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Perimenopause or Menopause? How to Tell.


One of the most common questions we get asked at our OB/GYN practice on Long Island is, “Am I in perimenopause or menopause?” This question often comes up when a patient is having symptoms of menopause, but is still having periods. To understand the difference between the two, let’s take a closer look.

Perimenopause vs. Menopause

Perimenopause: Menopause doesn’t happen overnight: The ovaries don’t stop producing estrogen as if a light switch were turned off. Instead, estrogen levels slowly decline over several years—more like a dimmer switch. This time of declining estrogen levels is referred to as “perimenopause.” During perimenopause, hormone levels fluctuate as the body slowly transitions to menopause. Perimenopause usually lasts anywhere from 3 to 5 years and usually affects women beginning in their mid-40s. However, the duration of perimenopause can vary substantially, and its onset can start earlier or later in different women.

Menopause: Menopause occurs when the ovaries stop releasing eggs producing estrogen, and menstruation ceases. “Official” menopause is declared when a woman has gone without a period for one year. This typically happens to women around age 50 (the average age of menopause in the U.S. is 51). However, menopause can occur earlier or later depending on a woman’s health, her genetics, and her medical history.

Understanding the Symptoms

The symptoms of menopause and perimenopause often overlap, so it can be difficult to tell them apart. During the last 1 to 2 years of perimenopause, estrogen levels decline rapidly. This results in a variety of symptoms, including:

  • Hot flashes: These sudden sensations of heat, flushing, and sweating occur because of hormonal changes but can also be triggered by spicy foods, alcohol, caffeine, stress, and other factors. Hot flashes can occur before, during, and after menopause.
  • Night sweats: Like hot flashes, night sweats can cause excessive sweating at night. This may result in sleep disturbances and can impact sleep quality, causing fatigue throughout the day.
  • Mood swings and irritability: If you thought losing your period would mean a better-regulated mood, think again! Mood swings occur in both perimenopause and menopause, and are a result of – you guessed it – hormonal changes. Feeling sad, anxious, or irritable are all common signs of perimenopause and menopause. These feelings are normal and can fluctuate frequently.
  • Vaginal dryness and discomfort: A lack of estrogen is responsible for vaginal dryness and discomfort, particularly during sex. That’s because estrogen in the blood is required to keep the vaginal skin healthy and supple. Once estrogen declines, vaginal pain and dryness can occur. Usually, this is a relatively late symptom of menopause.
  • Irregular periods: A common complaint during perimenopause is irregular periods. As women approach menopause, many notice that their periods arrive closer together (for example, a 28-day cycle may become a 24- or 25-day cycle). Periods may be missed. Eventually, your period will become less and less frequent until it stops completely. Periods may not be “on time” during perimenopause, but they should still be “organized”: Bleeding between periods is not normal, even during perimenopause.

So, What’s the Difference?

Perimenopause and menopause represent a physiologic continuum, a normal process. The main difference between perimenopause and menopause is that menopause is defined as the time after your period has stopped. If you are experiencing symptoms and are still having periods, it’s likely that you are in perimenopause.

Can Bloodwork Help?

Many women ask if bloodwork can help to determine whether they are in perimenopause or menopause. In truth, bloodwork is rarely necessary: Usually, this is a diagnosis we can make just by speaking to patients. Moreover, because hormone levels fluctuate widely during perimenopause, a single set of labs—which shows us only a “snapshot” in time—is not particularly helpful.

What You Can Do

It’s important to remember that perimenopause and menopause are completely natural and normal processes, and no two women will experience them in exactly the same way. Some women may breeze right through, while others may have years of uncomfortable symptoms. If symptoms become unmanageable, we can recommend lifestyle changes as well as hormonal and non-hormonal remedies to keep you feeling your best.

At The Woman’s Health Pavilion, our OB-GYNs and gynecologists in Queens and Nassau County are here to help and support you. We offer medical solutions to help you manage your symptoms and renew your quality of life.

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