Perimenopause vs menopause: what's the difference?
Short answer
Perimenopause is the transition: the years when your hormones swing and your periods start to change. Menopause is a single point in time, confirmed once you've gone 12 months in a row without a period. Everything after that point is postmenopause.
The average age of menopause is 51, and perimenopause usually starts several years before that, often in your 40s. So if you're still getting periods, even irregular ones, you're not in menopause yet.
On this page
The three stages at a glance
| Stage | What's happening | Your periods | Typical timing |
|---|---|---|---|
| Perimenopause | Estrogen from the ovaries starts to fluctuate and ovulation becomes less regular. | Cycles get shorter or longer, flow gets heavier or lighter. Later, periods are skipped. | Often begins in the 40s. Lasts about 4 years on average, and can run up to 8. |
| Menopause | One point in time: the date that marks 12 months since your final period. | None for 12 consecutive months. | Average age 51. |
| Postmenopause | Life after that point. Estrogen stays low. | None. Any bleeding now needs checking. | The rest of your life. Some symptoms, like hot flashes, can continue for years. |
How periods change through perimenopause
Your cycle is the clearest clue. Early in perimenopause the changes are often subtle. It's common for cycles to get a little shorter, and bleeding can be lighter or heavier than you're used to. As the transition goes on, cycle length can vary by 7 days or more from one month to the next. In the late transition, gaps of 60 days or more between periods become common.
Clinicians use a staging system called STRAW+10 to describe this. It defines the early and late transition mainly by bleeding patterns, which is why our quiz asks about your periods before anything else.
How to tell which one you're in
- Still having periods, even irregular ones? That points to perimenopause.
- No period for 12 months in a row? You've reached menopause, and from here you're postmenopausal.
- Can't tell because of an IUD, an ablation or a hysterectomy? Your cycle can't guide you, so age and symptoms carry more weight. The quiz has a dedicated answer for this, and a doctor can help.
A single hormone blood test often can't settle it. In perimenopause the ovaries release hormones erratically, so levels swing from day to day (see our guide to at-home hormone tests).
Symptoms: lots of overlap, a few differences
Hot flashes and night sweats are the most commonly reported symptoms of the transition. One large US study found that up to 80% of women experience them at some point. Sleep problems, mood changes and heavier or unpredictable bleeding are common in perimenopause too. Some women notice only a few mild symptoms, and others have many that are severe.
Some changes tend to show up later. Vaginal dryness and irritation (the genitourinary syndrome of menopause) often isn't a problem during perimenopause and may not become one until several years after menopause. Bone loss speeds up in the first 4-8 years after menopause because estrogen is lower.
Hot flashes don't necessarily stop at menopause. In the SWAN study of more than 3,000 women, frequent hot flashes or night sweats lasted a median of 7.4 years in total and continued a median of 4.5 years after the final period. Women whose symptoms started early in the transition tended to have them longest.
Can you still get pregnant?
Yes. Even when cycles are irregular, pregnancy is still possible in perimenopause. If you don't want to get pregnant, The Menopause Society advises using birth control until menopause is confirmed, 12 months after your final period.
Treatment works in both stages
Hormone therapy is effective for bothersome hot flashes and night sweats in both perimenopause and after menopause. If you still have a uterus, estrogen is paired with a progestogen to protect its lining. Non-hormonal options exist too. See Which type of HRT is right for you? and non-hormonal options.
When to see a doctor
- Any bleeding after 12 months without a period.
- Very heavy bleeding, bleeding between periods or bleeding after sex. Changes in bleeding are common in perimenopause, but they're still worth reporting because abnormal bleeding can signal another problem.
- Symptoms that are disrupting your sleep, work or relationships. You don't have to wait them out.
Frequently asked questions
What age does perimenopause start?
Estrogen levels usually start to fluctuate in your 30s and 40s, and most women notice changes in their 40s. The average age of menopause itself is 51.
How long does perimenopause last?
About four years on average, but it can last up to eight. Some people pass through in a few months.
I haven't had a period in 6 months. Is that menopause?
Not yet. Menopause is confirmed at 12 months. Gaps of 60 days or more are typical of late perimenopause, and periods can come back.
Do hot flashes stop once I reach menopause?
Often not straight away. In SWAN, frequent hot flashes continued a median of 4.5 years after the final period.
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Sources
- American College of Obstetricians and Gynecologists. The Menopause Years (patient FAQ).acog.org
- The Menopause Society. Perimenopause (patient education).menopause.org
- Cleveland Clinic. Perimenopause: Age, Stages, Signs, Symptoms & Treatment.my.clevelandclinic.org
- Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539.pubmed.ncbi.nlm.nih.gov - 2015
- Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10). J Clin Endocrinol Metab. 2012;97(4):1159-68.pubmed.ncbi.nlm.nih.gov - 2012
Keep reading
- SymptomsIs irregular periods a sign of perimenopause?
- SymptomsPerimenopause symptoms by age: 40, 44, 47 and 50
- SymptomsWhy perimenopause causes hot flashes
- Hormone therapyDoes progesterone help you sleep in perimenopause?