Perimenopause in 4 Stages: A Helpful Way to Understand What’s Happening

Most people think of “menopause” as a long phase of life, but technically, menopause is just one day - the last or final menstrual period - however we can only recognise it retrospectively - on the 12-month anniversary of your last period.

The real transition happens in the years leading up to that day. This is called perimenopause. It’s the time when hormones begin to fluctuate, often causing physical, emotional, and mental changes that can be confusing and difficult to manage. On average, perimenopause lasts about four years, but for some women it can stretch to eight or even ten.

To make things more confusing, there’s no single test that can confirm you’re in perimenopause. Hormone levels shift daily, and standard blood tests often come back “normal,” even when symptoms are very real.

While the medical world doesn’t formally define stages of perimenopause, many women go through similar patterns during this transition. This 4-stage framework is not a diagnostic tool, but it can be a helpful way to make sense of what’s happening in your own body and to feel less alone in the process.

Stage 1: Very Early Perimenopause

Your periods are still regular, but something feels different

This stage is easy to miss. Your cycle may be on time, but you start noticing changes in how you feel - physically, mentally, or emotionally. It often begins in the late 30s to early 40s and is frequently dismissed or overlooked.

Common symptoms:

• Feeling more anxious or overwhelmed

• A drop in self-confidence

• Alcohol intolerance

• PMS that feels more intense

• Heavier periods

• Cycles changing by a few days – maybe shorter

Personal note:I remember feeling that something was changing in my body, but I didn’t want to admit what it was. Deep down, I knew it might be perimenopause, but I associated that with getting old. So I pushed back and tried to resist the changes. If I had my time again, I would have approached it very differently.

Stage 2: Early Perimenopause

Your cycle becomes unpredictable, and symptoms start to build

This is when things become more noticeable. Your period might arrive early or late, and your hormones can swing wildly - especially estrogen, which may spike much higher than usual while progesterone drops.

You might notice:

• Breast tenderness

• Challenging to manage weight gain

• Migraines or worse headaches

• Mood swings or emotional outbursts

• Increased food sensitivities or allergies

• Crushing fatigue

Personal note:I felt like I was either on a high or a low, with no in-between. I still laugh (a little) about how I’d regularly storm up to the supermarket staff to rant about mouldy strawberries. It felt like an out of body experience - and not like the ‘usual’ me.

Stage 3: Late Perimenopause Transition

Your periods are spacing out, and estrogen starts to decline

This is often when the more “classic” menopause symptoms begin, even though you haven’t technically reached menopause. As estrogen levels drop more consistently, your body reacts in new and sometimes surprising ways.

Typical symptoms include:

• Hot flushes and night sweats

• Vaginal dryness or discomfort

• Joint and muscle aches

• Changing body shape, belly fat, weight gain

• Brain fog or forgetfulness

• Mood changes

• Ongoing fatigue

Personal note At one point, night sweats hit hard. I’d wake up several times a night soaked and need to change clothes, sometimes even the sheets. It severely impacted my sleep and left me running on empty. Looking back, I wish I’d reached out for support instead of battling along alone.

Stage 4: Late Perimenopause

Your periods become rare or stop altogether or feel like they go on forever

You might go months without bleeding, then suddenly have a period that lasts for longer than usual. You're still in perimenopause until it's been a full year without one. For some women, this stage brings relief. For others, symptoms linger or even intensify.

You may still experience:

• Hot flushes

• Poor sleep

• Low mood or energy

• Vaginal dryness or low libido

Personal note Things started to shift about 18 months after I hit that menopause mark. At first, some symptoms worsened before settling, but once my body adjusted, I started to feel like myself again - maybe even better than before.

You Don’t Have to Wait for Menopause to Get Help

If this sounds familiar and it's affecting your quality of life, know this: you don’t have to just wait it out. There are effective ways to feel better at every stage of the menopause transition. Some women benefit from Menopause Hormone Therapy (MHT). Others find support through lifestyle changes, naturopathy, or personalised care that focuses on sleep, nutrition, movement, and stress.There’s no one-size-fits-all approach. The key is finding what works for your body, your symptoms and your life.

What You’re Feeling Is Real

There’s no perfect test to confirm perimenopause. That’s why so many women are left feeling confused, dismissed or unsure about what’s happening. But if you’re noticing changes in your cycle, energy, mood, or body, it’s worth paying attention. Your hormones are changing - and you don’t have to navigate it alone.At the Midlife Women’s Clinic, we take perimenopause seriously. We offer evidence-based treatment options and compassionate, practical support to help you feel like yourself again.

Need support?

 If you're experiencing changes like these and want answers, book our Peri Assessment. We’ll help you understand what’s going on and what you can do next - no more guesswork.

 Better is possible

 Tania, Co-founder, Midlife Women’s Clinic