Perimenopause vs menopause and how to tell them apart
· Pausive Team
Your cycle is suddenly all over the place, you wake up hot at night and someone tells you it's "the menopause".
But if you still get periods, it's probably not menopause yet. People use the two words as if they meant the same thing, and they don't.
Knowing which one you're in shows you what will help. If you're just starting, our perimenopause supplement page is a good place to begin.
What is perimenopause?
Perimenopause means "around menopause". It's the years when your ovaries slowly wind down and your hormones rise and fall unevenly.
It usually starts in your mid to late 40s. For some women it lasts a few months; for others, closer to ten years.
In a long-running study of 2,570 women, it began at a median age of 47.5 and lasted nearly four years.1
The menopause definition, in plain words
Menopause isn't a phase. It's the day you reach 12 months in a row without a period, and you only know it looking back.
In the US, that happens at 51 on average. Every day after it is postmenopause, for the rest of your life. Our guide to the stages of menopause maps all four.
Am I in perimenopause or menopause?
Menopause is defined by your periods, so they answer most of it. One question settles it: have you had a period in the last 12 months?
- Yes, and your cycle is changing: you're most likely in perimenopause.
- No, for 12 months in a row: you've reached menopause, and you're now postmenopausal.
- You've had a hysterectomy or use hormonal birth control: periods can't tell you, so your symptoms and your doctor will.
"Clear language can help women describe what has changed and prepare questions for an appointment.
It is also important that a label never becomes a reason to dismiss concerns or assume every new symptom has the same cause."
The Hope Project
FSH levels in menopause and perimenopause
FSH is the hormone that tells your ovaries to work. It rises in perimenopause but changes from week to week, so one normal result doesn't rule it out.
After menopause, it stays high. A blood test helps most when you're under 45 or your symptoms are unusual.
Can you have periods during menopause?
No. If you're still bleeding, you're in perimenopause, even if periods come months apart. A gap of 11 months followed by a period restarts the count.
Perimenopause vs premenopause
Premenopause is the time before any of this starts: regular cycles and steady hormones. Perimenopause begins when your cycle starts to change.
5 differences between perimenopause and menopause
1. Perimenopause age vs menopause age
Perimenopause usually starts between 40 and 50, and menopause arrives around 51. Our article on what age perimenopause starts covers early cases.
The difference is in how long they last. Perimenopause is a stretch of years; menopause is one day, followed by postmenopause.
2. Perimenopause periods change, then stop
In perimenopause, your periods are still there, but they change: shorter or longer cycles, heavier or lighter bleeding, skipped months.
Once you go 60 days or more between periods, you've reached late perimenopause, the last stretch before menopause.2
You still ovulate some months, so pregnancy is possible. After menopause, periods are gone for good: any bleeding after that needs a doctor's check.
3. Perimenopause hormone levels swing
Perimenopause isn't a steady drop. Estrogen can spike higher than ever one month and crash the next, and that's behind much of how it feels.
After menopause, estrogen settles at a low, steady level. The ups and downs ease, even if some symptoms stay.
4. Perimenopause vs menopause symptoms
Most symptoms start in perimenopause: irregular periods, stronger PMS, mood swings, broken sleep and the first hot flashes.
Broken sleep tends to make mood swings worse. Our page on menopause mood swings covers the emotional side.
After menopause, the cycle symptoms fade. Hot flashes and night sweats often carry on, and vaginal dryness and bone loss become the new things to look after.
5. How each one is diagnosed
Perimenopause is diagnosed from your age, your cycle and your symptoms, not one test. Menopause is diagnosed by the calendar.
That's why tracking your cycle helps so much at the doctor. Note the dates, how heavy each period is and symptoms like night sweats.
Is perimenopause worse than menopause?
For many women, yes. Swinging hormones make perimenopause the most unpredictable stage: you never know which month will be easy.
It's also the stage that's hardest to spot. Mood swings, poor sleep and heavier periods at 44 rarely get linked to hormones.
Menopause brings more stability, but not always relief: hot flashes and night sweats lasted a median of 7.4 years in a large US study.3
In the same study, 4.5 of those years came after the last period.3 Our hot flash relief page has more on easing them.
Perimenopause supplements and what else helps
Pausive is our daily supplement for both stages: it supports hot flashes, night sweats, sleep broken by the heat and mood.
The basics matter in both: strength training, a cool bedroom, less alcohol and enough protein. Our night sweat relief page has ideas for cooler nights.
After menopause, the focus shifts to bones and heart. Our post menopause supplements page covers that stage.
If symptoms are hard to live with, talk to your doctor about hormone therapy too: it has the strongest evidence for hot flashes.
Perimenopause vs menopause FAQs
What is the difference between perimenopause and menopause?
Perimenopause is the years of change, when you still have periods. Menopause is the day you reach 12 months without one; after it comes postmenopause.
How long does perimenopause last before menopause?
About four years on average, but it ranges from a few months to around ten years. It ends at menopause, 12 months after your last period.
Do hot flashes start in perimenopause or menopause?
Usually in perimenopause, often in the later years when periods start skipping. They can carry on for years after menopause.
Can a blood test tell if I'm in menopause?
Not on its own. Hormone levels change from week to week in perimenopause, so doctors go by your age, cycle and symptoms.
What comes after menopause?
Postmenopause, which lasts for the rest of your life. Periods are gone, and many symptoms ease over time.
Can you be in perimenopause in your 30s?
It's uncommon but possible. If your cycle changes before 40, see your doctor to rule out early menopause and other causes.
Sources
- McKinlay SM et al., Maturitas, 1992: in 2,570 women, perimenopause started at a median age of 47.5 and lasted nearly four years.
- Harlow SD et al., Menopause, 2012: the STRAW+10 staging system, where late perimenopause begins with a gap of 60 days or more between periods.
- Avis NE et al., JAMA Internal Medicine, 2015: in the Study of Women's Health Across the Nation, hot flashes and night sweats lasted a median of 7.4 years in total, and 4.5 years after the last period.