Written by
Stacy Miller
At a certain age, every woman stops menstruating and enters a life stage called menopause. This change happens due to the diminished number of follicles in the ovaries, which leads to a sharp decrease in hormone levels like estrogen. However, the process isn’t sudden and entails a transitional period called perimenopause. Some women are surprised by perimenopause, expecting to go straight from peak fertility to menopause. But that isn’t the case, and the transition could take years.
Knowing the difference between perimenopause vs menopause allows you to make lifestyle choices that help you manage symptoms. The question is, what’s the difference between menopause and perimenopause, and what can you do to make the transition easier? In this article, we’ll discuss if there are differences between perimenopause vs menopause symptoms, when each stage starts and ends, and practical self-care strategies to make the process more manageable.
When talking about perimenopause versus menopause, it’s easy to confuse these two stages. Perimenopause is the transitional period when you move away from your peak fertility and your ovaries gradually stop releasing eggs. In turn, menstruation becomes irregular. Perimenopause generally starts at age 46, but some women may experience it early or later depending on factors like their genetic predisposition, medications, and certain lifestyle factors, such as smoking.
There are three stages of perimenopause: early, late, and menopause. In early perimenopause, you may expect to have mild symptoms, but as time goes on, they can become more pronounced. By late perimenopause, your periods are irregular, and you may struggle with hot flashes, night sweats, mood swings, vaginal dryness, and sleep issues. The increased symptoms are due to unpredictable hormone levels. As you enter the final stage called menopause, both estrogen and progesterone levels become almost undetectable, often worsening symptoms. Menopause lasts 12 months; when this period is over, you’re in postmenopause. Postmenopausal women can still experience symptoms like hot flashes and night sweats for up to 7-10 years.
Thus, the only difference between perimenopause and menopause is that perimenopause is a long journey, while menopause is just a part of it. Below is an age guide for each perimenopause stage.
Perimenopause vs postmenopause. Perimenopause refers to the transitional period leading to the infertile part of life, which includes the years before your final period. Postmenopause is the time after your final period, but you can only be certain you’ve reached it once 12 consecutive months without menstruation have passed.
Now that you know the transition away from peak reproduction can take up to 10 years, you’re probably wondering, “What is the difference between perimenopause and menopause symptoms?” Don’t be shocked, when it comes to symptoms menopause and perimenopause are similar.
However, let’s take one step back and have a look at how symptoms change in the late reproductive years to early perimenopause. Here is a table showing the common symptoms for women aged 40 to 45 and 45+ based on what Hormona app users log.
| users 40 to 44 yo | users 45 and above | ||
| physical symptom
% of users |
mental symptom
% of users |
physical symptom
% of users |
mental symptom
% of users |
| Fatigue 59% | Irritable 39% | Fatigue 59% | Feeling low 33% |
| Headache 54% | Sensitive 36% | Headache 53% | Sensitive 33% |
| Tender-breasts 47% | Feeling low 36% | Backache 46% | Irritable 32% |
| Backache 45% | Anxious 33% | Weight-gain 45% | Lack-of-concentration 30% |
| Cramps 42% | Stress 32% | Joint-pain 45% | Brain-fog 30% |
| Stomach-pain 40% | Mood-swings 30% | Dry-skin 42% | Anxious 28% |
| Dry-skin 38% | Lack-of-concentration
30% |
Tender-breasts 40% | Stress 28% |
| Constipation 38% | Brain-fog 29% | Stomach-pain 39% | Mood-swings 27% |
| Acne 36% | Sad 28% | Muscle-aches 39% | Sad 24% |
| Muscle-aches 36% | Angry 25% | Constipation 37% | Calm 21% |
Over a 10-year period, the top 10 symptoms shift, with weight gain, joint pain, and skin dryness becoming more prominent. These indicators often precede the broader shifts experienced during perimenopause.
You might be surprised to hear this, but the first perimenopausal symptoms are usually cognitive—not the hot flashes you might expect! This includes forgetfulness, brain fog, loss of concentration. Depressed mood, increase in pain, heavy menstrual bleeding, decrease in sexual desire and sleep issues join the first group when you progress the transition. Hot flashes, night sweats, heart palpitations usually happen around the final menstrual period and are both perimenopause and menopause symptoms. Urinary symptoms commonly progress when you are far from your last period in postmenopause.
Due to their similar symptoms, it’s impossible to differentiate between perimenopause vs menopause based on symptoms alone. The only way to tell if you’re in perimenopause, menopause, or even postmenopause is by the date of your last menstrual period.
