up.

– Mood changes, memory glitches, and irritability become more noticeable.

According to a 2021 study in Obstetrics and Gynecology, hot flashes and night sweats (collectively called vasomotor symptoms) affect up to 80% of women during this phase. Progesterone levels drop first, often resulting in estrogen dominance, which can explain the heavier periods and PMS-like symptoms.

This stage can last several years, and symptoms tend to come and go in waves.

Late Perimenopause (“Are we there yet?”)

Late perimenopause is marked by longer stretches without periods—sometimes up to 11 months. But if you go 12 months without menstruating, you’re officially in menopause.

During this final stretch:

– Estrogen production declines more steeply.

– Periods may stop altogether or come back unexpectedly.

– Hot flashes and sleep issues may peak.

– Vaginal dryness, libido changes, and urinary issues might appear or intensify.

Your ovaries are nearing their hormonal retirement. The chaos starts to subside, though the symptoms may still be persistent or annoying.

Menopause and Postmenopause (“The new normal”)

Once you’ve gone a full year without a period, congratulations—you’ve reached menopause. But don’t throw a party just yet (unless you want to!).

The first few years after menopause are often called early postmenopause, and symptoms can still linger. Estrogen is now at a permanently low level, which can affect bone density, heart health, skin elasticity, and more.

Hormone replacement therapy (HRT) may be a helpful option for some women during this time, depending on health history and symptom severity. The North American Menopause Society notes that HRT is most effective when started before age 60 or within 10 years of menopause onset.

So, How Do You Know What Stage You’re In?

Unfortunately, there’s no exact test that can pinpoint your spot on the perimenopause timeline. Blood tests for FSH (follicle-stimulating hormone) or estrogen can be inconsistent because hormone levels fluctuate daily. Tracking your symptoms and cycles is often more useful.

Apps like Balance or Clue can help, or you can go old-school with a notebook. Pay attention to changes in:

– Period regularity and flow

– Mood and energy

– Sleep patterns

– Hot flashes or night sweats

– Libido and vaginal comfort

Final Thoughts: This Is a Journey, Not a Diagnosis

The stages of perimenopause can feel like a confusing maze, especially when you’re juggling work, family, and your own shifting body. But knowing what to expect—and when—can help you feel more in control. It’s not just “getting older” or “being moody.” It’s biology, and it’s real.

Understanding where you are in the process can help you plan, prepare, and most importantly, advocate for yourself. If something feels off, trust your gut and talk to a healthcare provider who gets it. You deserve support, answers, and relief.

Perimenopause might not be a straight path, but with the right knowledge and tools, it’s one you can absolutely navigate.
If you are curious about your hormone balance or want to see if your symptoms are related to estrogen dominance, check out my FREE Hormone Quiz . You will receive immediate answers and suggestions to support you in optimizing your hormone balance and perimenopausal experience.

Here’s to YOUR vitality and hormonal balance!