Perimenopause means “around menopause.” Premenopause means “before menopause.” However, healthcare professionals prefer to use the term perimenopause to refer to the years before menopause, when hormone levels are changing but menstruation still occurs.

Menopause occurs when the ovaries stop making estrogen and other sex hormones. A healthcare professional will confirm menopause after a female has had no periods for 12 months in a row. After this, they will no longer be able to become pregnant without assistance.

Sex and gender exist on a spectrum. This article will use the term “female” to refer to a person’s sex assigned at birth.

The changes that lead to menopause happen gradually. Estrogen levels start to fluctuate in the years before menopause. In time, there will be disruption in the menstrual cycle, and other changes may follow. Periods may continue for several years before menopause begins.

This time is known as perimenopause. Some people call it premenopause, but perimenopause is the standard term within the medical community.

Some females do not experience perimenopause, instead moving straight into menopause.

Undergoing chemotherapy, having surgery to remove the ovaries, and other factors can all cause hormone levels to fall rapidly or suddenly.

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People sometimes use the terms premenopause and perimenopause interchangeably, but premenopause is not a scientifically accepted term.

The term “pre” means “before,” while the term “peri” means “around.” However, healthcare professionals use the word perimenopause to refer to the time before menopause. They do not use premenopause.

The two stages of menopause are perimenopause and postmenopause. Menopause is the point at which a female moves from one stage to the next.

In most cases, each stage is a gradual change that usually takes place over several years.

Learn more about menopause here.

It is not possible to pinpoint when perimenopause starts. For most females, it will be sometime around their mid-to-late 40s.

It usually lasts for around 4 years, but it can last for 2–8 years, according to the Office on Women’s Health. During this time, the ovaries start reducing the amount of estrogen they produce.

The menstrual cycle will become variable and eventually stop completely. When no periods have occurred for 12 months, a healthcare professional will confirm menopause. In the United States, the average age at menopause is 52 years. However, the age range for this can vary widely.

A female may know that they are starting perimenopause if their menstrual cycle varies by 7 days or more but they still have at least one period in 3 months.

During perimenopause, a female may start to experience:

  • a longer or shorter menstrual cycle
  • missing periods
  • heavier or lighter periods
  • hot flashes and night sweats
  • sleep problems
  • mood changes, including depression and anxiety
  • vaginal dryness, leading to painful intercourse

These symptoms may become more noticeable as menopause approaches, though they will not affect everyone.

Is it a hot flash? Learn more about this symptom here.

Menopause

Menopause occurs when there have been no periods for 12 months. It is a moment of transition rather than a stage. At this point, the ovaries no longer release eggs, and estrogen production in the ovaries has fallen significantly.

The transition from perimenopause to postmenopause happens when a female stops ovulating. However, experts point out that there is no clearly identifiable moment when this happens. They can only say that it occurs at some point during that transition.

How long do symptoms last? Learn more here.

Early postmenopause

When menstruation has not occurred for 12 months, early postmenopause begins.

The following changes may occur during this time:

  • hot flashes and night sweats
  • difficulty sleeping
  • a reduced sex drive
  • problems with thinking and memory
  • vaginal dryness, leading to pain during sex
  • headaches
  • mood changes
  • an irregular heartbeat, or palpitations
  • pain and stiffness in the joints
  • reduced muscle mass
  • more frequent urinary tract infections

If hormone levels change abruptly, menopause can start suddenly. This can happen naturally or as a result of surgery or another treatment.

Is it normal to see discharge during menopause? Learn more here.

Postmenopause

After around 3–6 years, most females enter late postmenopause, though this can vary widely. Vasomotor symptoms, such as hot flashes, can continue for several years.

The symptoms of menopause usually resolve over time, but some changes may be long-lasting.

Lower estrogen and progesterone production can increase the risk of:

  • osteoporosis, or weakening of the bones
  • heart disease
  • weight gain
  • loss of muscle mass
  • vaginal dryness
  • a reduction in the size of the vagina and urinary tract, or urinogenital atrophy

Falling estrogen and progesterone levels can trigger some of these changes, but aging may also play a role.

At-home, over-the-counter (OTC), and medical treatments can help manage the physical and mental impact of menopause.

Help for hot flashes

Hot flashes result when hormonal factors affect the circulatory system. These are known as vasomotor symptoms.

Some ways of managing them include:

  • avoiding triggers, such as spicy foods, hot drinks, and overheated rooms
  • breathing deeply and slowly
  • wearing loose-fitting, layered clothing that is easy to remove
  • keeping a fan nearby, especially at night
  • drinking cold liquids when a hot flash occurs

If hot flashes occur, they usually continue for 1–2 years, but they can last for 10 years or longer. Without treatment, they can last for 7.4 years, on average. For some females, they will never go away.

Oral birth control pills

Irregular periods, heavy bleeding, and cramping are common during perimenopause. Taking a low-dose oral birth control pill may help manage this.

According to one 2018 review, taking combined oral birth control pills may also help reduce the risk of:

  • irregular periods
  • heavy bleeding during menstruation
  • vasomotor symptoms, such as hot flashes
  • ovarian, endometrial, and colorectal cancers

However, there is some evidence to suggest that these may slightly increase the risk of breast cancer, blood clots, and heart attack.

Females can ask a healthcare professional about suitable options.

Medical treatments

Hormone therapies can help some females manage hot flashes and other symptoms. These may contain estrogen, progestin, or a combination of these hormones. Some options combine estrogen with other drugs.

Hormone treatment is available in the form of pills, patches, vaginal rings, sprays, and more.

A healthcare professional will look at the female’s medical history and their symptoms to help them decide if hormone treatment is suitable for them. They will offer the lowest possible dose because hormone treatment can have adverse effects.

For example, it may increase the risk of blood clots, liver problems, and some types of cancer. Minor adverse effects include headaches, painful breasts, and fluid retention.

Postmenopause management

In most cases, the discomfort of menopause will resolve in time. However, some challenges may remain.

Some tips for staying healthy during postmenopause include:

  • getting regular exercise
  • avoiding or quitting smoking
  • consuming a nutritious and varied diet
  • attending regular health checkups

For specific problems, such as vaginal dryness, OTC treatments may help. If not, a healthcare professional may prescribe or recommend an alternative.

Healthcare professionals can also advise on supplements, dietary measures, and lifestyle choices to help manage these risks as a female moves beyond menopause.

Can vitamins help during menopause? Learn more here.

Perimenopause refers to the time before menopause, when hormone changes start to occur but menstruation is also still occurring. When perimenopause ends, menopause occurs and postmenopause follows.

The literal meaning of premenopause is “before menopause,” but this is not an accepted medical term.