Perimenopause vs. menopause: how to know the difference
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, MBA
Wondering if you’re in perimenopause or menopause? We’ll help you decode the signs and symptoms of each, and share 12 tips to care for yourself through every change.
You’ve probably heard the term “menopause,” and maybe you even know what it means. But how about “perimenopause”? Maybe — but maybe not.
Like a lot of women’s health topics, they don’t tend to get much airtime, and when they do, it’s often with hushed tones and a bit of embarrassment. The result? Many people are left to quietly piece things together on their own — or suffer in silence.
Let’s change that.
Perimenopause and menopause are two transition periods, and while both of them involve sleep disruptions, changes in libido, mood changes, and hot flashes, they’re distinct phases with different timelines, symptoms, and needs. And no, they’re nothing to be embarrassed about.
If you’re experiencing perimenopause or menopause, or you’re just curious about them, here’s everything you need to know.
Perimenopause vs. menopause
Many people use the term “menopause” to describe the entire experience of slowly not having a period anymore. But perimenopause and menopause are two distinct stages — even if some symptoms overlap.
The main difference between the two comes down to timing and what’s happening with your hormones.
Perimenopause is the transition stage leading up to menopause. During this time, your estrogen and progesterone levels fluctuate. This is when most of the hallmark symptoms—hot flashes, mood swings, and skipped periods—start to show up. This can last a few years or more than a decade.
Menopause, on the other hand, happens when you haven’t had a period for 12 consecutive months. It’s specifically a single point in time that marks the end of your reproductive years. After that, you’re in postmenopause, where hormone levels settle into their new normal.
What is perimenopause?
Perimenopause is basically your body’s hormonal warm-up to menopause. It’s unpredictable, often drawn-out, and different for everyone. Typically, it starts in your 40s, but for some, it can begin earlier.
During this time, your ovaries gradually produce less estrogen and progesterone, which can lead to noticeable shifts in how you feel both physically and emotionally.
Here are some common symptoms of perimenopause:
Irregular or skipped periods
Heavier or lighter menstrual flow
Hot flashes and night sweats
Mood changes (irritability, anxiety, depression)
Sleep disturbances or insomnia
Brain fog or forgetfulness
Vaginal dryness or discomfort during sex
Changes in libido
Breast tenderness
Weight gain or shifting body composition
Fatigue even after a full night’s rest
What is menopause?
Menopause is the specific moment when you’ve gone 12 straight months without a period. It’s a single marker that signals your reproductive years have ended. This is officially when estrogen and progesterone levels settle into a new, consistently lower rhythm.
Here are some of the more common symptoms of menopause:
Persistent hot flashes or night sweats
Sleep disruptions or insomnia
Vaginal dryness or pain during sex
Decreased libido
Thinning hair or dry skin
Mood swings or increased anxiety
Memory issues or brain fog
Slower metabolism or weight gain
Joint aches or stiffness
Increased risk of osteoporosis or heart disease
It’s important to note that not everyone has every symptom, and that for many, the intensity lessens over time. Also, lower estrogen levels can still affect your health long after your last period, especially in areas like bone density and heart function.
How to know what stage you’re at
It’s not always easy to figure out if you’re in perimenopause, menopause, or postmenopause. To help you understand exactly what stage you’re at, pay attention to what your body’s telling you.
Start by tracking your symptoms, cycles, emotional changes, and physical symptoms. You could do this in your notes app or period tracker. Also ask yourself:
Has my period changed? Irregular timing, skipped months, or changes in flow often signal perimenopause. If it’s been 12 months without a period, you’re in menopause.
Am I noticing new symptoms? Hot flashes, sleep disruptions, mood swings, or sudden fatigue could mean your hormones are shifting.
Are my symptoms becoming more stable? Postmenopause symptoms typically mellow out, though some, like vaginal dryness or low libido, could persist.
If your experience doesn’t match textbook definitions, that’s completely fine. There’s no perfect formula — only your lived experience.
How to manage the symptoms of perimenopause and menopause: 12 tips to help you thrive
Symptoms of perimenopause and menopause can change the course of your day — and maybe even make you forget your own PIN number. But thankfully, there are simple ways to manage these side effects.
Here are 12 tips to help you feel better.
1. Track your symptoms and cycle patterns
Start with awareness. Use a journal or a cycle-tracking app to log changes in:
Periods (timing, flow, missed cycles)
Sleep quality
Mood
Energy levels
Physical symptoms (hot flashes, headaches, etc.)
Tracking symptoms can help you and your doctor make sense of what’s going on with your body.
(Here are six other ways to help improve your awareness if this isn’t your strong suit.)
2. Prioritize rest
Rest is recovery and helps give your nervous system time to downshift.
Take naps regularly if your schedule allows.
Try a 10-minute body scan or guided meditation.
Go on a break from your screens for 30 minutes and walk around your neighborhood.
💙 Prioritize your recovery time by listening to Rest with Tamara Levitt.
