Perimenopause or Menopause – What's the Difference?
The terms perimenopause and menopause are often used interchangeably, as if they are the same thing. But in actuality, they are not. Biologically speaking, perimenopause and menopause each have a unique hormonal landscape and health experience.
It’s also very important that you understand the differences. Because what your body may need during perimenopause is entirely different than what it may need during menopause. But if you didn’t know that, don’t worry. A lot of people don’t, and there was a time when I didn’t either.
Perimenopause – "Around the time of"
The prefix ‘peri’ is of Greek origin, for all of you language wonks out there, and it means ‘around.’ Attach the prefix ‘peri’ to the word ‘menopause’ and it literally means: around the time of menopause.
Actual menopause occurs when a woman has gone 12 consecutive months without a menstrual cycle. The bumps in the road along the way to menopause – hot flashes, night sweats, and mood swings – are the symptoms of peri-menopause. Unfortunately, there is no definitive line of demarcation separating perimenopause from menopause. They overlap and one segues into the other. The difference is probably best understood in terms of symptoms.
Perimenopause – Caution: Storms Ahead
For a majority of women, the hormones estrogen and progesterone begin to fluctuate ever so slightly around the ages of 35 to 40; though any symptoms are generally subtle and not unusually turbulent or erratic. You might skip a period, maybe even two. But then resume normal cycles again for another year or longer.
You may notice that a cycle is longer or shorter than usual. Perhaps your flow is heavier, or lighter, even scant. You might become more moody than usual around the time of your period; agitated, irritable, melancholy, or depressed.
You could also experience, entirely unbeknownst to you, anovulatory cycles - normal menstrual cycles where you do not ovulate; and which by the way, is also one of the reasons that many women begin to experience fertility problems around the ages of 35 to 40.
Usually, women begin to notice perimenopause symptoms around the ages of 43 to 47. The hormone fluctuations are more pronounced, causing women to complain about hot flashes, night sweats, and crazy mood swings.
They may also experience anxiety and panic attacks, insomnia, heart palpitations, and even vertigo. Crashing fatigue, exhaustion, vaginal dryness, and loss of libido are also common complaints of women in the throes of perimenopause.
Emotionally, you may feel drained, overwhelmed, and out of control. The emotional swings during perimenopause can be so dramatic for some women, that it’s also not unusual for them to wonder if they are going crazy.
Menopause – The Safe Harbor
The entire transition from perimenopause to menopause takes approximately 5 to 12 years; however, the intensity of the symptoms of perimenopause usually begins to wane after a couple of years or so. Personally, I like to think of perimenopause as riding an intense hormonal wave over a choppy, turbulent sea. In time, the waters become less volatile and bruising, allowing you to glide ashore into the safe harbor of actual menopause.
The difference in how women feel once they reach menopause compared to the years of perimenopause is quite remarkable. A sense of normalcy and emotional stability returns. Instead of feeling vulnerable, overwhelmed, and out of control, most women in menopause feel much more calm, centered, and energetic.
Much of this is due to the fact that estrogen levels have settled into a new normal, and as a result, testosterone levels are higher. Once a woman’s testosterone is no longer mitigated by her estrogen, she often manifests decidedly more male traits, such as a focused and energetic self-confidence. It is not unusual for women in menopause to become more outspoken, assured, and downright formidable. It is also not unusual for them to take up new career paths or new life challenges.
But low estrogen levels in menopause can also bring unique health issues as well. Women in menopause are at a higher risk of osteoporosis, heart disease, or stroke. Depression is also common for women in menopause, along with a lagging libido, hot flashes and night sweats, though not as intense as during perimenopause.
A lot of women choose hormone therapy during both perimenopause and menopause to balance their hormones and help with their symptoms. Choosing hormone therapy is a highly individual and personal choice that comes with both health benefits and risks.
If you are in perimenopause or menopause and considering hormone replacement therapy, it is vitally important that you understand both the risks and benefits, and that you make the decision under the care and guidance of your physician.