Early Transition
- Progesterone declining from mid-luteal phase
- Estrogen fluctuating — often rising then falling erratically
- FSH beginning to rise (but still unreliable as a diagnostic test)
Menstrual Changes
Variable cycle length — 7+ day difference from normal
Primary Symptoms
- • Brain fog and memory lapses
- • Anxiety — new onset or worsening
- • Mood instability ("the rage")
- • Sleep disruption
- • Irregular cycles
- • Heavier or lighter periods
Clinical Protocol
- Take a cycle history — look for the 7-day variability criterion
- Do NOT rely on a single FSH test to rule in or out perimenopause
- Screen for mood and cognitive symptoms, not just physical ones
- Consider progesterone supplementation trial if luteal symptoms dominate
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