Premenopause, Perimenopause, and Menopause


Menopause officially marks the end of female reproduction.

Although this life stage is well known, there are actually different stages within menopause that are important to recognize and understand. Menopause itself officially occurs when you stop menstruating.

Perimenopause, on the other hand, means “around menopause.” It’s also known as the menopause transitional phase and is called such because it happens before menopause.

Although they’re both part of the same overall life transition, menopause and perimenopause have different symptoms and treatment options.

Any questions, concerns, or abnormal symptoms should be discussed with your OB- GYN.

Premenopause vs. perimenopause

Premenopause and perimenopause are sometimes used interchangeably, but technically they have different meanings.

Premenopause is when you have no symptoms of perimenopause or menopause.

You still have periods — whether they’re regular or irregular — and are considered to be in your reproductive years. Some hormonal changes may be occurring, but there are no noticeable changes in your body.

On the other hand, during perimenopause, you’ll start to experience symptoms of menopause. They may include:

  • changes in your period cycle
  • hot flashes
  • sleep disturbances
  • mood swings

When perimenopause occurs

Perimenopause occurs well before you officially hit menopause.

In fact, according to the Cleveland Clinic, hormonal changes are seen 8 to 10 years ahead of menopause. This happens during your 30s or 40s even before the onset of perimenopause.

Perimenopause is marked by a drop in estrogen, the main female hormone produced by the ovaries. The estrogen levels can also go up and down more sporadically than they do in a typical 28-day cycle. This can cause irregular periods and other symptoms.

During the final stages of perimenopause, your body will produce less and less estrogen. Despite the sharp drop in estrogen, it’s still possible to get pregnant. Perimenopause can last for as little as a few months and as long as 4 years.

Menopause officially kicks in when the ovaries produce so little estrogen that eggs are no longer released. This also causes your period to stop.

Your doctor will diagnose menopause once you haven’t had a period for a full year.

You may enter menopause earlier than normal if you:

  • have a family history of early menopause
  • are a smoker
  • have had a hysterectomy or oophorectomy
  • have undergone cancer treatments

Symptoms of perimenopause and menopause

When it comes to menopause, most people think about the symptoms more than anything else. These can include those infamous hot flashes, but there are many other changes you might experience during this transition.

Perimenopause symptoms

Symptoms of perimenopause may include:

  • irregular periods
  • periods that are heavier or lighter than normal
  • worse premenstrual syndrome (PMS) before periods
  • breast tenderness
  • weight gain
  • hair changes
  • heart palpitations
  • headaches
  • loss of sex drive
  • concentration difficulties
  • forgetfulness
  • muscle aches
  • urinary tract infections (UTIs)
  • fertility issues in women who are trying to conceive
Menopause symptoms

As estrogen levels drop, you might start experiencing symptoms of menopause. Some of these can occur while you’re still at the perimenopause stage.

  • night sweats
  • hot flashes
  • depression
  • anxiety or irritability
  • mood swings
  • insomnia
  • fatigue
  • dry skin
  • vaginal dryness
  • frequent urination

When to call a doctor

You don’t necessarily have to call your doctor to obtain a perimenopause or menopause diagnosis, but there are instances when you should definitely see your OB-GYN.

Call right away if you experience:

  • spotting after your period
  • blood clots during your period
  • bleeding after sex
  • periods that are much longer or much shorter than normal

Some possible explanations are hormonal imbalances or fibroids, both of which are treatable. However, you also want to rule out the possibility of cancer.

You should also call your doctor if the symptoms of either perimenopause or menopause become severe enough to interfere with your daily life.

Treatments for perimenopause and menopause

There are both prescription and over-the-counter (OTC) treatments available for perimenopause and menopause.


Estrogen (hormone) therapy works by normalizing estrogen levels so sudden hormonal spikes and drops don’t cause uncomfortable symptoms. Some forms of estrogen may even help reduce the risk of osteoporosis.

Estrogen is available over the counter or by prescription. Of note, the Food and Drug Administration (FDA) may not regulate some of the OTC options.

Estrogen is usually combined with progestin and comes in many forms, including:

  • oral pills
  • creams
  • gels
  • skin patches
Other medications

Other menopause medications are more targeted. For example:

  • Prescription vaginal creams can alleviate dryness as well as pain from intercourse.
  • Antidepressants can help with mood swings.
  • The seizure medication gabapentin (Neurontin) can be an option for hot flashes.

Home remedies for perimenopause and menopause

There are also methods you can use to alleviate your symptoms at home.

Regular exercise can help improve your mood, weight gain issues, and even (ironically) your hot flashes.

Plan to include some form of physical activity in your daily routine. Just don’t work out before bedtime, as this can increase insomnia.

Getting enough rest can seem impossible if you’re dealing with insomnia.

Try doing a relaxing activity right before bed, such as gentle yoga or a warm bath. Avoid daytime naps, as this can interfere with your ability to sleep at night.

Here are a few other methods you can try to relieve symptoms:

  • Pay attention to your diet and avoid large meals.
  • Quit smoking, if you smoke.
  • Only drink alcohol in moderation.
  • Limit caffeine to small quantities and only have it in the morning.


Perimenopause and menopause are both transitional phases that indicate an end to your reproductive years.

There are certainly adjustments to be made, but remember that not all aspects are negative.

With all of the available treatments, you can get through these stages more comfortably with a bit more freedom, too.

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