Perimenopause, Menopause & Premenopause: Explained

From your first period to your last, your body goes through several hormonal phases — and terms like perimenopause, menopause, and premenopause describe different stages in that journey. Knowing what each one means can help you understand the changes you’re experiencing now or might face in the future. 

Understanding the female reproductive timeline

Premenopause, perimenopause and menopause, these three phases mark key milestones in the reproductive timeline of a woman’s life. These terms are often used interchangeably, but technically, all of them hold different meanings. 

The female reproductive timeline is not only biologically unique but also symbolically rich, representing the phenomenon of energy, creation and wisdom. Here’s a breakdown of each phase:

• Premenopause begins with puberty, usually between the ages of 12-16 years. This is when ovulation starts, and if the egg released is not fertilised, it sheds along with the uterus lining, resulting in menstruation. This stage marks the arrival of a woman’s reproductive years. 

• Perimenopause is the transitional phase that usually begins in the mid-40s, when the oestrogen levels start fluctuating. These hormonal changes lead to disruptions in menstrual cycles, along with other debilitating symptoms of perimenopause like hot flashes, mood swings and poor sleep. This phase is a gradual process, and not something that takes place overnight. During perimenopause, oestrogen levels fluctuate unpredictably — at times even rising above normal before their eventual decline — while follicle-stimulating hormone (FSH) steadily increases.

• Menopause is officially diagnosed when a woman has gone 12 consecutive months without a single menstrual period. It is not a transitional phase, but a point in time, marking the end of fertility. At menopause, levels of both oestrogen and progesterone stay low, while androgens decrease at a slower pace, leading to a “relative androgen excess” that may cause acne or increased facial hair.

What is premenopause?

Premenopause refers to the time frame between menarche (the emergence of menstrual cycles) and menopause. The prefix “pre” means before, and in this context, it refers to the years before menopause hits, when no symptoms of perimenopause or menopause are typically visible. 

A person is considered premenopausal when they are in their fertile years, experiencing regular periods and are at their peak of reproductive function. This phase does not involve the classic symptoms of menopause or perimenopause, like 

• Night sweats
• Irregular periods
• Hot flashes
• Vaginal dryness 
• Brain fog

What is perimenopause, and when does it start?

Perimenopause is the transitional phase in the reproductive timeline leading up to menopause. The prefix ‘peri’ means around, signifying that this phase begins around menopause, the point in time marking the end of fertility. 

It’s highly probable that you’ll often know when perimenopause has hit you, the oestrogen levels drop significantly, leading to irregularities in your menstrual cycles and a host of other classic symptoms of perimenopause, such as:

• Shorter or longer periods
• Heavier or lighter bleeding
• Hot flashes
• Night sweats
• Fatigue
• Increased urinary sensitivity
• Brain fog 
• Vaginal dryness

The perimenopausal journey of every woman is different from that of another. Some women may experience mild discomfort, while others may face disruptive symptoms. Perhaps, tailoring your treatments and lifestyle habits to your unique needs is essential. 

It is also important to note that certain symptoms of perimenopause mirror those of menopause, so determining where exactly you stand in the transition can feel a bit tricky, especially without any medical guidance. 

What happens during menopause?

Menopause is when periods stop coming entirely. It is the natural and permanent end of menstruation, typically occurring between the ages of 45 and 55. This phase is officially diagnosed when a woman has gone 12 consecutive months without a menstrual period, devoid of any medical conditions. 

During this phase, your ovaries stop releasing eggs and the oestrogen production becomes dormant, while the androgen levels (male sex hormones) become relatively more dominant. This hormonal shift can lead to many symptoms of menopause such as: 

• Extreme mood disorders
• Brain fog or forgetfulness
• Elevated cholesterol levels 
• Decreased bone density
• Trouble sleeping 

Early menopause, including surgical menopause before the age of 45, raises the risk of osteoporosis, cardiovascular disease, and metabolic syndrome due to a longer duration of oestrogen deficiency.

Key differences and common symptoms between premenopause, perimenopause, and menopause

While menopause is widely associated with the reproductive timeline, the end of fertility and menstrual cycles, many distinct stages in and around menopause need to be recognised and understood. 

Here is a breakdown of the key differences and common symptoms between premenopause vs perimenopause vs menopause: 

1. Premenopause

• This phase defines the reproductive years, when a woman experiences regular menstrual cycles. 

• The prefix “pre” means before, determining that premenopause occurs years before menopause sets in. 

• It typically presents no symptoms associated with perimenopause or menopause. 

2. Perimenopause

• This is a natural transitional phase leading up to menopause. 

• It is characterised by a significant drop in oestrogen and progesterone levels. 

• These hormonal fluctuations lead to an array of typical perimenopause symptoms like hot flashes, night sweats, disruptive menstrual cycles, mood swings and low energy levels. 

• Perimenopause typically begins in the late 30s or early 40s and can last from several months to up to four years (or longer in some cases).

3. Menopause

• This isn’t a transitional month; it is a significant point in time, determining that the reproductive years have come to an end. 

• It is typically validated when a woman has no menstrual periods for 12 consecutive months. 

• The oestrogen levels drop significantly, leading to a hormonal rollercoaster of ups and downs, and triggering a range of emotional and physical symptoms. 

• Symptoms of menopause include extreme mood disorders, anxiety, depression, elevated cholesterol levels, hot flashes, decreased bone density, vaginal dryness and insomnia.

How to know which stage you're in?

Since there is often ambiguity between the symptoms of perimenopause, menopause and premenopause, there is no single definitive way to know which stage you are in. The only reliable indicator tends to be your menstrual cycle. 

• When you start menstruating, it marks your blossoming into womanhood, the beginning of premenopause (the fertile years). 

• When your hormones start fluctuating and your periods become irregular between the ages of 35 and 40, you may have entered the perimenopausal transitional stage. 

• When you go 12 consecutive months without a single menstrual period, it signals that you’ve reached menopause, the end of your reproductive years. 

However, it is important to understand that the process is not always linear. Some may go several months without a single period, only for it to make a comeback unexpectedly, and sometimes even more frequently than before. The cycles can become very sporadic and unpredictable. 

When symptoms become disruptive or very difficult to manage, it is always recommended to consult a healthcare professional to help you assess your hormonal health and guide you through the journey. 

The final takeaway

Premenopause, perimenopause and menopause are all natural stages in the empowering journey of womanhood. There is no denying that certain symptoms of perimenopause and menopause may herald unwelcome changes, but it is important to remember that not all aspects of these transitional phases are negative. With the right support, including a balanced diet, healthy lifestyle choices, and a resilient mindset, women can navigate this phase with strength, grace, and a focus on both physical and mental well-being.

Frequently Asked Questions

1. What are the common symptoms of perimenopause?

Perimenopause symptoms can vary from woman to woman, but some of the most common include irregular periods, hot flashes or night sweats, mood swings or increased irritability, and sleep disturbances.

2. How do I know if I’m in menopause or just perimenopausal?

If you’re still getting periods even if they’re irregular, you’re likely in perimenopause. Menopause is confirmed only after 12 months without a menstrual period. 

3. Can symptoms start even if I still have regular periods?

Yes. During early perimenopause, hormone levels may fluctuate even while cycles remain regular. You might start noticing subtle symptoms like mood changes, breast tenderness, or sleep issues.