top of page

What are the Symptoms of Perimenopause and Menopause?

Fifty percent of the population experiences perimenopause and menopause. However, we don’t talk about it. “We,” meaning moms, daughters, grandmothers, aunties, and friends which means we don’t fully understand it. Our doctors don’t prepare us, and they tend to only discuss it when we bring up symptoms. However, how does a woman or AFAB person even know they are in perimenopause or menopause? What are the symptoms?

I conducted a podcast interview with Dr. Lara Briden, author of Hormone Repair Manual: Every Woman's Guide to Healthy Hormones After 40, and she shared that there are four phases to perimenopause, which is the time leading up to menopause. This means perimenopause symptoms adjust over time due to the extreme fluctuations in estrogen and progesterone levels.

The Hormonal Yin and Yang

Before we dive into the phases, it is important to understand the role of progesterone and estrogen. These definitions are from the Centre for Menstrual Cycle & Ovulation Research (CeMCOR) run by Dr. Jerilynn Prior.

Graphic Showing how Estrogen and Progesterone Hormone Levels Fluctuate over a Woman's Lifetime


An important group of hormones essential for the healthy functioning of reproductive and other tissues. During the reproductive years in women estrogens are primarily made in the ovaries, and there are three kinds of estrogens.

  • Estradiol is the ovarian hormone of the premenopausal years,

  • Estrone is the hormone of the menopausal years and

  • Estriol, a weak estrogen, is present in high levels during pregnancy.

High estrogen levels are associated with nausea, decreased sex drive, breast tenderness, mood swings, headaches, hair loss, insulin resistance and fluid retention.

Low estrogen is associated with painful sex due to a lack of vaginal lubrication, an increase in urinary tract infection (UTIs) due to a thinning of the urethra, hot flashes,, headaches or accentuation of pre-existing migraines, and depression.


This is an important ovarian hormone produced by the ovaries following ovulation during the menstrual cycle. Progesterone, which stops the proliferation of estrogen, causes the endometrium to accept and nurture a fertilized egg. If fertilization does not occur estrogen and progesterone levels decrease and a period results.

Low progesterone levels are associated with abdominal pain, sore breasts, vaginal dryness, mood swings, low libido, and headaches.

Perimenopause Phases & Your Hormones

Graphic describing the 4 phases of Perimenopause

Phase 1: Very Early Perimenopause

During this time period, which lasts about 2-5 years, your menstrual cycles are still regular. However, your body begins to produce less progesterone and more estrogen. As a result, you may experience sleep disturbance, migraines, heavier periods and increased period pain.

Phase 2: Early Menopause Transition

This is when irregular periods begin, where the variation, assuming that, up to this point, you have had regular cycles, is seven or more days. Here, your progesterone levels are low and the high estrogen levels from phase one begin to fluctuate. As a result, night sweats and hot flashes worsen.

Phase 3: Late Menopause Transition

This occurs when you have your first menstrual cycle that is more than 60 days. The good news is that your breast pain eases but hot flashes and night sweats may intensify. You may also have a couple of heavy periods during this time.

Phase 4: Late Perimenopause

With menopause being defined as 12 consecutive months without a menstrual cycle, late perimenopause is inclusive of these final 12 months where you experience decreased mood symptoms and fewer migraines.

Once you have hit the 12-month mark, the technical term is “post menopause” as menopause is a specific day. The average age of menopause in the United Sta