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What is the difference between perimenopause and menopause?


Many women notice changes in their bodies as they approach midlife, but it’s not always clear what is happening and why. Two terms you often come across are perimenopause and menopause. While many people use the word menopause most often, this is the actual difference between perimenopause and menopause and symptoms and changes that occur.


What is Perimenopause? 

Perimenopause is the transitional period leading up to menopause. It typically begins in a woman’s 40s, though it can start earlier or later. During perimenopause, our ovaries produce less estrogen and progesterone, the hormones responsible for regulating your menstrual cycle and many other processes in the body. The amount of hormones in your body can fluctuate a lot and therefore you can also experience fluctuations in symptoms.

This hormonal shift can cause irregular periods, changes in mood, and physical symptoms. Perimenopause can last anywhere from several months to up to 10 years, so it’s a gradual transition rather than an overnight change.


How Hormones Change During Perimenopause and Menopause 

During perimenopause and menopause, several key hormones change: Estrogen – Estrogen levels fluctuate and eventually decline. Progesterone – Progesterone declines earlier than estrogen. Testosterone – Levels gradually decline


These hormones affect things like:

  • Menstrual cycle regularity 

  • Vaginal and urinary tract health 

  • Bone density 

  • Cardiovascular health 

  • Brain function and mood regulation 

  • Irregular periods 

  • Sleep disturbances 

  • Water retention or bloating 

  • Libido and sexual function 

  • Muscle mass and strength 

  • Mood and energy 


FSH and LH – Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) rise as the ovaries produce fewer sex hormones.


Can I do a FSH test and see if I am in perimenopause or menopause? FSH tests aren’t very informative once a woman reaches her mid-40s and her menstrual cycles start to become irregular. The National Institute for Health and Care Excellence (NICE) emphasizes that FSH testing isn’t required to diagnose menopause in women over 45. There are good reasons for this: During perimenopause, hormone levels fluctuate widely. One month your FSH may appear within the normal range, and the next month it could be elevated. This variability means that a single test result doesn’t provide a reliable picture.


Cortisol and stress hormones – Hormonal changes can affect the stress response, sometimes amplifying symptoms like hot flashes, fatigue, digestive issues, and emotional sensitivity.

These shifts explain why symptoms vary widely from woman to woman and why digestive issues, sleep problems, mood changes, and hot flashes are common.


What is Menopause? 

Menopause is officially defined as the point in time when a woman has not had a menstrual period for 12 consecutive months. This marks the end of reproductive fertility. By menopause, the ovaries have largely stopped producing estrogen and progesterone.

The symptoms that started in perimenopause may continue during menopause, but they often stabilize over time. Menopause usually occurs around age 51 on average, though there is wide variation.


Common Symptoms 

Hormonal changes during perimenopause and menopause can impact many areas of life. Symptoms vary from woman to woman, and some may experience only a few, while others experience many. The intensity of symptoms can vary a lot as well. There are more than 30 symptoms of perimenopause and menopause. Here are some common ones: 


Physical symptoms: 

  • Hot flashes and night sweats 

  • Irregular periods or skipped cycles 

  • Vaginal dryness 

  • Sleep disturbances 

  • Fatigue and low energy 

  • Weight changes, especially around the abdomen 

  • Joint and muscle aches 


Emotional and cognitive symptoms: 

  • Mood swings 

  • Irritability or anxiety 

  • Low motivation 

  • Brain fog or difficulty concentrating 

  • Reduced memory clarity 


Digestive and metabolic changes: 

  • Bloating and digestive discomfort 

  • Changes in appetite

  • Altered metabolism 

  • Gut sensitivity, sometimes worsening IBS symptoms


Other impacts: 

  • Changes in libido 

  • Hair thinning and skin changes 

  • Changes in bone density (osteoporosis risk) 

  • Cardiovascular health shifts 



Supporting Your Body and Mind 

During perimenopause and menopause, your body and mind benefit from a holistic, supportive approach rather than only looking at isolated problems. That is what I do with the Eat Grow Flow method:


EAT – Learn how to nourish your changing physiology instead of fighting it. This includes adapting meals to support your new needs, adjusting specifically for problems you may have, and create stable energy throughout the day. Focus needs to be on what is on your plate rather than cutting things out without strategy.


GROW – Transform your relationship with yourself. Learn about the internal and emotional shifts happening during this stage and turn that awareness into the ability to make intentional changes that you need.


FLOW – Here we take the knowledge and start acting with purpose in a way that works for you. Build practical habits, routines, and strategies that fit your life while easing symptoms and improving overall wellbeing.

With Eat Grow Flow, small, consistent changes in nutrition, mindset, and daily habits can make a big difference in how you feel physically and emotionally during this transitional period. 





References:  American Society for Reproductive Medicine. (2023). Menopausal transition (perimenopause): What is it? ReproductiveFacts. https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/menopausal-transition-perimenopause-what-is-it/  

Burger, H. G., Hale, G. E., Dennerstein, L., & Robertson, D. M. (2008). Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause, 15(4), 603–612. https://doi.org/10.1097/gme.0b013e318174ea4d  

Pinkerton, J. V. (2023). Menopause. In MSD Manual Consumer Version. https://www.msdmanuals.com/home/women-s-health-issues/menopause/menopause  

 
 
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