Understanding Perimenopause & Menopause: A Phase-by-Phase Guide
Menopause is a natural transition in every woman’s life, marking the end of her reproductive years. While many associate menopause with their last menstrual period, the process actually unfolds over several years and in distinct phases—each with its own set of hormonal shifts and transitions. Understanding these phases can help a woman support her body more readily through each stage and mitigate some of the abrupt or extreme shifts.
Below is a phase-by-phase guide of each stage, what to expect, what can arise, and how to support your body through the menopause journey. We’ve also included suggestions for blood testing.
Regular testing throughout each phase can help clarify any imbalances that may need your attention and help ease the transitions as they arise. With the right diet and lifestyle, you can support your body to move through this natural process with ease and balance.
Support for Every Phase of Menopause
Nourishment – Drink plenty of water each day—aim for around half your body weight in ounces. Feed your body balanced meals with plenty of fiber, protein, and healthy fats, while limiting excessive alcohol intake and processed foods.
Movement – Depending on your physical fitness and energy levels, this can include anything from walking outside or gentle yoga to strength training and hiking. Exercising outdoors offers the added benefit of vitamin D from the sun, along with the calming, anti-anxiety effects of being in nature. Walking daily is one of the most effective and accessible forms of exercise, supporting cardiovascular health, mood, and joint mobility. In addition, incorporating weight-bearing exercise becomes essential beginning in perimenopause, as it helps maintain bone density, muscle mass, and metabolic health.
Sleep – Aim for 8-10 hours of quality sleep each night to help regulate hormones, support emotional well-being, and promote physical recovery throughout every stage of menopause.
Stress Reduction – Meditation, calming breathwork, time in nature, and unplugging from technology can be incredibly supportive for reducing stress. Anything grounding and calming helps regulate the nervous system, especially as the body becomes more sensitive to cortisol during each phase.
Phase 1 - Perimenopause
Perimenopause is the beginning of a gradual shift in hormones. During this stage, hormone levels—particularly estrogen—start to fluctuate, and progesterone may begin to decline. These changes can impact a woman’s fertility and menstrual cycle, and, for some, may trigger a range of symptoms.
This phase tends to begin in a woman’s early-to-mid 40s (though it can begin as early as the mid-30s or as late as the early 50s), when many women begin to see some slight shifts in their menstrual cycle. It may become slightly more erratic, and this change may be accompanied by heightened symptoms around menstruation, including: difficulty sleeping, more dramatic mood swings, or increased irritability. Fertility is still possible during this phase. Supporting your body through diet and lifestyle is essential, as it becomes more sensitive to stressors. If conception is your goal, it's even more important to consider lab testing to identify and address any underlying imbalances.
Perimenopause often begins subtly, but offering your body extra care—through regular blood testing, supportive nutrition, quality sleep, consistent movement, and stress management, especially around/during menstruation—can help ease symptoms and lessen the impact of this transition on your overall well-being.
A1C
Insulin resistance
CRP
Lipid Panel
MTHFR
Liver & Kidney Panel
Iron/Ferritin Panel
Homocysteine
Thyroid Panel
Full Hormone Panel + Testosterone
Mid-Luteal Phase Progesterone
Prolactin
DHEA
SHBG
AMH
Omega Balance
Vit D
Zinc
B Vitamins
Cortisol
Stool Test/Microbiome Analysis
During this phase—Focus on: hormonal fluctuation, adrenal function, detox pathways, early nutrient depletion, and cycle regulation.
Phase 2 - Late Perimenopause
During late perimenopause, hormonal changes may become more pronounced. Estrogen levels drop more sharply, and anovulatory cycles (menstrual cycles without ovulation) can become more frequent. This can lead to more significant changes in menstrual patterns and, for some, more symptoms.
This phase typically begins in a woman’s mid-40s to early-50s. Menstrual cycles may become less frequent, and many women start to notice increased fatigue, along with more pronounced changes in mood and memory. It can be a challenging time due to the unpredictability of symptoms. However, many of these symptoms can be managed—or even prevented—through regular blood testing, proper nutrition, and consistent low-impact exercise.
Some choose to pursue bioidentical hormone replacement therapy (BHRT) during this phase. When carefully monitored and tailored to your body’s unique needs, it can help promote hormonal balance and regulation for some individuals.
This approach can be especially helpful in managing symptoms such as sleep disturbances, mood shifts, and hot flashes, though it’s important to consult a knowledgeable healthcare provider to determine if it’s right for you. Be sure to book regular lab visits to ensure you find the right dosage for you.
For many, periods come less often—sometimes just every few months—as they get closer to menopause.
A1C
CRP
Lipid Panel
Apo-b
Lpa
Insulin resistance
MTHFR
Liver & Kidney Panel
Iron/Ferritin Panel
Thyroid Panel
Thyroid Antibodies
Full Hormone Panel + Testosterone
Omega Balance
B12
Vit D
Zinc
Cortisol
Dexa Scan
During this phase—Focus on: estrogen detox, adrenal fatigue, insulin resistance, inflammation, sleep disruption, mood, and possible hormone replacement.
Phase 3 - Menopause
Menopause is defined as the absence of menstrual periods for 12 consecutive months with no other underlying medical cause. At this point, the ovaries have stopped releasing eggs, and hormone production has stabilized at consistently low levels.
This phase typically begins around age 51, although depending on lifestyle factors, genetics, and medical conditions, it can begin anywhere between ages 45-58. Some women may experience symptoms, though in this stage, the body begins to stabilize more.
While menopause marks the close of the reproductive years, it also ushers in a new chapter. For many women, symptoms soften with time, and with nurturing support and intentional living, this stage can awaken a sense of renewed vitality. It often brings a deepening of inner strength, self-trust, and presence—a threshold into the timeless wisdom of women.
A1C
CRP
Lipid Panel
Apo-B
Lpa
MTHFR
Liver & Kidney Panel
Urine - Full panel
Iron/Ferritin Panel
Thyroid Panel
Thyroid Antibodies
Omega Balance
B12
Vit D
K2
Cortisol
Dexa Scan
During this phase—Focus on: longevity, bone health, cardiovascular risk, cognitive function, and hormone replacement guidance.