Perimenopause is not a single, uniform phase but rather a series of transitions leading up to menopause. According to Dr Lara Briden, perimenopause can be divided into four distinct stages, each with unique hormonal shifts and symptoms. Understanding these stages can help women navigate the changes with greater ease and confidence. Here’s a graphic I created off the back of the knowledge that Dr Briden shares, that may help you to understand where each phase sits across the ~10 year period:
Below is an outline of what happens during each phase and the most common symptoms. Bear in mind, that you could experience some of these symptoms at any phase, as everyone is different. Joint pain is an example. But something like hot flashes, you won’t typically see during early perimenopause. Remember, everyone is different and when it comes to your perimenopause journey, it’s N of 1. Or, sample size of 1. Your experience will be different to everyone else’s. Let’s dive into each phase!
1. Very Early Perimenopause
This stage typically begins in the late 30s or early 40s. Menstrual cycles are still regular, but subtle hormonal shifts start to occur. Progesterone levels begin to decline, while estrogen levels may fluctuate unpredictably. This phase lasts 2 – 5 years.
Common Symptoms:
Anovulatory cycles (a cycle where you don’t ovulate)
Heavier periods
Increased period pain
Migraines
Mild sleep disturbances
2. Early Menopause Transition
During this stage, estrogen levels fluctuate more dramatically, leading to noticeable cycle irregularities. Periods may become shorter, longer, heavier, or lighter. This phase lasts 2 – 3 years from the start of irregular cycles to your first missed cycle.
Common Symptoms:
More pronounced mood swings
Increased anxiety or depression
Hot flashes and night sweats begin
Changes in libido and vaginal dryness
3. Late Menopause Transition
This phase is characterised by longer gaps between periods, or cycles longer than 60 days. Estrogen levels continue to drop, and hot flashes and night sweats can intensify, but if you’ve been experiencing breast pain, this can start to reduce.
Common Symptoms:
More frequent hot flashes and night sweats
Sleep disturbances intensify
Brain fog and memory issues
Joint pain and frozen shoulder
4. Late Perimenopause
In this final stage, the body prepares for the complete cessation of menstrual cycles. This is the time where you are waiting to hit 12 months with no period. Estrogen and progesterone levels are at their lowest, and symptoms may peak before stabilising.
Common Symptoms:
Persistent hot flashes and night sweats
Fewer migraines and mood swings as estrogen begins to stabilise
Difficulty maintaining weight (although this can occur from the beginning of perimenopause, everyone is different!)
Then the final phase, which isn’t listed as number 5, but is the next phase after perimenopause…Menopause! Starts 12 months after your last period. You now have lower progesterone and estrogen, and all those perimenopause symptoms should ease.
Supplement Support:
The following four supplements can be used across any stage of perimenopause, and here is why:
Magnesium:
Used in over 300 chemical processes in the body
Research has found it reduces intensity and frequency of migraines(c)(d).
Improves insulin sensitivity and mood stability
Supports sleep regulation and managing cortisol levels
2. Taurine:
Often combined with magnesium as a powerhouse combination, it is an amino acid that supports neurotransmitter balance, reducing irritability and anxiety (when it’s combined with magnesium at the right dose, it does the opposite of what the V Energy drinks would lead you to believe!)
As estrogen declines during perimenopause, taurine steps in to support cardiovascular health and helps counteract oxidative stress(a).
It can also aid in cellular hydration and detoxification (b) and support cognitive function and stabilise mood.
Vitamin D:
Critical for immune function (h) and hormone production (j)
Crucial for mood regulation (k)
Aids in calcium absorption and bone protection (i)
Fish oil: Fish oil supplementation is considered almost essential in some respects because omega-3 fatty acids are essential nutrients that the human body cannot produce itself. They’re crucial for various bodily functions including brain health, heart health, inflammation control, and cell growth; most people do not consume enough omega-3s through diet alone. But specifically for perimenopause fish-oil supports the following:
Helps to reduce inflammation and support joint health (g)
Supports cognition (f) and is cardioprotective (e)
Final Thoughts
Now that you know the four stages of perimenopause, common symptoms and some natural ways to support your symptoms, I hope you feel more empowered to take control of your health. By laying down a solid foundation and having good habits when it comes to managing stress, sleep, exercising, lowering toxic load and eating well, you are off to a fantastic start. Remember though, start with 1 – 2 things and then build. If you try to do too much it WILL fall to the way-side. Then if you need too, reach for some of these key supplements, but do so with a practitioner and in conjunction with your doctor.
The next article in this series will focus on the role of nutrition and exercise during perimenopause and how hormones influence these essential lifestyle factors.
Before you go…
If you liked this article, and know of someone else who would too, don’t forget to share! I really appreciate it.
References:
(a). El Idrissi, A., & Trenkner, E. (2004). Taurine as a modulator of excitatory and inhibitory neurotransmission. Neurochemical research, 29(1), 189–197. https://doi.org/10.1023/b:nere.0000010448.17740.6e
(b) 5. Matheus Uba Chupel, Luciele Guerra Minuzzi, Guilherme Furtado, Mário Leonardo Santos, Eef Hogervorst, Edith Filaire, and Ana Maria Teixeira. 2018. Exercise and taurine in inflammation, cognition, and peripheral markers of blood-brain barrier integrity in older women. Applied Physiology, Nutrition, and Metabolism. 43(7): 733-741. https://doi.org/10.1139/apnm-2017-0775 Qi
(c) Raffaelli B, Storch E, Overeem LH, et al.. Sex hormones and calcitonin gene–related peptide in women with migraine: a cross-sectional, matched cohort study. Neurology. 2023;100(17):e1825-e1835.
(d) Dolati S, Rikhtegar R, Mehdizadeh A, Yousefi M. The Role of Magnesium in Pathophysiology and Migraine Treatment. Biol Trace Elem Res. 2020;196(2):375-383. doi:10.1007/s12011-019-01931-z
(e) Tur JA, Bibiloni MM, Sureda A, Pons A. Dietary sources of omega 3 fatty acids: public health risks and benefits. British Journal of Nutrition. 2012;107(S2):S23-S52. doi:10.1017/S0007114512001456
(f) Decandia D, Landolfo E, Sacchetti S, Gelfo F, Petrosini L, Cutuli D. n-3 PUFA Improve Emotion and Cognition during Menopause: A Systematic Review. Nutrients. 2022; 14(9):1982. https://doi.org/10.3390/nu14091982
(g) Shawl M, Geetha T, Burnett D, Babu JR. Omega-3 Supplementation and Its Effects on Osteoarthritis. Nutrients. 2024; 16(11):1650. https://doi.org/10.3390/nu16111650
(h) Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-886. doi:10.2310/JIM.0b013e31821b8755
(i) Laird E, Ward M, McSorley E, Strain JJ, Wallace J. Vitamin D and bone health: potential mechanisms. Nutrients. 2010;2(7):693-724. doi:10.3390/nu2070693
(j) Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr. 2008;88(2):491S-499S. doi:10.1093/ajcn/88.2.491S.
(k) Mikola T, Marx W, Lane MM, et al. The effect of vitamin D supplementation on depressive symptoms in adults: A systematic review and meta‐analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2023;63(33):11784-11801. doi:10.1080/10408398.2022.2096560.
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