Unfortunately, experiencing symptoms does not improve quality of life. To understand the real impact of symptoms on work, life, healthcare visits, and costs, the researchers surveyed more than eight thousand women aged 40 to 64 living in the USA. As expected, women with symptoms missed more work and used more healthcare services and had lower quality of life than those without. Women who were employed often worked while feeling unwell, which was shown to impair productivity.
Entering postmenopause has long-term health implications, which include an increased risk of bone density loss, heart attacks and heart disease, and obesity.
As estrogen levels decrease, women are at risk for losing bone density, which can lead to fractures. Ensuring you have enough calcium in your diet, exercising, and taking HRT when prescribed by your doctor can all help prevent bone density loss.
Perimenopause significantly increases a woman’s risk of heart disease again due to declining estrogen. This loss triggers unfavorable changes in cholesterol, insulin resistance, fat distribution, blood pressure, and blood vessel health.
Weight gain during perimenopause and menopause is driven by declining estrogen (who would have thought!), along with aging, less activity, poor diet, and emotional eating. That’s why it is so important to prioritize nutrient-dense foods that can provide sufficient nourishment to your body.
When discussing “What is the difference between menopause and perimenopause?”, one of the easiest ways to tell the difference is through age. Perimenopause typically starts at age 46 and can last 4 to 10 years. The first two stages can last around 3 and 2.5 years each, while the final stage, menopause, lasts 12 months.
Perimenopause isn’t a sudden occurrence; it’s a gradual transition where your estrogen and progesterone levels begin to slowly drop. During this time, it’s easy to wonder, “What’s the difference between menopause and perimenopause?” since you may experience similar symptoms. However, as perimenopause progresses, symptom severity typically increases.
While no lifestyle or diet change will stop the hormone decline that happens during perimenopause and menopause, there are strategies you can use to help manage symptoms.
Choosing a diet rich in vitamins and minerals will give your body added support and nutrients to help you feel your best during this life transition. It’s also important to limit processed and sugary foods, alcohol, and caffeine.
Staying active with daily exercise will make it easier to manage weight, limit bone loss, and protect your heart health. It doesn’t have to be intense; easy exercises like hiking, yoga, biking, pilates, and swimming are highly effective.
Sleep and rest are essential for supporting hormone health and protecting your mental, physical, and emotional wellbeing. Healthy sleep hygiene, like having a set sleep/ wake schedule, avoiding screens before bed, and limiting stimulants, can promote better sleep quality.
Understanding hormonal changes during perimenopause can take the fear out of the transition. Tracking symptoms is a great way to monitor what’s happening in your body and make lifestyle adjustments when needed. It’s also helpful when speaking to your doctor about medical intervention.
Hormona is the leading hormone tracking app that makes it easy to monitor your symptoms and test your hormone levels. By inputting symptoms, you can get trends and make lifestyle choices to support your overall health. Hormona empowers women to take charge of their hormone health in all life stages by offering personalized insights, comprehensive, scientifically based resources, and symptom correlation.
Along with Hormona, there are other resources you can use to learn more about perimenopause and menopause. The Menopause Society offers support and guidance based on scientific and evidence-based research. You can also find health wellness resources from The Endocrine Society and local help groups. You can also reach out to your healthcare provider for additional support.
Perimenopause is a natural life transition that begins around age 46 as hormone levels start to fluctuate more than they did before. Understanding what is expected to happen during the transition will help you to make the best lifestyle and care decisions. Hormone tracking with Hormona is one of the best ways to get in-depth insights into your hormonal health and better understand your body so you can feel your best at any stage.
The average age of perimenopausal onset is 46.
After perimenopause, women may experience worsening symptoms as they enter postmenopause. You may expect hot flashes and night sweats to subside in 10 years after the final period. Unfortunately, after that period it’s more common to experience worsening of urinary symptoms.
Generally, the farther you are in the menopausal transition, the more severe your symptoms can be. That’s why in menopause, you may experience more severe hot flashes, night sweats, sleep issues, and decreased libido compared to earlier stages. During early perimenopause, you may have little to no symptoms.
Perimenopause doesn’t happen suddenly; it’s a gradual process that happens as your estrogen and progesterone hormone levels start to decline.
Perimenopause fatigue can feel like tiredness, low energy, trouble concentrating, and persistent exhaustion. You may also experience mood swings, muscle weakness, and trouble sleeping.
Perimenopause commonly lasts between 4-7 years and can take up to 10 years before you enter postmenopause.
While they are similar, perimenopause and premenopause aren’t exactly the same. Perimenopause is the start of the menopause transition, when hormone levels begin to decline, while premenopause is the time before the last period which includes perimenopause. However, definitions can vary between sources.
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Dr Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the myriad of sleep.
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