Do you know that although perimenopause appear to be one continuous process, there are actually 3 stages of menopause transition.
At the earliest stages of perimenopause, you may not even notice the subtle signs. However, as you progress through the stages, your symptoms become more noticeable. When you know the signs, you can to begin to look after your health much earlier.
By the time you notice changes to the pattern or length of you menstrual cycles, hormonal changes have begun to affect your fertility, as your ovaries…
- Reduce in size and
- Begin to skip ovulation
In due time, anovulation reduce the release of oestrogen, progesterone and other female hormone levels too. Why is this important?
When you know the early signs of perimenopause, you can begin to protect yourself from menopause associated health risks.
For many women, the early signs may be easily interpreted as severe PMS. For some, a missed period may be seen as the result of too much stress.
Of course there may be other reasons why the pattern of your periods change and you need to see your doctor to investigate why.
However, if you are in your late thirties or early forties, these may be signs of early stages of perimenopause. So…
How Can You Know If You Are In The Early Stages Of Perimenopause?
There is a gold standard used to describe of the hormonal stages women go through during menopause transition.
The 2001 scientists from five countries, examined research evidence from studies carried out around the health and endocrine changes midlife women go through.
As a result, the findings of The Stages of Reproductive Aging Workshop (STRAW +10) is the current gold standard used to describe the…
The Stages Of Perimenopause
(PMC3340904)
In 2001, STRAW+10 describes the female life into 3 broad Phases. These are…
- Reproductive: Stages -5, -4 and -3
- Menopausal Transition: Stages -2 (early) and -1 (late)
- Postmenopause: Stages +1 (early) and +2 (late)
The original study is limited in usefulness, as the stages only applied to healthy women.
By 2011, advances in science provided better understanding of the changes that occur, between the hypothalamus-pituitary-ovarian axis, during menopause transition. As a result, further Stages were added to enable better clinical decision making.
For this post, I focus on the stages of perimenopause. Let us start at the…
Late Reproductive Stage (Stage -3)
At this stage you may or may not notice subtle changes to your menstrual pattern.
This stage describes the point when fertility and the ability to get pregnant begins to decline. Before you notice outward signs of menstrual changes, changes in your endocrine system has already began.
There are two subdivisions of this stage.
In Stage -3b your periods and early (follicle stimulating hormone) FSH levels remain regular.
However, if tests were carried out, results would show low levels for…
- Anti-Müllerian hormone (AMH) (thought to be more accurate predictor of ovarian function) and
- Antral follicle counts (AFC), this is your ovarian reserve
By Stage -3a, you may notice shorter cycles as FSH levels increase and fluctuate. At this stage, your body increase FSH production to stimulate follicle maturation, in order to release an egg. However, AMH and AFC remains low.
From a lifestyle perspective, this may be the stage when we are too busy with our young families, to notice the subtle signs of early perimenopause.
In my mid to late thirties, I was studying for my midwifery degree and raising two children on my own. So it was easy to miss the early signs.
Knowing what I know now, I understand that stress and other lifestyle factors, influence how our bodies manage menopause transition.
Early Menopausal Transition (Stage -2)
At this stage, you may notice obvious changes to your cycles, as your periods begin to …
- Arrive earlier or later by a week or so
- Get heavier or lighter
- Become shorter or longer
From a hormonal viewpoint, your…
- Your FSH levels are higher in the early follicular phase
- But your AMH and AFC remains low
Late Menopausal Transition (Stage -1)
By this stage, you may notice missed periods of 60 days or more. Likewise, if your hormones and egg reserves are tested, results would show…
- Hormone fluctuations and
- Periods without egg release (anovulation)
FSH levels fluctuate from being at menopausal range, to being at reproductive age range.
Consequently, this is the reason why FSH test is an unreliable marker of menopause transition. It is also the reason why GP’s do not test levels when you are over 45 years and show signs of perimenopause symptoms.
Of course, test results should be taken in context as to when the test is carried out, in relation to your menstrual cycle. Results should also be individualised to your symptoms.
This is the stage when most women experience the common symptoms of perimenopause, such as…
- Hot flushes
- Insomnia
- Fatigue
- Brain fog
- Weight gain
However, it is important to see menopause as…
A Natural Transition And Not A Deficiency Disease
Through a healthy diet and lifestyle, you can support your body to prevent low oestrogen levels from affecting your health negatively.
This does not need to be complicated and can be as simple as providing your body with the vitamins, minerals and other nutrients you need to support your immune and other systems.
At the same time, if you replace processed foods, refined carbohydrates and high fat foods with whole-foods, you begin to nourish your body through menopausal transition.
What perimenopause stage are you in?
