Perimenopause vs menopause comes down to timing. Perimenopause is the transition, often lasting several years, when periods become irregular and symptoms like hot flashes may start. Menopause is the point when you have gone 12 months in a row without a period. After that you are postmenopausal. Menopause usually happens between ages 45 and 55.
This is general information, not medical advice. Talk to your doctor or pharmacist about your own situation.
Perimenopause is the time leading up to menopause, also called the menopausal transition. The NHS describes it as the stage when your periods become irregular. Symptoms often begin here, and you can still get pregnant.
Menopause is your final menstrual period. The Menopause Society says it can be confirmed after 12 months in a row without a period, and the NHS adds that this applies when you are not using hormonal contraception. Mayo Clinic counts any vaginal bleeding or spotting, too.
Postmenopause is the span of time after menopause.
Because menopause is defined by a year with no periods, you only know you have reached it looking back. The National Institute on Aging (NIA) notes that many people call the whole transition "menopause," but true menopause cannot be confirmed until a year after the final period. For the same reason, The Menopause Society's technical definition stretches perimenopause to one year after the last period. It also points out that perimenopause only happens with natural menopause, not with menopause caused by surgery or cancer treatment.
When the transition starts. The NIA says most women begin the menopausal transition between 45 and 55, and that it may last several years. It usually starts with changes to your menstrual cycle.
Average age at menopause. In the U.S., Mayo Clinic gives the average age as 51 and the NIA gives 52. Either way, the normal range is wide.
Early menopause. The NHS says early menopause or premature ovarian insufficiency can happen before 45. The Menopause Society defines premature menopause as menopause at or before age 40, and Mayo Clinic says about 1% of people reach menopause before 40.
Menopause after surgery or treatment. Menopause can also be induced, when both ovaries are removed or damaged by cancer treatment. The NIA notes that after surgery to remove the ovaries, without hormones, periods stop and symptoms may start right away.
How long symptoms last. Estimates vary. The NIA says symptoms can last between two and eight years. The NHS says they usually last 7 to 9 years, sometimes longer, and can change along the way.
Symptoms do not switch off on a set date. The NHS says they can happen during perimenopause and menopause and can continue afterward. Some people barely notice them, while for others they have a big impact on work, family life and relationships.
Common in perimenopause
Period changes, often the first sign. Periods may come more or less often, get heavier or lighter, or be shorter or longer.
Hot flashes and night sweats, among the most common symptoms. The NIA says most hot flashes last between 30 seconds and 10 minutes.
Sleep problems, which may be worse with night sweats.
Mood changes, memory problems and brain fog.
Vaginal and bladder changes, such as dryness, more UTIs or needing to pee more often.
Other changes listed by the NHS, including palpitations, worse headaches, joint and muscle aches, and weight gain around the stomach.
After menopause
Periods have stopped. Any vaginal bleeding after 12 months without a period needs checking.
Hot flashes can carry on. The NIA says that for many women they last for many years after menopause.
Some symptoms, such as joint pain and vaginal dryness, can continue, according to the NHS.
Long-term health risks change. The NIA says women become more vulnerable to heart disease, stroke and osteoporosis after menopause, and recommends a healthy diet, staying active, and enough calcium and vitamin D.
The NHS says there is no routine test for perimenopause or menopause, and a doctor may diagnose it based on your age and symptoms. The NIA adds that it can be hard to tell, so your doctor may ask about your age, symptoms and family history. In some cases, for example if your periods stopped at an early age, they may suggest a blood test to check hormone levels.
Hormonal contraception can blur the picture. The NHS explains that the progestogen-only pill, the hormonal coil (IUS), the implant and the injection can make periods irregular or stop them, while the combined pill causes monthly bleeds for as long as you take it. A doctor can help you work out the right contraception for your age and stage.
A clear record of your periods and symptoms makes the conversation easier. Our guide to perimenopause symptoms to track covers what to write down before an appointment.
You do not have to wait until symptoms are severe. The NHS says to contact a GP if you think you have symptoms and want to know your options, and that early advice can help reduce the effect on your health, relationships and work. Also see a doctor if:
your periods come very close together, last more than a week, or the bleeding is heavy
you bleed or spot after sex or between periods
you still have periods but are bleeding more, not less, than before
you notice a faster or more noticeable heartbeat than usual (palpitations)
you have any vaginal bleeding after 12 months without a period, even if it happened once or was only spotting
your periods change or stop, or you get menopause symptoms, before 45
moodiness, irritability or low mood is affecting you. The NIA suggests talking with your primary care provider or a mental health professional, and says treatments are available.
The NHS says bleeding after menopause is not usually serious, but it can be a sign of cancer, which may be easier to treat when found early. Mayo Clinic says to see your healthcare professional as soon as you can if it happens, and to keep up wellness visits before, during and after menopause.
If you still have periods, even irregular ones, you have not reached menopause yet. Once you go 12 months in a row without a period, and you are not using hormonal contraception, you have reached menopause. A doctor can help if it is unclear.
Yes. The NHS says you still need contraception for 1 year after your final period if you are 50 or over, and for 2 years if you are 40 to 49. Ask your doctor what applies to you.
Not always. The NHS says some symptoms, such as joint pain and vaginal dryness, can continue, and the NIA says hot flashes last for many years after menopause for many women.
About 51 to 52 in the U.S., according to Mayo Clinic and the NIA. The NHS says it usually happens between 45 and 55. Menopause at or before 40 is considered premature.
My Midlife Story: Menopause is a symptom journal for iPhone and iPad, made for anyone going through perimenopause or menopause. You can log symptoms such as hot flashes, night sweats, sleep and brain fog with one tap, each saved with the date and time, mark "Something changed" when a symptom or treatment shifts, and filter your notes by the last 7, 30 or 90 days or a year.
Before an appointment, it can turn chosen notes and questions into a one-page visit brief you can edit, print or save as a PDF. It does not diagnose or recommend treatment. There is no account and no ads, your records stay on your device, and it is free with an optional Premium upgrade.
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