Perimenopause VS Menopause: What’s the Difference & What Should You Expect?
Navigating changes in our body can be confusing at the best of times – especially when it comes to terms like perimenopause and menopause. Are they the same thing? Is one worse than the other? How do I know which one I’m experiencing or if it even is one of them?
Let’s try to break it down and make it easier to understand, without all the medical jargon.
Understanding the Basics
Think of perimenopause and menopause as two chapters in the same book – the book of your hormonal change.
What is Perimenopause?
The prequel (as they say in the movies) to Menopause. It’s the time on our life when our bodies begin to slowly stop producing oestrogen and progesterone. It can sneak up on us in our 30’s or 40’s … yes you read that right, our 30’s, and can last up to 10 years … yes, you read that correctly too!
During perimenopause our periods can become unpredictable. One month is heavy, another is spotting, or it skips altogether. The fluctuations are caused by changing hormone levels. These differing hormone levels can also trigger a wide range of symptoms, it more on that later.
What is Menopause?
The term “menopause” was introduced in 1821 by French physician Charles-Pierre-Louis de Gardanne. Derived from the Greek root “meno,” meaning “month” and linked to the moon, combined with “pause,” signifying a halt or stop, the word directly translates to the cessation of the monthly cycle. It’s officially the end of your reproductive years. We officially reach menopause after 12 full months without a period – so no spotting and no bleeding. It usually hits us between the ages of 45 and 55 but it can be earlier or later and can be “natural” or ‘”surgical”. If you have both your ovaries removed for whatever reason, at whatever age we automatically go into menopause.
Unlike perimenopause, which is all about hormonal ups and downs, menopause means those hormones have dropped. Oestrogen to a low level and stayed low (small amounts of oestrogen is produced in other part of the body like fat tissue and adrenal glands) and progesterone essentially stops (it’s mainly produced after ovulation, and we don’t ovulate anymore after menopause).
Symptoms: What to Expect and When
Common symptoms we have probably all heard of
| Symptoms | Perimenopause | Menopause |
| Irregular Periods | Very common | Periods have stopped |
| Hot Flushes | Common, come and go, unpredictable | Often more intense and persistent |
| Night Sweats | Yes, especially in the later stages | Yes, typically more regular |
| Mood Swings | Can feel like PMS x 10 | Can continue but tend to stabilise |
| Vaginal Dryness | Begins mildly | Prominent due to lack of oestrogen and lead to Genitourinary Syndrome of Menopause (GSM) |
| Sleep Issues | Common trouble falling asleep, wake up often | My get worse due to hot flushes and hormone changes |
| Libido Changes | Up and down | Often but individuals vary |
| Fatigue and brain fog | Yes, especially mid to late perimenopause | Can persist post menopause |
| Bone density concerns | Not immediately significant | Can be life altering changes |
Uncommon symptoms you probably didn’t even realise were due to perimenopause
Perimenopause symptoms in particular are vast and different for everyone. Besides the usual hot flushes, night sweats and sleep issues there a whole range of others that we don’t always hear about.
| Heart Palpitations | a sensation of a racing, pounding or irregular heartbeat. Typically, short-lived and harmless but you should always tell your doctor about them |
| Weight gain and weight redistribution | Oestrogen reduces causing fat distribution to shift from hips and thighs to abdominal visceral fat |
| Psychological changes | depressions, anxiety, irritability, mood swings, panic attacks |
| Fatigue | changes to hormones levels and sleep disturbances can lead to fatigue and feeling tired both physically and mentally |
| Sore or tender breasts | Can be an early indicator of perimenopause and feels different to breast tenderness felt during PMS |
| Gut issues | Acid reflux, diarrhoea, constipation, bloating |
| Neurological issues | Migraines, brain fog, memory problems, dizziness/vertigo, tingling |
| Musculoskeletal | Frozen shoulder, joint pain and stiffness, aching muscles, loss of grip strength, gluteal tendinopathy, osteoporosis |
| Changes to skin, hair and nails | Dry itchy skin, weak brittle nails, hair loss, acne, pigmentation |
| Eye problems | Dry itchy eyes |
| Mouth and dental issues | burning sensation in the mouth, metallic taste, gum disease |
| Urinary issues | Frequency, incontinence, overactive bladder |
| Allergies | new or increase allergy symptoms |
| Body odour | increased sweating and night sweats can cause body odour issues; hormone fluctuation can increase odour producing bacteria. |
Just know you are not going crazy, you are not imagining it, it is real, and you can be helped to reduce or eliminate most of the symptoms.