Perimenopause and Menopause: What’s the Difference?

Perimenopause and menopause are normal and natural stages that typically occur when a woman is in her forties or fifties, toward the end of what is considered her reproductive life. Perimenopause is the stage around menopause but before you officially reach it. (The prefix “peri” comes from Greek for “about”). During perimenopause, which many women experience during their forties, menstrual cycles are irregular, and fertility declines, but conceiving a child may still be possible.

You enter late perimenopause when there are at least 60 days between some periods. This can happen soon after the early stage begins or, more commonly, not for several years. The hormones in a woman’s system are in flux during this time, and the fluctuations may trigger symptoms such as hot flashes.

Since an egg that has ovulated but has not yet been fertilized is what triggers a monthly period, or menstrual bleed, it makes sense that a woman’s eggs are the central reason she enters perimenopause.

When a female child is born, she has all the eggs she’ll ever have. Over the years, the quality of these eggs declines, says Nanette Santoro, MD, a professor of obstetrics and gynecology, reproductive endocrinology, and infertility and reproductive sciences at the University of Colorado School of Medicine in Anschutz and a longtime menopause researcher. When the degeneration reaches a critical stage, follicle-stimulating hormone and luteinizing hormone ramp up, trying to force these lackluster eggs to ovulate.

“The hormones are going up because they’re trying harder and harder to get the ovaries to work,” she says. The rise in these two hormones is typically associated with being in perimenopause.

• Hot flashes
• Trouble sleeping, often from hot flashes at night, known as night sweats
• Vaginal dryness
• Low libido
• Needing to pee more often
• Mood changes, sometimes including depression or irritability

Women who are younger when they start perimenopause typically experience symptoms longer than women who are older, Santoro says.

• Osteoporosis and an increased in risk of bone fractures (menopause leads to a period of rapid bone loss so this risk is present longer in women who go through premature menopause)
• Dementia, because estrogen has protective effects on the brain
• Heart disease
• Mental health problems, since early menopause can affect sense of the self, especially in women who still want to have children

Missed periods can have causes other than menopause, Santoro says. Especially if you’re younger than age 45, she suggests checking with a healthcare professional if your periods become wildly erratic or stop altogether. And since pregnancy is still a possibility, it’s important to check whether that’s also a possible cause.

Likewise, changes to your period could be caused by taking medications — like antipsychotics, blood pressure drugs, and  antidepressants to treat other medical conditions — or contraceptive pills might be stopping periods. If you’re worried about period changes or concerned about perimenopause, seeking a clinical opinion can put your mind at ease and help you find solutions.

• Menopause begins a full year after your last menstrual bleeding, while perimenopause is the transitional stage before it, characterized by irregular cycles and fluctuating hormones.
• Symptoms like hot flashes, trouble sleeping, and mood changes are most common in late perimenopause but can persist for 7 to 10 years after you reach menopause.
• If you are experiencing wildly erratic or stopped periods, especially if you are under 45, consult a healthcare professional to rule out other potential causes, like pregnancy or underlying health conditions.
• Treatments including hormone replacement therapy, lifestyle changes, and natural remedies can help you find relief from perimenopausal symptoms.