The different stages of PERImenopause

August 18, 2023.

medically reviewed by Patricia Shelton, MD

How do I know if I am in late or early perimenopause?

Although the process is a little different for every woman, there are defined perimenopause stages. How do you know which stage you’re in? What can you expect as you pass through this phase of life?

Perimenopause is the transition to menopause. During this period, your hormone levels may fluctuate, leading to a variety of symptoms. Perimenopause ends when you go through menopause, meaning that you haven’t had a period for a full year.

Early perimenopause involves changes in the menstrual cycle

In general, early perimenopause begins several years before menopause, often in the early to mid 40s. 

Early perimenopause begins when your cycle becomes more irregular than it was during your reproductive years. When you notice a persistent change of at least seven days in the length of your cycles, this indicates that you’ve officially entered early perimenopause.

For women who have always had a regular menstrual cycle, the transition to early perimenopause is more clear. However, some women generally have irregular cycles, even during their reproductive years. If your cycles have always been irregular, then it can be challenging to be sure when you’ve entered early perimenopause. If you’re in your late 30s or 40s, and you’re experiencing perimenopausal symptoms like hot flashes, then you’re likely to be in early perimenopause, even if your irregular cycle makes it tough to be sure.

It’s important to note that women may notice symptoms related to shifting hormone levels even before there’s an impact on the menstrual cycle. Symptoms like brain fog, mood swings, and trouble sleeping may begin even before your cycle changes. However, you’ve officially entered early perimenopause when you start to notice changes in your cycle.

Late perimenopause involves skipped periods

As perimenopause continues to progress, menstruation becomes more irregular, and very long cycles become more and more common.

You’re officially in late perimenopause if you go at least 60 days between periods. This doesn’t mean that all of your cycles have to last for this long; in fact, the space between periods is often highly irregular during this period. However, if you’ve gone at least 60 days between periods at least once, then you’ve entered late perimenopause. 

Late perimenopause usually lasts for about one to three years. Eventually, when you’ve gone a full year since your last period, you have officially gone through menopause.

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Symptoms of early and late perimenopause

As mentioned earlier, some symptoms of perimenopause may begin even before the menstrual cycle becomes irregular. In general, symptoms will become more and more noticeable as perimenopause progresses. 

Women in early perimenopause may start to experience vasomotor symptoms, like hot flashes and night sweats. These symptoms become more common during late perimenopause, and then taper off after menopause. Vaginal dryness is most common during late perimenopause, although pain during sex often starts during the early stage. Changes in mood and sleep can occur throughout the perimenopausal period, beginning even before the shifts in the menstrual cycle.

Although many women experience challenges during perimenopause, it’s very important to remember that you don’t have to suffer through this alone. There are a variety of treatments that can help with perimenopausal symptoms, including both hormonal and nonhormonal options. If you’re struggling with symptoms that might indicate perimenopause, talk to a health professional to learn more about your options. Your quality of life is important.


Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep; 61(3): 419–432. doi: 10.1097/GRF.0000000000000389

Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr 1; 25(4): 332–339. doi: 10.1089/jwh.2015.5556

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Patricia Shelton

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