Stages of Peri-menopause

Working out which stage of peri-menopause you’re in, and when you’ll come out the other side can be really tricky. Read on to find out more about the 4 stages of peri-menopause, and how the menopause transition is also a stage in itself.

What is Peri-menopause?

In a nutsell, peri-menopause is the lead up to menopause. It’s the name we usually give to desribe the various hormone changes, and their symptoms that come about as we end our reproductive phase.

Most of us don’t want to be having babies, or even the option of having a baby in our 60’s, 70’s or 80’s, so nature has kindly obliged! Oestrogen has a key role to play in our monthly reproductive cycle, and our wellbeing throughout our reproductive life. In order to keep us infertile in our later years, we need less oestrogen. Oestrogen comes in different forms, and the most potent form is prevalent in regulating our menstrual cycle. During peri-menopause, levels of this most potent form drop as the ovaries wind down. The adrenal glands start to take over oestrogen production, and all being well, we end up with more of the less potent form, but still enough to keep ourselves healthy into old age.

Various processes have to go on to enable this to happen, and every woman experiences their transition in her own unique way. Whilst there are some trends with the symptoms at different stages, there’s no right or wrong way to experience menopause, and these trends aren’t definitive.

Overall, symptoms of peri-menopause can include:

  • Fatigue
  • Weight gain
  • Brain fog
  • Aches & Pains
  • Hot flushes/night sweats
  • Anxiety/insomnia
  • Vaginal dryness

There are lots more symptoms besides, and we’ll talk about them more in a moment.

Peri-menopause is a Life Stage

As we reach our 40’s, there’s a lot of focus on peri-menopause and a lot of it isn’t terribly positive! It is a big change, but it’s important to understand the bigger picture that peri-menopause sits within. It’s fair to say, you’ll never be the same again after menopause, but in a good way. Whether we like it or not, we’re aging and changing all the time. Each age and stage has its blessings and curses. In our 20’s we have boundless energy but a tendency to make silly mistakes because we lack the wisdom that comes with age. By our 60’s we have bucketfuls of wisdom but not quite the stamina we had in our 20’s. The human body was never designed to live at 100 mph for our entire lives. Slowing down is normal, natural and perfectly fine. It gives us time to reflect, consolidate our wisdom and perhaps follow new directions.

In the west, a woman’s life traditionally has 3 phases:

Maiden – also known as the child. Oestrogen levels are naturally low.

Mother – after menarche when there’s the potential to childbear. Oestrogen levels are naturally higher, but still fluctuate throughout the monthly cycle.

Crone – after childbearing, when (ideally!) there’s the opportunity to rest and be free of responsibility again. Oestrogen levels are lower, but we still have respectable amounts of oestrogen.

Within each of these phases, there are smaller phases which melt one into the next. The only definitive points are menarche, the first period, then the start of all the subsequent periods. Ovulation has tell-tale signs but most women don’t know the exact moment they ovulate. The exact moment a woman becomes a mother is still up for debate, leaving the final definitive moment: menopause. Menopause marks the first anniversary of the last period.

How Long Does Peri-menopause Last?

It depends on so many things! Your genetics, and where in the world you are both come into it but typically it lasts 3-5 years. Occasionally peri-menopause can go on for 10 years, and of course some of the early symptoms can be so subtle they either go unoticed or are mistaken for something else.

What Are The Stages Of Peri-menopause?

As I said, there’s no definitive point where one stage ends and the next starts, but for ease, let’s go with the 4 stages of peri-menopause. They are:

  1. Very early peri-menopause transition.
  2. Early peri-menopause transition.
  3. Late peri-menopause transition.
  4. Late peri-menopause.

Very early Peri-menopause transition

This is where your periods are regular (or normal for you) but you’re noticing some subtle changes. Often one of the first signs of peri-menopause is anxiety, but other changes include:

  • Alcohol intolerance
  • Loss of self confidence
  • It takes more effort to lose weight
  • Mood changes
  • PMS symptoms worsening
  • Heavier periods
  • Cycle starting to change length by a few days, and may shorten.

