First, Progesterone

During perimenopause, the hormone that usually starts to drop first is progesterone. As ciswomen age, the number of ovarian follicles (which contain eggs) decreases, and this can lead to a decline in progesterone production. This decrease in progesterone can cause changes in the menstrual cycle, such as irregular periods, heavy bleeding, or missed periods.

In addition to a decline in progesterone, estrogen levels can also fluctuate during perimenopause. In some, estrogen levels may increase in response to the decreasing levels of progesterone, leading to symptoms such as breast tenderness and bloating.

However, as perimenopause progresses, estrogen levels may also begin to decline, which can cause symptoms such as hot flashes, night sweats, and vaginal dryness.


Stages of Perimenopause

Perimenopause refers to the period of time leading up to menopause when your body undergoes hormonal changes that ultimately result in the cessation of menstruation. During perimenopause, hormone levels fluctuate and you may experience various symptoms.

The hormonal stages of perimenopause can be divided into three phases: early, middle, and late.

  1. Early Perimenopause: This phase can last for several years and is characterized by fluctuating hormone levels, irregular periods, and symptoms such as hot flashes, night sweats, and mood changes.
  2. Middle Perimenopause: During this phase, hormone levels continue to fluctuate and periods may become more irregular. Symptoms such as vaginal dryness, decreased libido, and sleep disturbances may occur.
  3. Late Perimenopause: In this final phase, hormone levels begin to decrease significantly, and periods may become very irregular or stop altogether. Symptoms such as hot flashes, night sweats, and mood changes may continue, and women may experience additional symptoms such as urinary incontinence and joint pain.

It is important to note that every experience with perimenopause can be different, and not all women will experience every symptom. If you are experiencing symptoms that are impacting your quality of life, it is recommended to consult with your healthcare provider.



Menopause is a natural biological process that marks the end of a cis-woman’s reproductive years. It is defined as the time when you have not had a menstrual period for 12 consecutive months, which typically occurs between the ages of 45 and 55.

During the menopause transition, the ovaries gradually stop producing eggs, and hormone production, particularly estrogen and progesterone, declines. This decline in hormone production can cause a variety of physical and emotional changes, including hot flashes, night sweats, vaginal dryness, sleep disturbances, mood changes, and changes in sexual function.

Menopause can be a gradual process that occurs over several years, known as perimenopause, or it can occur suddenly due to medical treatment or surgery that removes the ovaries. The symptoms of menopause can be managed with lifestyle changes, such as stress reduction, a healthy diet, and regular exercise, as well as hormone replacement therapy (HRT), which involves taking estrogen and/or progesterone to replace the hormones that the ovaries are no longer producing.

It is important to discuss options for managing the symptoms of menopause with your healthcare provider to determine the best course of treatment for your individual needs.

To find a menopause specialist in your area (Canada and USA) search The North American Menopause Society database.