The Difference Between Perimenopause and Menopause

How can you tell if you’re in perimenopause or menopause, and what’s the difference? Unlike getting educated on what to expect for our first period, we don’t talk much about what to expect when your period becomes irregular and eventually stops, so you might not feel well-informed about what to expect as you enter this completely normal, natural, and inevitable stage of life.

Knowing the key differences between perimenopause and menopause can help you navigate this change and feel empowered and confident rather than blindsided and out of control. Read on to learn more about what you might experience on your journey to menopause and how to know exactly which stage you’re in.

What is Perimenopause?

Perimenopause is the period when your ovaries gradually stop developing and releasing eggs due to declining estrogen levels. It is a normal biological process lasting anywhere from two to ten years. There is significant variation in when perimenopause begins. It could start in your 30s or your 50s. For most women, it starts in their early 40s, although some women may start perimenopause in their 30s. Perimenopause can be a gradual, slow burn or happen relatively fast. Every woman is unique in how and when she experiences perimenopause. Experts have shown that factors that can affect your perimenopause experience are race, ethnicity, diet, lifestyle, BMI, and socioeconomic status.

What is Menopause?

You reach menopause when your ovaries have completely ceased functioning. Natural menopause, which most women will experience, occurs when you haven’t had a period for twelve consecutive months. Menopause can also occur suddenly when you have your ovaries surgically removed or undergo certain kinds of chemotherapy. If you are using birth control to suppress your period or you have a history of period irregularity, talk to your health care provider or find a certified menopause practitioner. The median age in the U.S. for reaching natural menopause is 51, and the age range is 45 to 55. However, some women reach menopause early, before age 45. Other women reach menopause after age 55, but almost always before age 60. Interestingly, research has shown that women who smoke tend to begin menopause one and a half to two years earlier than non-smokers.

How to Tell What Stage of Menopause You’re In

A defining symptom of the later phase of perimenopause is menstrual cycle irregularity. During perimenopause, you will still have menstrual periods, although they become irregular and may also become shorter and lighter or longer and heavier than usual. This is a strong sign that you are approaching menopause. You will need to continue using birth control to prevent pregnancy during perimenopause because you may still be ovulating.

Many women assume early on that perimenopause symptoms are due to something else. Also, if you are not yet experiencing irregular periods, your healthcare clinician may tell you you have not started perimenopause. However, recent research has shown that the symptoms of perimenopause can start well ahead of period irregularity.

You are considered to have reached menopause when you go twelve consecutive months without a period that’s not due to another cause, such as birth control, cancer treatment, or surgery to remove the ovaries. Since you are no longer developing or releasing eggs, you will no longer need to use birth control to prevent pregnancy. After reaching menopause, if you experience any bleeding, no matter how light, consult your healthcare provider. While usually not serious, postmenopausal bleeding can signify uterine cancer, and it’s always a good idea to immediately check it out.

The risk of heart disease increases rapidly during the menopause life stage. In fact, it’s the #1 killer of women. Exercise, a healthy diet, and stress reduction are key to improving the health of your heart.

Menopause Symptoms – What To Expect

There is some crossover in symptoms between perimenopause and menopause, but there are also some significant differences.

During both menopause and perimenopause, you could have any or all of the following major symptoms:

  • Hot flashes and night sweats
  • Sleep disturbance
  • Vaginal dryness
  • Decrease in libido
  • Mood changes

Hot flashes and night sweats, a symptom eighty percent of women will experience, usually start when you are in the later stage of perimenopause. Many women with sleep disturbance are not aware that nighttime hot flashes may be the culprit. Although experts have found that some women will continue to have hot flashes for an average of seven to nine years, you will have less hormone fluctuation once you reach menopause and can generally expect to experience fewer and less severe hot flashes and night sweats over time.

Although you will often begin to notice vaginal dryness during perimenopause, this symptom worsens once you’re in menopause due to lower estrogen levels. The mucosal layer of your vaginal wall will begin to thin and atrophy. This is known as the genitourinary syndrome of menopause (GSM,) and it can lead to painful sexual intercourse, vaginal infections, and urinary tract infections.

Research shows that once you have reached menopause and are postmenopausal, your low estrogen levels can leave you vulnerable to some health conditions you were protected from in your earlier years.  Low estrogen increases bone resorption, making your bones weaker and putting you at risk for developing osteoporosis. Low-density lipoproteins (LPL) production increases in a low estrogen environment, and blood vessel walls tend to constrict. This puts menopausal women at increased risk for developing high blood pressure and cardiovascular disease.

Managing Symptoms of Perimenopause and Menopause

You’ve figured out where you are in your menopause journey. Now it’s time to decide what you want to do next.

Talk to your healthcare provider about your options if you’re having many negative symptoms disrupting your quality of life. Hormone Therapy can minimize or even stop hot flashes, night sweats, and vaginal dryness. When hot flashes are well-managed, you tend to sleep better and are less fatigued.

Hormone therapy is not for everyone, however. Certain health conditions contraindicate hormone therapy, so ask your provider if it’s something you can use or download Midday and use the hormone therapy decision support tool developed by top clinical experts to learn whether hormone therapy is right for you. If it’s not, ask about other supportive therapies that would be more appropriate for you. Several holistic options are available, and other medications can assist with symptom control. For example, antidepressant medications can help with depression and mood swings, and vaginal estrogen creams can help with vaginal dryness and pain with intercourse.

According to researchers, regular physical exercise can minimize bone loss and weight gain and improve mood and sleep quality.

Studies have shown that changes in diet may also help manage menopause symptoms. Increasing calcium, vitamin D, vitamin K, magnesium, and beta-carotene intake, for example, has been shown to improve cardiovascular health and reduce bone resorption in menopausal women. Low-fat diets with adequate protein may decrease menopause-related weight gain.   

Final Thoughts About Perimenopause and Menopause

Menopause is a natural life stage that brings plenty of physical changes. Knowing where you are in the journey can alleviate uncertainty and help you decide how best to manage any symptoms you might have. Knowledge is power, and it can help you understand your body better, relieve bothersome symptoms, and restore your sense of control and well-being so you can focus on enjoying the gifts of being a woman in midlife.

Looking for more expert support on knowing where you’re at in the menopause journey and what to expect next? Download Midday from the App Store or visit us at Midday.Health.

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.

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