Perimenopause vs. Menopause

Reviewed by Dr. Lisa Czanko MD, MPH

You may have heard the words “perimenopause” and “menopause” tossed around to conjure up images of The Golden Girls (RIP Betty White), but what exactly do these terms mean?

 Around half of the entire population will go through perimenopause and menopause. So why is it a mystery for so many what happens during menopause and perimenopause?

 Let’s start the conversation.

What happens during menopause?

Medically speaking, the term “menopause” refers to the final menstrual period. Someone is considered to be “in menopause” when they have gone for a full year without a period. In the United States, the average age for menopause is 51.4, but early menopause symptoms can occur anywhere from age 40 through the late 50s. 

People can have many different symptoms related to the decreased hormone levels that occur with menopause. These symptoms are often portrayed in the media as a woman in her 50s fanning herself due to hot flashes, but symptoms are more complex than that and it is definitely not a “one size fits all” experience. 

In addition to the hot flashes and night sweats that about 80% of people in menopause experience, other common symptoms include mood changes, vaginal dryness, painful sex, difficulty sleeping, and weight gain. 

Some people may have a few of these, while others may not have any of these symptoms at all.

Menopause does not occur overnight. There is a transition time that leads up to the final period, referred to as “perimenopause.” Even though essentially all people with ovaries experience perimenopause, the experience varies greatly from person to person. 

On average, perimenopause lasts about two to eight years, but perimenopause symptoms can last for up to 14 years. 

The stages of perimenopause

Do you remember when you had your first period? Your periods very likely did not begin as a predictable event every month; people usually experience a wide range of bleeding patterns for the first two years after they start getting their period. 

People will often experience something similar in the years leading up to menopause as well. The reason is the same: fluctuating hormone levels. 

During perimenopause, hormone levels change and are not as coordinated as they once were. About five years before the final period, people will have changes in their periods—how often they occur, how heavy they are, and how long they last. 

When you enter the stages of perimenopause, cycles are often shorter and the period may come sooner than expected. As a person gets closer to their final period, the changing hormones often result in longer or skipped cycles due to not ovulating (producing an egg). The amount of flow during the period changes as well, and may be heavier or lighter. 

Even though changes in bleeding patterns are expected during perimenopause, there are some period symptoms that should be evaluated by a medical provider to ensure there are no other serious conditions present. 

Perimenopause symptoms that need medical attention:

• Bleeding in-between periods
• Bleeding that saturates one or more pads or tampons in an hour or less. Or, the passing of large blood clots
• Bleeding that lasts longer than 7 days
• Periods that occur more frequently than every 21 days

I'm experiencing perimenopause symptoms – now what?

If horrible perimenopause symptoms are interfering with a person’s life and causing distress, talking about treatment options with a health care provider can help. 

Even though these perimenopause symptoms may be normal, there are still options for relief, ranging from lifestyle measures to over-the-counter options to prescription medications, and a medical provider experienced in helping perimenopause people is a great resource to guide you to the best option for your individual situation. 

As long as someone is still getting a period, it is possible to get pregnant. For individuals who engage in vaginal-penile sex and do not desire pregnancy, it is important to continue using reliable birth control. 

In addition to preventing pregnancy, some kinds of hormonal birth control have the added benefit of helping horrible perimenopause symptoms such as heavy vaginal bleeding, hot flashes, night sweats, and mood changes. 

Let’s get the word out

While we all know the importance of providing health education on contraception and pregnancy, it’s just as important to turn the spotlight on perimenopause and menopause and the unique experiences that come during this time.

The more we talk about the changes our bodies go through, the more we normalize these changes, and that is a healthy thing for everyone!

This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that you have read on this blog or in any linked materials. If you think you may have a medical emergency, call your doctor or emergency services immediately.

The opinions and views expressed on this blog and website have no relation to those of any academic, hospital, health practice or other institution.

Citations

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Cleveland Clinic. Perimenopause. Updated [October 5, 2021]. Accessed [January 3, 2022]. https://my.clevelandclinic.org/health/diseases/21608-perimenopause 

Conaway B, Jacobson JD, Zieve D. Menopause. National Library of Medicine Medline Plus. [June 30, 2019] Updated [November 30, 2021]. Accessed [December 22, 2021]. https://medlineplus.gov/ency/article/000894.htm

Eunice Kennedy Shriver National Institute of Child Health and Human Development. About Menopause. US Department of Health and Human Services National Institutes of Health. Updated [November 16, 2021]. Accessed [December 22, 2021]. https://www.nichd.nih.gov/health/topics/menopause/conditioninfo

National Institute on Aging. What Is Menopause? US Department of Health and Human Services National Institutes of Health. Updated [September 30, 2021]. Accessed [December 28, 2021]. https://www.nia.nih.gov/health/what-menopause 

North American Menopause Society. Menopause 101: A primer for the perimenopausal. Updated [2021]. Accessed [December 22, 2021]. http://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal 

Office on Women’s Health. Menopause Basics. US Department of Health and Human Services. Updated [March 18, 2019]. Accessed [January 12, 2022]. https://www.womenshealth.gov/menopause/menopause-basics

Santoro N et al. Menstrual Cycle Hormone Changes in Women Traversing Menopause: Study of Women’s Health Across the Nation. J Clin Endocrinol Metab. 2017 Jul 1; 102(7): 2218–2229. doi: 10.1210/jc.2016-4017