Reproductive Peak
- Estrogen and progesterone cycling normally
- Subtle AMH (ovarian reserve) decline begins
- Early FSH fluctuations possible in late -3
Menstrual Changes
Regular, 21–35 day cycles
Primary Symptoms
- • Premenstrual mood changes intensifying
- • Increased PMS severity
- • Early changes in cycle length
Clinical Protocol
- Discuss family planning timeline if relevant
- Note worsening PMS as a potential early perimenopause signal
- Baseline assessment if symptoms are significantly impacting quality of life
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