Early Peri-menopause Transition

This is where your cycle starts to change more noticeably, and can be at least 6-7 days early or late. Contrary to popular belief, at this stage oestrogen levels are fluctuating but aren’t always low. They can peak up to 4 times higher than before peri-menopause started, and the progesterone which would counterbalance the effects is comparatively low. As a result, you can have symptoms of oestrogen excess/low progesterone which include:

  • Breast pain
  • Heavy periods
  • Migraines
  • Weight gain
  • Irritability
  • Fatigue
  • New allergies/ food intolerances

Late Peri-menopause Transition

This is the point where oestrogen levels are declining, leading to a different set of symptoms, although you’ll notice that weight gain and fatigue are common themes throughout! This is what gives us the classic menopause symptoms that we all know:

  • Hot flushes / night sweats
  • Aches & pains
  • Vaginal dryness / atrophy
  • Fatigue
  • Mood swings
  • Brain fog
  • Weight gain

Late Peri-Menopause

By now you’re crossing the dates off your calendar, wondering if you’ve already had your last period. Welcome to late peri-menopause! You won’t be getting periods, but you might still notice a few symptoms like hot flushes, which may be random or cyclical. If you’re noticing these symptoms after your official menopause (1 year anniversary), it’s worth looking into some treatment as your hormones might not have completely resettled.

Menopause and Spiritual Transformation

Menopause in general was seen as a time of deep spiritual transformation, and it still should be! The transition from mother to crone is way beyond our conscious control and doesn’t happen overnight. It’s sometimes described as a death and rebirth, where you shed people, places, things, and ideals that no longer serve you, and replace them with something better. For some women that can mean something simple like taking up a new hobby, and for others it can mean major life changes. 

The spiritual ‘symptoms’ of menopause are more generic and can last throughout all four stages. They include things like:

  • Feeling like you don’t know yourself anymore
  • Feeling lost, alone, or disconnected from those around you.
  • Questioning ideas and beliefs that you’ve always held.
  • Feeling pulled in a new direction, or back towards things you did in your early childhood.
  • Wanting to retreat and check out of the world for a while.

Once we understand menopause for what it is, the whole process becomes much easier and much more positive. In Japan the word for menopause is ‘Konenki’. ‘Ko’ means renewal or regeneration. ‘Nen’ means years, and ‘Ki’ means energy or life force, the same as in ‘Rei-Ki’ or ‘Qi-Gong’. In China, menopause is known as the ‘second spring’, and is seen as a time of rebirth into a wiser, calmer state of being. It’s only in the west that we’re taught to dread menopause and medicate at every opportunity!

How Can I Tell Which Stage Of Peri-menopause I’m In?

The most definitive sign is by looking at what your periods are doing, as there’s usually no mistaking when your period starts. If your cycle is definitely lengthening, it would indicate that you’re in the later stages, particularly if you’re also getting symptoms of oestrogen deficiency like hot flushes, vaginal dryness or aches and pains.

That said, some women’s periods stop suddenly, and others just get lighter and lighter until they’re all gone. It can also be difficult to tell where you’re at if you’re having cancer treatment for example, or using a Mirena coil to top up your progesterone levels.

You could look at DUTCH testing to get an accurate hormone profile over a period of time, rather than a snap shot as you would get in a blood test. That will give you a clear picture as to what your levels of each hormone look like, and roughly where you are in your transition.

Alternatively, you complete this questionnaire to find out how menopausal you are. It’s in ‘Healthie’, the platform we use for consultations, because it’s the safest place we can keep your answers, and it will take you about 5 minutes.

What Are The Best Treatments For Peri-menopause?

Every time you have a normal, natural cycle, you make a positive contribution towards your health after menopause. That’s because you release the most potent form of oestrogen, which helps to protect your heart, brain and bones and support your general wellbeing. Ideally you need to continue having normal, natural cycles and hold menopause off for as long as you can. 

If you’re noticing that your cycle is changing, your bleed is heavier, or you’re getting other symptoms, herbal treatment is a perfect option. Instead of directly replacing your hormones, it supports your body in learning to make new ones itself. Your herbal medicine is made up according to your needs, and I usually blend 6-7 herbs together into one bottle. Those would include:

  • herbs to treat the underlying causes of any long term problems
  • some to buffer the effects of stress
  • others to calm the wild fluctuations in hormones
  • others to address specific symptoms

But now is also the perfect window of opportunity to get your health in order by cleaning up your diet, getting better quality sleep, or becoming more active. Knowing what to do is one thing, but actually doing it is something else entirely. We’re busy people nowadays, and finding the time and/or motivation to make these positive changes can be really hard. That’s why I now offer both health coaching and menopause hypnotherapy to work alongside the herbal treatment, in my Menopause Rescue Programme. 

Whatever’s going on for you, try to see your menopause as a time of positive change. If you’re struggling, there’s so much you can do in terms of self care and specific treatments, so feel free to browse the rest of this site and see what might work for you.



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