What is The Difference Between Perimenopause And Menopause?

Described as “the storm before the calm”, perimenopause is the phase before menopause, and is when symptoms start for many women. Here’s everything you need to know.

There are so many questions that need answering about perimenopause. What is perimenopause and how is it different to menopause? How long will it last? What are the most common symptoms of perimenopause? Why did I find my car keys in the fridge…?

Car keys aside – blame the hormone-induced brain fog for that one – these are serious questions and we answer them here. 

What is Perimenopause?

Perimenopause is defined as the period of time when your body is transitioning toward menopause. Your periods may become irregular, and your fertility is on the decline. However, it is still possible to conceive.

The perimenopause phase is broken down in two stages. During the early stage, your periods may be erratic. They may not last as long as normal and may be lighter than usual. During the later stage, you may experience at least 60 days between your periods. Your hormones are fluctuating, which may trigger hot flashes and some other symptoms. In the last few years of this transition, you will experience a dramatic loss of oestrogen.

How your cycle is affected?

Perimenopause could show up as a shortening of your cycle – maybe from 28 days down to 25 or 26 – or your cycle could get longer.

Your periods may become a little shorter or lighter or indeed longer and heavier.

How you feel will vary from month to month. That’s because your ovaries don’t just stop producing oestrogen. Levels of oestrogen fluctuate over some years, going towards a kind of up and down, stuttering stop. Levels of progesterone vary too at this time, and this plays a part too.

READ MORE The link between menopause and anxiety.

What is Menopause?

Menopause is the point when you have not had a period for 12 months. So it is something that you can only know in retrospect. At this point, you no longer get your period at all. Since the perimenopause and menopause phases of your cycle are related, it is important to understand what to expect during transition and how to ease the symptoms.

What is the average age of perimenopause?

The average age of menopause is 51, while 45 is the average age for the perimenopause phase to begin. It’s important to know that you will still be having periods during perimenopause, but they may be becoming irregular. You may experience other symptoms as well.

Perimenopause could start in your 30s, if you have an early menopause. One in a hundred women will have the menopause under the age of 40.

Does ethnicity affect perimenopause and menopause?

The Study of Women’s Health Across the Nation, is designed to better understand the health of women during midlife. It examines women of all ethnicities and backgrounds between the ages of 40 and 55.

Results show that the symptoms of perimenopause differ among these groups of women. For example, Chinese and Japanese women have less severe symptoms. Most frequently, African American women experience hot flashes, night sweats, vaginal dryness and forgetfulness. Hispanic women report the most urine leakage and vaginal dryness and suffer the highest increase in heart rate.

READ MORE What causes brain fog during menopause?

A 2008 study that was published in the American Journal of Epidemiology found that Latinas and Native Americans experience the earliest onset of perimenopause. On the other hand, women of Japanese descent experience this transition later. Since this transitional phase sees a drop in oestrogen, later onset means better health in the long-term, especially for the bones, brain, and heart.

In 2009, a study of 150 women uncovered what ethnicities experienced the most symptoms. It was found that Asian females have the least amount of symptoms. On the opposite end of the spectrum, African American women have the most.

READ MORE Dr Shahzadi Harper on why menopause is a diversity issue.

How do you know you’re in perimenopause?

It can be hard to know, as the symptoms are so variable. And the fact that hormone levels fluctuate can make it difficult for women to know what’s happening. You might have a bad month where oestrogen levels are low and you have more of the symptoms. You might feel really tired, low, irritable one month, or have some hot flushes or feel anxious. Then the next, your oestrogen levels are up again and you feel fine.

So often women will put their symptoms down to other things – stress, work, children. It can take a while to realise there is a pattern. Despite the up and down fluctuations, what is happening is that oestrogen levels are, over this time, generally heading downwards as your ovaries run out of eggs.

How long does perimenopause last?

The average time period of this transitional phase is approximately four years. Some women may be in this stage for shorter periods, and others may experience it for a longer time. How do you know when your perimenopause is finished? As your levels of oestrogen rise and fall unevenly, your menstrual cycle may become longer or shorter. In fact, there may be cycles when you do not ovulate. After you have gone one year without your period, this transition phase ends. You are now in menopause.

