Menopause vs. perimenopause: What’s the difference?

Menopause and perimenopause are natural parts of aging for women and other people assigned female at birth. Although they are closely connected, the terms refer to two different stages of life. Understanding the differences between the two will help you better anticipate what to expect as you grow older.

The end of a person's childbearing years is known as menopause. It is when a woman no longer menstruates and ceases to release eggs from her ovaries.

The time frame that leads up to menopause is called perimenopause. During this stage of life, the body makes the transition to menopause.

Although perimenopause leads to menopause, there are many differences between these two stages of life.

Timing and duration

Perimenopause typically begins between ages 45 and 55. It can last as long as 14 years, but the average duration is 7 years. For some people, perimenopause occurs much more quickly.

Menopause occurs when you’ve gone without a menstrual period for 12 months in a row without any other medical cause. The average age for menopause is 51 or 52 years. You can think of menopause like a finish line of a race and perimenopause as the race course. After you cross the finish line, you enter the postmenopause phase, which lasts for the rest of your life.

Menstrual periods

During perimenopause, you will likely notice changes in your menstrual periods. The duration of and time between periods may vary or be different from what you experienced in the past. Bleeding can be heavier or lighter compared to periods in the past. Some people also experience spotting between menstrual periods. As you move closer to menopause, you may have fewer periods and go months without having one.

Menopause marks the end of menstruation. Once you reach menopause, you no longer have periods.

Fertility

During perimenopause, ovulation often becomes more irregular. However, it is possible to become pregnant during this life stage. People who try to get pregnant during perimenopause may have a more difficult time doing so because of irregular ovulation and the quality of remaining eggs. In most cases, you should continue to use birth control throughout perimenopause if you're sexually active and don't wish to become pregnant.

After menopause, your ovaries stop releasing eggs. As a result, it is highly unlikely that you will become pregnant from sexual intercourse. However, some postmenopausal people do successfully conceive with the help of fertility medications and the use of eggs from a donor or eggs that were previously frozen.

Symptoms and body changes

During perimenopause, symptoms associated with menopause may begin, including:

• Breast tenderness
• Changes in sex drive
• Headaches
• Hot flashes
• Difficulty concentrating
• Dry eyes
• Dry skin
• Hair thinning or hair loss
• Increased need to urinate
• Irritability
• Mood swings
• Muscle and joint pain
• Night sweats
• PMS symptoms that are more severe
• Rapid heartbeat
• Sleep problems
• Vaginal dryness
• Weight gain or a change in body fat distribution

The severity of symptoms varies, and some people may experience only one or two signs of perimenopause. Once you reach menopause, symptoms like hot flashes may persist for up to 10 years, but for most people, they gradually subside within a few years after menstruation stops. Some changes like vaginal dryness may continue throughout life.

If you believe you're experiencing symptoms of perimenopause or menopause, talk to your healthcare provider. In addition to helping you determine if you're in one of these life stages, they can recommend treatments and lifestyle changes that can help you manage symptoms. You may also be able to manage some symptoms with the help of over-the-counter menopause products.

Published January 2023.