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Comparing premenopause and perimenopause


Comparing premenopause and perimenopause
By Rachel Nall RN BSN CCRN
Reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI

During her life, a woman experiences many hormone fluctuations that affect her fertility. When she starts her period, she can potentially conceive a child. As she gets older, her reproductive hormone levels drop and eventually cease, leading to what is known as menopause.

Menopause is when the ovaries stop making estrogen and other sex hormones, causing a woman to have no periods for 12 consecutive months. Although other parts of the body will still make these hormones, their levels decrease significantly during menopause.

Hormone levels do not usually decrease overnight, however. Instead, a woman enters a phase of her reproductive life known as perimenopause, where her hormone levels start to decrease. This phase causes symptoms and signals that menopause may occur in the next year or years.

Premenopause vs. perimenopause

Premenopause can describe when a woman is experiencing normal periods. Perimenopause is the time of transition towards menopause.

Premenopause and perimenopause are similar terms that are sometimes used in place of each other.

The term "pre" means "before" and the term "peri" means "surrounding" or "near". Technically, a woman is in premenopause anytime before she enters menopause.

Some doctors refer to premenopause as the time between a woman's first and last period.

For this reason, the term perimenopause may more accurately describe when a woman is close to menopause, as it implies a decrease in hormone levels.

Doctors may also use the term "menopause transition" to describe a woman who is in perimenopause.

Doctors have identified three stages of menopause: perimenopause, menopause, and postmenopause. Each stage is a gradual change that usually takes place over several years.


During perimenopause, the body reduces the amount of estrogen and eggs it produces. This can start after the age of 30.

Perimenopause usually occurs 3-4 years before a woman enters menopause, but it may begin as early as 10 years before. During this time, the ovaries start reducing the amount of estrogen they produce.

Ultimately, they will stop releasing eggs and a woman will stop having periods. A woman can be in perimenopause and still get pregnant.
The perimenopause phase most commonly occurs in a woman's 40s, but it may occur in her 30s. The symptoms of perimenopause may become more pronounced as she gets closer to menopause.

During menopause, a woman's ovaries no longer release eggs and estrogen production in the ovaries slows down considerably. The symptoms experienced in perimenopause may continue into menopause.

Technically, menopause is defined as the time when a woman has not had a period for 12 months in a row.

Postmenopause is the stage after menopause. At this juncture, a woman may experience an increase in symptoms associated with reduced estrogen production.
However, she will generally have reduced menopausal symptoms. Treatments are available, but they have side effects that are important for a woman to discuss with her doctor.

Perimenopause can last anywhere from 3 to 10 years. Technically, premenopause lasts from when a woman has her first period to when she gets her final period and enters menopause.

If a woman experiences menopause before age 45, doctors refer to this as early menopause. If menopause occurs before age 40, it is known as premature menopause.

There are some instances when a doctor might recommend a medication- or surgically-induced menopause. This will cause menopause to occur earlier or more quickly that it would do naturally.

Symptoms at each stage
During each stage of menopause, there are symptoms that a woman may experience, as well as internal changes in hormone production that can be tested for by a doctor.

Premenopause symptoms
While hormone levels fluctuate naturally during premenopause, a woman is unlikely to have symptoms related to a loss of estrogen.

Instead, a woman in premenopause will usually have regular or semi-regular periods, be fertile, and may experience symptoms of premenstrual syndrome (PMS).
Symptoms of PMS include:

  • cramps
  • mood swings
  • nausea
  • anxiety or irritability
  • depression
  • bloating
  • tender breasts
Perimenopause symptoms
Declining hormone levels can lead to a number of symptoms. Irregular periods are often the first noticeable symptom for a woman in perimenopause.

Night sweats and insomnia are possible symptoms of perimenopause.

Other symptoms of perimenopause include:
  • dry, thinning skin
  • hair loss or thinning
  • hot flashes, or a sudden, overwhelming sense of heat
  • insomnia
  • night sweats
  • sudden unexplained mood swings
  • trouble concentrating
  • urinary urgency, or feeling the need to urinate more often but passing only a small amount of urine
  • vaginal dryness
  • weight gain
A woman in perimenopause may also notice changes in her menstrual cycle, such as worsening of her premenstrual symptoms.

Menopause symptoms
A woman is in menopause when she has not had her period for 12 months in a row. This occurs at an average age of about 51 years.

During menopause, a woman may experience symptoms similar to perimenopause, but they can be more pronounced, as hormone levels will have dropped significantly.

Examples of these symptoms include hot flashes, difficulty sleeping, and vaginal dryness. These changes are called vasomotor symptoms.

Postmenopause symptoms
Postmenopause occurs after a woman has been through menopause. This phase will last for the remainder of her life.

A doctor can order blood tests to determine if a woman is in the postmenopause phase. A doctor may test for follicle stimulating hormone (FSH). Although hormone levels may vary, FSH levels are usually higher in postmenopause.

Perimenopause and menopause symptoms are very similar and are managed similarly. There are both at-home and medical ways to manage symptoms at each stage.

Premenopause management
Managing premenopause involves alleviating the symptoms of PMS. This can include taking over-the-counter pain medications and using heating pads for premenstrual cramps.

Some women use oral contraceptive pills to help reduce pain and discomfort during premenopause.

Perimenopause management
Women in perimenopause often experience irregular periods, which can cause heavy bleeding and cramping. This is sometimes treated with a low-dose oral contraceptive pill.

Oral contraceptive pills have been shown to reduce some of the effects of decreasing hormone levels related to menopause. Examples include reduced bone loss and protection against endometrial and ovarian cancers.

Help for hot flashes
For perimenopause and menopause-related hot flashes, there are several ways to minimize symptoms. These include:

  • avoiding triggers, such as spicy foods, hot drinks, and warm climates
  • breathing deeply and slowly
  • wearing loose-fitting, layered clothing that can be removed easily
  • keeping a fan nearby, especially at night
  • drinking cold liquids when a hot flash occurs
Medical treatments
Doctors may recommend low-dose estrogen pills, patches, or creams to reduce the effects of severe hot flashes.

However, estrogen therapy is associated with increased risks for some cancers, especially breast cancer. Therefore, it is important that a woman takes the smallest effective dose.

If a woman does not wish to use estrogen therapy, she may be able to take antidepressants, such as venlafaxine or selective serotonin reuptake inhibitors (SSRIs), to help with the symptoms.

Postmenopausal management
While most women will experience a reduction or complete stop of vasomotor symptoms after menopause, they may still have some symptoms. These include vaginal dryness, difficulty sleeping, and mood swings.

Applying a water-based lubricant before sex can help to reduce the effects of vaginal dryness and discomfort.

Some women may choose to take menopausal hormone therapy (MHT). This type of medication includes estrogen and progesterone. If a woman has had a hysterectomy, she will only take estrogen.

These treatments can reduce vasomotor symptoms and the occurrence of mood swings. However, they do increase the risk for blood clots, heart attack, stroke, and breast cancer.

A woman should carefully consider the risks before beginning treatment.