Perimenopause symptoms

During this transitional phase, you may experience many of the following perimenopause symptoms:

  • Irregular Periods. When your hormone levels remain balanced, you have regular periods. However, perimenopause sees a fluctuation in oestrogen and progesterone. Therefore, spotting and irregular periods are likely. However, if bleeding is especially heavy and lasts for longer than three weeks at a time, it is best to seek medical attention.
  • Night Sweats. Waking up with sweaty pyjamas or sheets is common for many perimenopausal women.
  • Hot Flashes. The most common symptoms during this transition are hot flashes (or hot flushes). You may suddenly feel a surge of heat in your chest or facial region. Luckily, they only last a few minutes. They may occur each day or at unexpected times.
  • Changes in Sleep Patterns. Many have trouble sleeping and experience insomnia during perimenopause.
  • Changes in Mood. You may feel depressed or irritable for no explained reason.
  • Weight Gain. When your oestrogen is out of control, you may notice weight gain. It’s important to note that HRT does not cause weight gain, it is your body’s hormones. 
  • Vaginal Dryness. Due to a drop in hormones, you may notice a low sex drive and vaginal dryness during intercourse.
  • Difficulty Concentrating. Focus is often difficult during this time of transition.
  • Headaches. It is quite common to feel headaches or migraines when your hormones are fluctuating.
  • Joint discomfort. As oestrogen drops, you may experience stiff and achy joints.

READ MORE What are the 34 menopause symptoms?

How can HRT help with perimenopausal symptoms?

Hormone replacement therapy, or HRT, can be a useful way to lower symptoms associated with the transition toward menopause. HRT involves adding small amounts of oestrogen and, for some women, progesterone to your body. The amounts simply top up the decline caused by perimenopause. HRT does not give you extra hormones.

HRT will help to relieve the symptoms of perimenopause. For many women, the benefits are felt quickly, with hot flushes and night sweats stopping within just a few days. The mental health symptoms, like anxiety and mood swings, can also be alleviated. HRT has proven to decrease vaginal dryness. You should allow at least three months for the HRT benefits to be felt in your body.

It’s a good idea to take HRT because of all the health benefits. Especially when it’s taken earlier, it protects heart health, prevents and can treat osteoporosis, reduce the risk of bowel cancer and may well help decrease the chance of getting dementia and type two diabetes. That’s especially true if you’re between the ages of 50 and 60, when the benefits far outweighs any risks for the vast majority of women, according to NICE guidance of 2015.

READ MORE Perimenopause, HRT and sex drive, all the facts.

HRT can be taken in many forms: there are patches, gels, pills and sprays. Always consult your doctor to discuss the best options for  you.

READ MORE: HRT, is it safe? Everything you need to know. 

Why does everyone get different perimenopause symptoms? 

It’s individual for every woman. 80% of women get hot flushes and night sweats, the other 20 per cent don’t. In fact, in Japan, only seven per cent of women get hot flushes, which could be down to diet or genetics or a combination of the two.

Some women get no symptoms at all, and don’t even realise they are in the perimenopause. Most women get a combination of symptoms. 

How Complementary Therapies Help with Symptoms

Numerous complementary therapies help to minimize or eliminate symptoms experienced during perimenopause. It’s important to note that none of them have any evidence-based research to back up their claims, but some women may find them helpful.

Common complementary remedies include primrose oil, red clover, and black cohosh. These herbs may relieve hot flashes. To ease anxiety, you may consider St. John’s Wort. Ginkgo biloba may help to heighten your mood and memory as well.

Other alternative treatments offer symptoms of relief as well. For example, acupuncture, cognitive behavioural therapy, and other relaxation techniques often provide some type of help in the short-term. However, it is essential to receive guidance from your medical provider before adding anything to your diet.

Lifestyle Measures that Help with perimenopausal Symptoms

Besides medical measures, there are some lifestyle changes that help lower symptoms during the transition toward menopause.

  • Quit Smoking and Drinking. No surprise that smoking and drinking are two habits that make symptoms worse. Research shows that alcohol disrupts sleep, increases frequency of hot flashes and leads to depression. Quitting smoking and drinking will make you feel better.
  • Eat Healthy. Eating fruits, vegetables, and whole grains increases your overall health. Consuming calcium-rich foods helps prevent osteoporosis as well. You should avoid caffeine so that it does not disrupt your sleep or encourage hot flashes.
  • Exercise Regularly. Keeping active improves sleep and mood and helps manage weight gain. You can exercise for as little as 30 minutes each day to reap the benefits.
  • Lubricate. To make sex more pleasurable, you should try using an OTC water-based lubricant. Avoid products that contain glycerin, which may cause irritation.

READ MORE Alcohol, HRT and menopause, what you need to know.


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