Menopause is a complex subject — and sometimes, the language surrounding it can feel confusing. Is there a difference between premenopause and perimenopause? What do the terms mean — and why do we hear both?
To clarify the issue, let’s look at menopause — what it is, why it happens — and the changes that lead up to it.
What Is Menopause?
Simply put, menopause is when you stop having periods. Officially, menopause begins 12 months after you had your last period. When you go through menopause, you can’t get pregnant naturally because your body has stopped making eggs.
Menopause doesn’t happen overnight. It’s a long process that takes years, as your ovaries produce lower levels of the hormones estrogen and progesterone.
Menopause is a normal part of getting older, but that doesn’t mean it’s easy for everyone. Many people going through menopause experience hot flashes, sleep problems, and other side effects. Others sail through menopause with very few symptoms.
According to the U.S. Department of Health & Human Services Office on Women’s Health, the average age of menopause is 52. But menopause can happen earlier or later in a person’s life.
What Is Premenopause?
Premenopause means “before menopause” — the time between your first period (called menarche) and your last period, which signals the start of menopause.
Some people use the term premenopause interchangeably with perimenopause. But doctors prefer the term perimenopause, which more accurately describes the transition from the “fertile years” to menopause.
What Is Perimenopause?
Perimenopause means “around menopause” — and generally describes the transition time leading up to menopause. During this time, your hormones begin to change. Your periods may become irregular because you’re not consistently releasing eggs. Many people start having symptoms of menopause when they stop ovulating consistently.
Perimenopause usually lasts about four years and typically starts in your mid-40s — although the time frame can vary. People who smoke usually enter perimenopause earlier than those who don’t.
Some medical issues and treatments can complicate menopause timing. For example, chemotherapy can put you into early menopause (either temporarily or permanently). Surgery to remove both ovaries puts you into menopause no matter your age.
How Will I Know if I’m in Perimenopause?
Sometimes, the signs of perimenopause are subtle at first. Keep in mind that every person’s experience of going through perimenopause and menopause is unique. The symptoms and their intensity can vary greatly.
No test can determine if you’re in perimenopause. If you have any symptoms that are bothering you, talk to your ob-gyn.
You may show all, none, or some of the following signs of perimenopause:
- Aches and pains — Many people going into menopause experience new, seemingly random joint or muscle pain during perimenopause.
- Brain fog — Feeling forgetful during perimenopause is common. Again, your shifting hormones may cause any short-term memory problems or trouble concentrating.
- Changes in your body — During perimenopause, you may lose muscle mass or gain fat around your waist. Your hair may thin out, and your skin may feel drier.
- Higher cholesterol — Lower estrogen levels affect your cholesterol levels. Higher cholesterol raises your risk for stroke and heart disease.
- Hot flashes — During perimenopause, many people start having hot flashes, a warm feeling that suddenly spreads over the whole body. Hot flashes usually start around the face and neck and may last from 30 seconds to 10 minutes. The frequency varies — hot flashes can happen rarely, once or twice a day, or several times an hour.
- Irregular periods — You may not ovulate every month during perimenopause, so you may skip periods. Your menstrual cycles may suddenly get longer or shorter. And your periods may get lighter or heavier than usual.
- Low libido — You may feel less interested in sex during perimenopause. Arousal may take longer.
- Mood swings — Your rapidly shifting hormones can cause you to feel irritable, moody, or depressed.
- Night sweats and trouble sleeping — You may have trouble falling asleep or wake up in the middle of the night drenched in sweat. During perimenopause, many people have trouble falling back to sleep when awake.
- Vaginal dryness — During perimenopause, sex can become painful as your vaginal tissue becomes thinner and drier.
How Do I Treat My Symptoms of Perimenopause?
Though perimenopause is a normal part of life, some people suffer intense discomfort from hot flashes and other symptoms. Talk to your doctor about what you’re experiencing. Help is available for bothersome perimenopause symptoms.
Note: You can still get pregnant during perimenopause, even though you might ovulate irregularly. You should continue to use birth control until one full year after your last period. Birth control can even help regulate symptoms of perimenopause.
Medical treatments
Your doctor may recommend the following treatments to relieve hot flashes, vaginal dryness, night sweats, and mood swings.
- Antidepressants — Some of these drugs also provide relief from severe hot flashes.
- Birth control pills — A low-dose birth control pill can help control perimenopause symptoms. They can help regulate your periods and your menstrual flow.
- Prescription vaginal creams — These can alleviate vaginal dryness.
Hormone therapy
Hormone therapy involves replacing the hormones that you lose during perimenopause. It may also help lower your risk of osteoporosis, heart disease, and dementia.
The two types of hormone therapy are:
- Combination therapy — For people who still have a uterus. It combines estrogen and progesterone in pill or patch form.
- Estrogen therapy — If you had a hysterectomy (removal of your uterus), you may need estrogen. Estrogen can come in patch, pill, cream, gel, spray, or vaginal ring form.
Lifestyle changes
You can often get relief from perimenopause symptoms by trying the following:
- Avoid the heat — High temperatures can aggravate hot flashes and night sweats.
- Develop good sleep habits — Keep your bedroom cool and dark, go to bed at the same time each night, and limit screen time in the evening.
- Eat well — A diet rich in lean protein, whole grains, fruit, and vegetables is best.
- Reduce stress — Exercise, meditation, and self-care can help.
- Manage your weight — Being overweight or obese can make hot flashes worse.
- Quit smoking — Smoking can trigger hot flashes and lead to earlier menopause.
- Use vaginal lubricants — These can help make sex more comfortable.
- Watch for hot flash triggers — Avoid caffeine, spicy foods, and alcohol.
Editor's Note: This article was originally published on , and was last reviewed on .