3. Keep it cool (literally)
Hot flashes and night sweats can feel like your body is staging a protest. Here are some cooling strategies that can help:
Sleep in breathable fabrics like cotton.
Use moisture-wicking sheets or cooling pillows.
Keep a fan nearby.
Try layering lightweight clothing you can take off throughout the day.
4. Move your body
Gentle movement can help regulate your mood, support your bone health, and ease joint pain.
Try yoga, swimming, dancing, or strength training with light weights.
If motivation is tough, commit to just five minutes. Usually that’s more than enough to shift your state.
(Here are seven other easy movement exercises that can get your blood flowing.)
5. Nourish without punishment
Fuel your body with what helps you feel steady and strong throughout the day.
Focus on fiber, protein, and healthy fats to stabilize energy and mood.
Dark leafy greens, fortified plant milks, and salmon can all help protect your bones.
Hormonal shifts can increase bloating and dryness, so stay hydrated.
💙 Heighten your awareness at meal time by listening to Tamara Levitt’s Mindful Eating series.
6. Be mindful of alcohol and caffeine
Caffeine and alcohol can both intensify hot flashes and worsen sleep. To make it easy on yourself, try:
Experimenting with cutting back gradually
Drinking alcohol-free alternatives or herbal teas like chamomile
7. Support your mental health
Mood changes during perimenopause and menopause are real and very common. Get support by:
Talking to a therapist who understands midlife hormonal shifts
Journaling to help offload stress and clarify emotions
Practicing guided meditations to help reset your perspective
Also, if you’re struggling with anxiety or depression, reach out for help. You don’t have to go through it alone. (Here are 12 tips to help you cope if you’re dealing with depression right now.)
8. Explore hormone therapy (HT) or non-hormonal options
Not everyone needs or wants hormone therapy, but for some, it can be life-changing. Reach out to a healthcare provider who specializes in menopause to explore safe and personalized options. They may recommend:
Estrogen therapy, which can reduce hot flashes and prevent bone loss
Non-hormonal prescriptions (like SSRIs or gabapentin), which can help you manage certain symptoms
9. Care for your pelvic and sexual health
Lower estrogen levels can lead to vaginal dryness, discomfort, or urinary changes. To feel better, consider trying:
Using water-based or silicone-based lubricants for comfort during intimacy
Vaginal moisturizers for regular hydration
Pelvic floor physical therapy to help with urinary support
10. Build your support system
Hearing, “Oh my god, me too” can really help ease the weight of isolation.
Find a friend to talk honestly about what’s happening to your body.
Join a virtual menopause support group or a local community.
If you have a partner, include them in the conversation so they can understand what you’re going through.
11. Advocate for yourself in healthcare settings
Too many people are dismissed or misdiagnosed during perimenopause. If your doctor isn’t listening, it’s okay to seek a second opinion.
Ask direct questions like: “Could this be related to perimenopause?” and “What treatment options are available to me?”
Look for practitioners who are menopause-certified or well-versed in this topic.
12. Show yourself radical compassion
Your body’s navigating a profound transition, so practice radical self-compassion.
Make things as easy on yourself as you can. During this time, it’s more than okay to say no to extra obligations, and to order take out instead of make dinner.
Perimenopause vs menopause FAQs
At what age do perimenopause and menopause happen?
Most people enter perimenopause in their 40s, but for others, it happens in their mid-30s. It’s different for everyone, and genetics can play a role. If your mother or older sister entered perimenopause early or late, you might follow a similar trajectory.
Menopause usually occurs between ages 45 and 55, with the average age in the U.S. being 51. Some people do reach menopause earlier due to genetics, health conditions, or surgical interventions like a hysterectomy.
What’s the first sign of perimenopause?
For many, the first sign is a change in their menstrual cycle, especially if it’s consistently off by seven or more days. Other symptoms include mood changes, anxiety, disrupted sleep, or sudden hot flashes.
Many people are caught off guard because these changes can feel subtle at first or get misattributed to stress or aging. If you’ve been feeling “off” for weeks or months now, especially around your cycle, perimenopause just might be the reason.
Can you get pregnant during perimenopause?
You can still get pregnant during perimenopause, as you’re still ovulating.
If you don’t want to become pregnant, continue using contraception until you’ve gone a full 12 months without a period. If you’re trying to conceive during perimenopause, talk to a doctor, as more planning and medical guidance may be needed.
How do you know if it's perimenopause or menopause?
The clearest marker is your menstrual history. If you’re still getting your period, even if it’s spaced out, you’re most likely in perimenopause. Once you’ve gone 12 consecutive months without a period, you’ve reached menopause.
That said, the symptoms like hot flashes and mood swings can overlap, which is why it’s helpful to track your cycle over time.
How long do menopause symptoms last?
For some people, menopause symptoms like hot flashes, night sweats, and mood swings taper off a year or two after menopause. For others, they can last up to 10 years or more.
Also, certain symptoms like vaginal dryness or changes in your bone density may become more noticeable in postmenopause. It’s also pretty common for symptoms to ebb and flow rather than disappear completely.
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