The Changes of Perimenopause

When I thought about menopause in my 20s, it seemed pretty far away. However, as I progress through the second half of my 30s, the transition to menopause doesn’t actually seem (and isn’t!) that far away.

Even though the average age of menopause is fifty to fifty-one years old in North America, the menopause transition can start wayyy before that (like a decade before).

Menopause, Perimenopause, Menopause Transition, Post-Menopause: What does it all mean?

These terms are sometimes used interchangeably, but they mean different things. Let’s get nuanced:

Menopause: reached once you’re of the average/expected age of menopause and gone 12 months without a period.

Menopause Transition: the years leading up to the final period ever marked by declining reproductive function and hormone change.

Perimenopause: a combination of the above two terms, i.e., the years leading up to the final period + the 12 months it takes to officially reach menopause.

Post-menopause: Once you’ve reached menopause, which is more of an event, you’re now post-menopause 🙂

And there you have it, all the lingo that you’ll probably heard of (or will hear of).

Pink background. In the foreground is an analogue white alarm clock with a small chalkboard clip that says: MENOPAUSE

What happens in the menopause transition?

Early perimenopausal changes are typically subtle.

In early perimenopause, your total cycle length can start changing. A 7-day change (this can be shorter or longer) vs. regular cycles can indicate our entry into this phase of menstrual life. Two (consecutive or non-consecutive) changes in cycle length is indicative of perimenopause in someone who has regular cycles.

Different people have different experiences, and these aren’t necessarily going to be similar to your family members either. 

Changes in blood flow volume and PMS symptoms can be seen at this time as well.

Other changes that are common include:

These can be present daily or they may ebb and flow.

As you approach the final period ever, your FSH (follicle stimulating hormone) tries to stimulate follicles (that contain eggs) to grow but there’s not that many around. You will probably have many anovulatory cycles in which no egg is released. Consequently, your hormone levels and bleeding patterns change. Progesterone is pretty much only made after ovulation, so, as you can imagine, if there’s no ovulation, there’s not much progesterone either. 

Regardless of where in the menopause transition you are, cycle tracking is really helpful so that you can understand the changes in your hormones and the impact all of that is having on the rest of you.


  • Track when your period starts: day 1 is the first day of menstrual bleeding.
  • Try to track ovulation which usually happens around 10-14 days before your period starts and is typically accompanied by egg-whitey cervical mucus and maybe some transient abdominal pain.
  • Track your premenstrual experience like mood changes, breast or nipple sensitivity, bloating, and appetite changes.
  • Note down any other changes your noticing like sleep issues, digestive change, anxiety or low mood or irritability, etc.


Unfortunately, sex hormone testing doesn’t tell us too much about where in your menopause transition you are and it also doesn’t really change how we help you through the transition if you’re having a lot of manifestations of hormone change.

FSH (follicle-stimulating hormone) can start to go up, but it only does so as you get really close to that final period ever.

This doesn’t mean that we can’t test hormones at all. It simply means that, in most cases, sex hormones aren’t really going to really tell us much. There are instances when we do want to run them to rule in or rule out something, though. 

Other testing probably has a bigger role, like blood pressure, cholesterol, blood sugar, insulin, vitamin D, TSH, iron, B12, etc.  This is because there are natural changes in your cardiometabolic health including your heart, blood vessels, thyroid, liver, metabolism, etc. as menopause is reached (and beyond!).

What do I do if I’m having a hard time?

Well, stay tuned for a few future posts where I’ll break down lifestyle, naturopathic, and conventional options available to you 🙂