What is the difference between premenopause, perimenopause and menopause?

Dr. Julia Schlam Edelman
OBGYN (Obstetrician & Gynecologist)

Postmenopause is a permanent phase that follows perimenopause. Postmenopause marks the end of your fertile years. Once you enter the postmenopause phase, you remain in it for the rest of your life. These two distinct phases affect your health differently. For example, postmenopausal women cannot conceive; perimenopausal women can and do. The ability to conceive is just one example of the differences between them.

Treatment options differ by phase of menopause. The risks, benefits and safety profiles of a given hormone, medication, supplement or surgical procedure may be drastically different for a post-menopausal woman than they are for one who is perimenopausal. Measures that maintain or restore health in one phase can be detrimental in another. For example, a perimenopausal nonsmoker who is experiencing severe hot flashes may benefit from taking a low-dose birth control pill. The hormones in the pill might relieve her symptoms. On the other hand, even a low-dose birth control pill is not suitable for a postmenopausal woman over 50. The hormone levels are too high for her system. Moreover, the pill delivers hormones in a cyclic pattern that does not match a postmenopausal woman's biology. Since she no longer has a menstrual cycle, her hormones stay constant.

Even if your body behaves the same way in postmenopause as it did in perimenopause, there are significant differences to note. For example, if you are perimenopausal, bleeding is expected. If you are postmenopausal, even a small amount of bleeding is a warning sign. It can signal that there is a problem in the uterus. While 9 out of 10 times that problem is not due to cancer, one out of 10 times the post-menopausal bleeding is due to cancer. In postmenopause, a single episode of bleeding may be a woman's only warning sign.

Perimenopause and postmenopause are not the same thing and the terms are not interchangeable. Women can be perimenopausal or postmenopausal, but not "menopausal," and it is important to know which you are.

Dr. Christina Hibbert
Psychology Specialist

The emotional differences between perimenopause and menopause can be quite dramatic. In Perimenopause (the transition from menstruation to no menstruation which can take months or even years) many women experience emotional symptoms. The most common symptoms include irritability, insomnia, and depressed mood. However, there are a host of symptoms perimenopausal women may experience, including anxiety, anger, rage, frustration, sadness, memory and thinking difficulties, and even personality changes. Women with a history of emotional sensitivity to hormone shifts (like PMS and Postpartum Depression) are usually more likely to experience these or other emotional symptoms.

Once Menopause enters (no menstruation for at least 12 months), the Perimenopausal symptoms often subside. With or without Hormone Replacement Therapy, most women recover health, mental health, and vitality. This is the first time since puberty that hormones are no longer in play, which can lead to surprising differences in personality and can bring relief for many women who previously struggled with hormone-related symptoms like PMS. In fact, Menopause can bring a new sense of freedom and control in life!

Premenopause is before menopause and perimenopause is around menopause. In general, premenopause is before any menopausal symptoms begin: a normally menstruating female. Perimenopause describes a time in the female’s life that some of the symptoms of menopause present while there still may be menses occurring. During this time women may experience hot flushes, fatigue, irritability and change in libido. At least 50 percent of women have no symptoms prior to menopause. Most of the women who do have symptoms, those symptoms will disappear during the five years after menses cease.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Premenopause is just what it sounds like, the time in a woman's reproductive life before she goes into menopause. It takes an average of four years for the levels of estrogen produced by the ovaries to get low enough for periods to stop completely. Twelve months after the last period, a women is considered postmenopausal.

The primary factor distinguishing perimenopause from menopause is menstruation. Women in perimenopause are still producing estrogen and having periods, whereas women who have entered menopause have not menstruated for at least 12 months.

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Premenopause as a term should refer to a woman before menopause has occurred, meaning a woman still having menstrual cycles whether they are regular or irregular. Perimenopause should refer to a woman who has begun to have menstrual irregularities due to changes in hormones, eventually leading to menopause. Technically speaking, all perimenopausal women are premenopausal but not all premenopausal women are perimenopausal.
Dr. Afua Mintah, MD
OBGYN (Obstetrician & Gynecologist)

Premenopause and perimenopause are used interchangeably to describe the time frame and symptomatology leading up to menopause. Premenopause, or perimenopause, may start as early as age 40. The average age of menopause is 51. Symptoms of premenopause or perimenopause before the age of 40 should be evaluated by a doctor.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.