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Premenopause vs. Perimenopause: What’s the Difference?

Cassie Hart

At the onset of puberty, the female body begins it’s first of several key reproductive phases experienced during life. Menstrual periods are the key fertility indicator during most of these years, but as women grow older, they may experience symptoms related to other hormonal shifts and declines, such as hot flashes and vaginal dryness.

This is often when conversations about the menopause transition begin. While “menopause” often gets the majority of focus, there are actually three “official” stages of menopause: perimenopause, menopause, and postmenopause.1

These terms are oftentimes used interchangeably, but technically, this is not correct. To complicate things further, another word – premenopause – is sometimes also substituted for perimenopause, which is also not quite accurate. To better understand each of these unique phases and their meanings, let’s take a closer look at what happens during these stages of menopause, and clarify the differences between them.

What Age Does Premenopause Occur?

Premenopause isn’t an official medical term, but it’s still sometimes used in conversations related to the menopause transition – and it does have its own definition. The prefix “pre” means “before,” so premenopause truly means “before menopause.” However, because perimenopause also occurs before menopause, it’s understandable how these two words may be confused

Premenopause takes place over an extended period of time over a woman’s reproductive years – beginning with a girl’s first period and continuing until perimenopause begins. There are no major noticeable changes to the body during premenopause; hormone levels vary in a cyclic, well-orchestrated way each cycle, and periods still occur throughout the entire time frame.2

What is Perimenopause and What Age Does It Start?

Perimenopause is a transitional period of time that occurs during the years before menopause. If you’re curious about what average age perimenopause starts, it typically begins when women are in their 40s, typically around 40-44 years old, but it can start earlier for some.3 It’s most frequently marked by symptoms, shifts in menstruation and mood swings, however, there are over 32 other recognized symptoms that may occur during this transitional period as well.

Symptoms of perimenopause are due to volatile hormonal changes – for example, estrogen production is variable and sometimes incredibly elevated during perimenopause, and progesterone levels may rise and fall – these fluctuating hormone levels can affect the body, causing symptoms such as those mentioned above. It’s important to note that perimenopause can last anywhere from 4-8 years,4 but every woman is different.

While many women experience a handful of the classic symptoms of perimenopause, some may not make the connection between their symptoms and perimenopause. Additionally, if the ovaries have been removed, or compromised by certain medical procedures, such as specific cancer treatments, perimenopause may be skipped altogether – throwing women into immediate menopause, with little to no warning.

Understanding the Differences: Premenopause vs. Perimenopause

As we’ve noted, premenopause and perimenopause occur before the full shift to menopause, but they are not exactly the same. However, because there are some similarities between these two phases, such as the occasional absence of menopause-specific symptoms like hot flashes, vaginal dryness, and sleep disturbances–especially in the early years of perimenopause–it may seem as if they are more alike than different.

Perimenopause is characterized by fluctuating hormone levels prior to the onset of menopause, when several symptoms of shifting hormones start to occur. Premenopause takes place over a longer duration of time, beginning with a girl’s first period and continuing through the onset of perimenopause.5 It should also be noted that premenopause is considered to be more of a casual term, and is not technically an official phase of menopause. Perimenopause is the accepted term that healthcare professionals use and is one of the “official” menopause stages.6

What is Menopause?

You may be wondering, what about the other official stages of this hormonal transition? Following perimenopause is menopause. Menopause is the official end of a woman’s reproductive years, and it’s confirmed when a period has not occurred for 12 consecutive months, or 366 days. If you’ve gone several months without a period and then experience one, your countdown to menopause resets. The average age of menopause is 51 years old.7

Some women may experience menopause suddenly as mentioned earlier, such as when the ovaries and/or uterus are surgically removed for medical reasons. Because these organs, which produce reproductive hormones, are no longer functioning in the body, menstruation will cease, often immediately, and menopause is determined to have occurred at this point.8

Others who transition naturally through menopause may experience symptoms for around 7 years, but they may last up to 14 years - this transitional period is unique to every woman and can depend on things such as race and ethnicity, genetics, and certain lifestyle factors, like smoking.9

What is Postmenopause?

The final official stage of menopause, postmenopause, lasts from the cessation of a woman’s period through the end of life. Some women may continue to experience hallmark symptoms, such as hot flashes and fatigue as they did in perimenopause, while others may find relief from these symptoms during postmenopause, as hormone levels even out to their new normal.10

When to Seek Help for Symptoms

A call or visit with a healthcare provider is a good idea if you feel like you’re starting to experience symptoms of perimenopause or menopause, or if you have general questions about your reproductive health. No matter what age you are, if any of the following symptoms arise, consider contacting your provider:11

  • Large blood clots during your period
  • Spotting after your period
  • Bleeding after sex
  • Longer or shorter periods than normal

With the exception of a medical intervention, most women experience several reproductive stages, naturally. Knowing the differences between each stage–and using the correct words to describe them–can be helpful for understanding what your body is, or will soon be, going through, as well as for discussing feasible symptom management with your healthcare provider.





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