What is The Difference Between Perimenopause And Menopause?

Described as “the storm before the calm”, perimenopause is the phase before menopause, and is when symptoms start for many women. Here’s everything you need to know.

There are so many questions that need answering about perimenopause. What is perimenopause and how is it different to menopause? How long will it last? What are the most common symptoms of perimenopause? Why did I find my car keys in the fridge…?

Car keys aside – blame the hormone-induced brain fog for that one – these are serious questions and we answer them here. 

What is Perimenopause?

Perimenopause is defined as the period of time when your body is transitioning toward menopause. Your periods may become irregular, and your fertility is on the decline. However, it is still possible to conceive.

The perimenopause phase is broken down in two stages. During the early stage, your periods may be erratic. They may not last as long as normal and may be lighter than usual. During the later stage, you may experience at least 60 days between your periods. Your hormones are fluctuating, which may trigger hot flashes and some other symptoms. In the last few years of this transition, you will experience a dramatic loss of oestrogen.

READ MORE: Menopause expert and GP Dr Rebecca Lewis on your perimenopause years.

What is Menopause?

Menopause is the point when you have not had a period for 12 months. So it is something that you can only know in retrospect. At this point, you no longer get your period at all. Since the perimenopause and menopause phases of your cycle are related, it is important to understand what to expect during transition and how to ease the symptoms.

What is the average age of perimenopause?

The average age of menopause is 51, while 45 is the average age for the perimenopause phase to begin. It’s important to know that you will still be having periods during perimenopause, but they may be becoming irregular. You may experience other symptoms as well.

Does ethnicity affect perimenopause and menopause?

The Study of Women’s Health Across the Nation, is designed to better understand the health of women during midlife. It examines women of all ethnicities and backgrounds between the ages of 40 and 55.

Results show that the symptoms of perimenopause differ among these groups of women. For example, Chinese and Japanese women have less severe symptoms. Most frequently, African American women experience hot flashes, night sweats, vaginal dryness and forgetfulness. Hispanic women report the most urine leakage and vaginal dryness and suffer the highest increase in heart rate.

A 2008 study that was published in the American Journal of Epidemiology found that Latinas and Native Americans experience the earliest onset of perimenopause. On the other hand, women of Japanese descent experience this transition later. Since this transitional phase sees a drop in oestrogen, later onset means better health in the long-term, especially for the bones, brain, and heart.

In 2009, a study of 150 women uncovered what ethnicities experienced the most symptoms. It was found that Asian females have the least amount of symptoms. On the opposite end of the spectrum, African American women have the most.

READ MORE: Dr Shahzadi Harper on why menopause is a diversity issue.

How long does perimenopause last?

The average time period of this transitional phase is approximately four years. Some women may be in this stage for shorter periods, and others may experience it for a longer time. How do you know when your perimenopause is finished? As your levels of oestrogen rise and fall unevenly, your menstrual cycle may become longer or shorter. In fact, there may be cycles when you do not ovulate. After you have gone one year without your period, this transition phase ends. You are now in menopause.

Perimenopause symptoms

During this transitional phase, you may experience many of the following perimenopause symptoms:

  • Irregular Periods. When your hormone levels remain balanced, you have regular periods. However, perimenopause sees a fluctuation in oestrogen and progesterone. Therefore, spotting and irregular periods are likely. However, if bleeding is especially heavy and lasts for longer than three weeks at a time, it is best to seek medical attention.
  • Night Sweats. Waking up with sweaty pyjamas or sheets is common for many perimenopausal women.
  • Hot Flashes. The most common symptoms during this transition are hot flashes (or hot flushes). You may suddenly feel a surge of heat in your chest or facial region. Luckily, they only last a few minutes. They may occur each day or at unexpected times.
  • Changes in Sleep Patterns. Many have trouble sleeping and experience insomnia during perimenopause.
  • Changes in Mood. You may feel depressed or irritable for no explained reason.
  • Weight Gain. When your oestrogen is out of control, you may notice weight gain. It’s important to note that HRT does not cause weight gain, it is your body’s hormones. 
  • Vaginal Dryness. Due to a drop in hormones, you may notice a low sex drive and vaginal dryness during intercourse.
  • Difficulty Concentrating. Focus is often difficult during this time of transition.
  • Headaches. It is quite common to feel headaches or migraines when your hormones are fluctuating.
  • Joint discomfort. As oestrogen drops, you may experience stiff and achy joints.

READ MORE: What are the 34 symptoms of the menopause?

How can HRT help with perimenopausal symptoms?

Hormone replacement therapy, or HRT, can be a useful way to lower symptoms associated with the transition toward menopause. HRT involves adding small amounts of oestrogen and, for some women, progesterone to your body. The amounts simply top up the decline caused by perimenopause. HRT does not give you extra hormones.

HRT will help to relieve the symptoms of perimenopause. For many women, the benefits are felt quickly, with hot flushes and night sweats stopping within just a few days. The mental health symptoms, like anxiety and mood swings, can also be alleviated. HRT has proven to decrease vaginal dryness. You should allow at least three months for the HRT benefits to be felt in your body.

As well as alleviating symptoms, HRT has long term health effects. It will protect your bones against osteoporosis, help your heart health and protect against Alzheimers. For many women, they find that HRT comes with far more benefits than risks.

HRT can be taken in many forms: there are patches, gels, pills and sprays. Always consult your doctor to discuss the best options for  you.

READ MORE: Menopause expert Dr Stephanie Goodwin on everything you need to know about HRT. 

How Complementary Therapies Help with Symptoms

Numerous complementary therapies help to minimize or eliminate symptoms experienced during perimenopause. It’s important to note that none of them have any evidence-based research to back up their claims, but some women may find them helpful.

Common complementary remedies include primrose oil, red clover, and black cohosh. These herbs may relieve hot flashes. To ease anxiety, you may consider St. John’s Wort. Ginkgo biloba may help to heighten your mood and memory as well.

Other alternative treatments offer symptoms of relief as well. For example, acupuncture, cognitive behavioral therapy, and other relaxation techniques often provide some type of help in the short-term. However, it is essential to receive guidance from your medical provider before adding anything to your diet.

READ MORE: A doctor’s guide to complementary medicine.

Lifestyle Measures that Help with perimenopausal Symptoms

Besides medical measures, there are some lifestyle changes that help lower symptoms during the transition toward menopause.

  • Quit Smoking and Drinking. No surprise that smoking and drinking are two habits that make symptoms worse. Research shows that alcohol disrupts sleep, increases frequency of hot flashes and leads to depression. Quitting smoking and drinking will make you feel better.
  • Eat Healthy. Eating fruits, vegetables, and whole grains increases your overall health. Consuming calcium-rich foods helps prevent osteoporosis as well. You should avoid caffeine so that it does not disrupt your sleep or encourage hot flashes.
  • Exercise Regularly. Keeping active improves sleep and mood and helps manage weight gain. You can exercise for as little as 30 minutes each day to reap the benefits.
  • Lubricate. To make sex more pleasurable, you should try using an OTC water-based lubricant. Avoid products that contain glycerin, which may cause irritation.


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