Woman in menopause with pensive look

What’s the Difference Between Perimenopause and Menopause?

Every woman will transition through menopause. But not every woman fully understands the difference between the various phases used to describe this life stage. Terms like premenopause, perimenopause, menopause, and postmenopause are often used interchangeably – but what do they actually mean and what are the differences between them? And perhaps more importantly, how do you know when you’ve reached the end of your menopausal journey?

While the many terms associated with the menopausal transition may seem like a recipe for confusion, each has its own important markers. Here's how to tell where you are, where you're headed, and how to manage the symptoms you're experiencing today.

Premenopause, Perimenopause, and Menopause: What Do They Mean?

The menopausal transition happens when the body's estrogen and progesterone levels decline. These volatile hormone shifts cause a woman's periods to become irregular, and eventually, stop completely.

Different terms are used to describe the stages leading up to, during, and after this point. So, let's take a look at each phase:

  • Premenopause, while not an official medical term, may be used to refer to the later years of a woman’s childbearing or reproductive years, which is the period of time right before she begins to experience any perimenopausal symptoms (such shifts in mood or missed periods).
  • Perimenopause is the transitional time leading up to a woman’s final menstrual period. It starts when a woman begins to notice missed or irregular periods, ’which typically coincides with when estrogen and progesterone levels begin to shift more dramatically. During perimenopause, it's common to experience symptoms including insomnia, mood changes, vaginal dryness or discomfort, and/or painful sex. Often beginning in a woman's mid-forties, perimenopause typically lasts between four and eight years.1
  • Menopause is defined as a woman's final menstrual period – it’s actually only one single moment in time. You'll know the period was your last one after you've gone a consecutive 12 months without experiencing another period. Most women experience menopause between ages 40 and 58, however, the average age that women enter menopause is 51.2
  • Postmenopause is the life stage immediately following menopause, once a woman hasn't had a period in 12 months and one day. Some of the symptoms of menopause may ease up or resolve during postmenopause, but some women may continue to experience common menopausal symptoms for years or decades after.3
  • Early menopause is menopause that occurs between ages 40 and 45, either naturally or due to medical reasons (i.e. a hysterectomy, certain cancer treatments, your family history or if you’re a smoker). If a woman goes through menopause before age 40, it's called premature menopause,4 which may also be caused by similar reasons.

How Can I Tell When I'm in Perimenopause?

Reaching menopause is a clear-cut event, marked by going 12 full months without a menstrual period. But knowing when you're in perimenopause, especially early on, isn't always so straightforward. This transitional stage is marked by irregular or absent ovulation and a subsequent shift in estrogen levels that correlates to a cluster of physical signs, though not every woman will experience every possible symptom. Hormone blood tests (follicle-stimulating hormone testing or FSH testing), salivary hormone testing or other exams geared toward diagnosing perimenopause typically aren't diagnostic but can support diagnosis, since a woman's hormone levels can change throughout her cycle making it difficult for healthcare providers to get accurate results.5

Common markers of perimenopause include6:

  • Irregular periods: Longer or shorter cycles, heavier or lighter periods, or missed periods all count as irregular. Once a woman experiences spaces of 60 days or longer in between periods, she's likely to be in late perimenopause. This also contributes to decreasing fertility.
  • Hot flashes: Sudden bursts of warmth experienced specifically in the upper neck, chest and face, the increased heart rate, the flushed skin; hot flashes can range in intensity and happen out of nowhere. When these uncomfortable surges happen at night, they're called night sweats.
  • Sleep problems: Problems falling asleep or staying asleep are common during perimenopause. These issues are often the result of hot flashes, but they can also occur independently.
  • Mood changes: It's more common to feel irritable, anxious, or depressed during perimenopause.
  • Vaginal dryness or painful sex: Decreasing estrogen levels during perimenopause can cause vaginal tissues to become drier and less elastic, resulting in dryness or discomfort. UTIs may become more common too.
  • Changes in sex drive: Shifting hormones, increased stress, and other factors can lead to lower libido.

It’s important to note that irregular or missed periods don't always signal perimenopause. Hormonal disorders, pregnancy (if you’re still menstruating, even irregularly and are sexually active) thyroid problems, significant weight changes, extreme stress, and even poor nutrition can all cause a woman of reproductive age to develop amenorrhea, or the absence of menstrual periods.7 If you suspect that your periods have stopped or changed for reasons unrelated to perimenopause or menopause, be sure to speak with your healthcare provider.

Treatments for Perimenopause and Menopause Symptoms

Whether you're in the midst of perimenopause or you're officially postmenopausal, there are ways to manage symptoms related to declining estrogen levels due to menopause.

  • Lifestyle measures: Eating healthy, exercising regularly, maintaining a consistent sleep schedule, and practicing stress reduction techniques can go a long way towards helping you feel your best, both physically and emotionally during perimenopause into postmenopause. Pay attention, too, to how caffeine and alcohol affect symptoms like hot flashes and sleep quality. If they seem to be triggers, consider limiting your consumption.8
  • OTC remedies: Vaginal lubricants used during sex and moisturizers used regularly can help to ease vaginal dryness and discomfort during sex. As always, be sure to talk with your healthcare provider before starting any new dietary supplements.
  • Prescription treatments: Systemic hormone therapy may be used to address hot flashes and night sweats, while vaginal estrogen can work to relieve dryness and discomfort. Certain antidepressants and other pharmacologic options may also be useful for managing hot flashes too.9 The decision to try hormone therapy is highly individualized, however, so be sure to discuss the pros and cons of prescription options with your healthcare provider to determine the best option for you.

Resources

  1. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
  2. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
  3. https://my.clevelandclinic.org/health/diseases/21837-postmenopause
  4. https://www.womenshealth.gov/menopause/early-or-premature-menopause
  5. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-when-i'm-in-menopause-
  6. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
  7. https://www.merckmanuals.com/home/women-s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/absence-of-menstrual-periods
  8. https://www.mayoclinic.org/diseases-conditions/perimenopause/diagnosis-treatment/drc-20354671
  9. https://www.mayoclinic.org/diseases-conditions/perimenopause/diagnosis-treatment/drc-20354671
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