What you’ll learn
We’ll cover the difference between perimenopause and menopause, what symptoms to expect during each stage of the transition, and strategies for managing the mental and physical changes you’ll experience.
Has your period become unpredictable? Are hot flashes stealing sleep from you every week? If you’re wondering if it’s menopause, perimenopause, or how to even tell them apart, you aren’t alone.
Understanding which phase you’re in will help you know what’s normal and which treatment options might work best for you. We’ll walk you through the differences between perimenopause and menopause, what symptoms you can expect during each phase, and practical methods for handling hot flashes, night sweats, brain fog, and everything else this life transition throws at you.
Understanding perimenopause, menopause, and premenopause
Need a rundown on the differences between perimenopause vs menopause or premenopause vs perimenopause? Let’s run through the basics to help you understand the stages of menopause.
- Perimenopause is the transitional time leading up to menopause. It can begin as early as your mid-30s up to your early 50s. During this phase, fluctuating hormone levels cause irregular periods and symptoms like hot flashes, mood changes, and vaginal dryness.
- Menopause starts when you’ve gone 12 consecutive months without a menstrual period. Symptoms may continue, but they’re usually less intense than during perimenopause.
- Premenopause sometimes gets confused with perimenopause, but it isn’t a formal medical stage. It’s just a term for your reproductive years before any of this transition begins. There are no perimenopausal symptoms during this time, just regular cycles.
Timeline of each menopause phase
Everyone’s experience through the phases of menopause is unique. However, knowing the general timeline can give you an idea of what to expect and when.
This chart offers a quick overview of each stage, typical age ranges, and how long each phase lasts.
| Stage of transition | Typical age range | Duration |
| Premenopause | Puberty to late 30s/early 40s. | The average woman has her period once every month over the span of 40 years. |
| Perimenopause | Average age is 47, but can start between early 40s to early 50s. | 4 to 8 years on average, though it widely varies. |
| Menopause | Average age is 51, but most women enter between 49 and 52. | Occurs when you have gone through 12 consecutive months without a period. |
| Postmenopause | Average age is 52. | Starts after your last period and lasts the rest of your life. |
Symptoms and hormonal changes
When comparing perimenopause vs menopause symptoms, you may wonder how they differ and which symptoms overlap. Many symptoms appear in both phases, with perimenopause being more unpredictable and menopause tending towards more consistent patterns that are less intense. The good news is that both phases can be managed with the right treatment.
Understanding what’s going on hormonally helps you make sense of your symptoms. Here’s what’s going on in your body.
| Symptom | What’s happening in your body |
| Irregular periods | Your menstrual cycle is disrupted by declining levels of progesterone and fluctuating estrogen. Periods might be lighter, heavier, or have erratic timing. This is the main sign of perimenopause. |
| Hot flashes andnight sweats | Estrogen fluctuations confuse your brain’s temperature control center (hypothalamus) and trigger a sudden rush of heat and sweating. |
| Mood swings, anxiety, irritability | Lower estrogen levels affect mood-regulating chemicals in the brain (serotonin, dopamine, and norepinephrine). When estrogen levels are in flux, so are your moods. |
| Brain fog | Estrogen plays a key role in supporting cognitive function. When the levels fluctuate, you may have trouble with concentration, word recall, and mental clarity. |
| Trouble sleeping | Progesterone helps promote sleep. As levels drop, you may have trouble falling asleep and staying asleep. This can be made worse by night sweats. |
| Vaginal dryness | Declining estrogen levels reduce vaginal moisture and elasticity, which causes discomfort and dryness. |
| Weight gain | A slower metabolism, reduced activity, and declining estrogen levels that shift fat storage to the abdomen play a role in weight gain during this transition. |
| Reduced sex drive | Lower testosterone levels (produced by your ovaries) plus vaginal discomfort can decrease libido in some women. |
Perimenopause symptoms
During perimenopause, you’ll start producing less estrogen and progesterone. That decline isn’t smooth, and hormone levels fluctuate from day to day, which explains why perimenopause symptoms can feel so unpredictable.
Common perimenopause symptoms include:
- Irregular periods
- Hot flashes
- Mood swings (anxiety, depression, irritability)
- Headaches
- Night sweats
- Brain fog
- Vaginal dryness
- Trouble sleeping
- Reduced sex drive
- Weight gain
Menopause symptoms
If you’ve gone 12 straight months without a period, you’ve reached menopause. Your estrogen and progesterone levels have reached low but consistent levels. This hormonal stability means symptoms are more predictable and usually less intense than perimenopause.
Some common menopause symptoms are:
- Hot flashes
- Changes in mood (anxiety, depression, irritability)
- No periods
- Vaginal dryness
- Bladder problems
- Trouble sleeping
- Night sweats
- Brain fog
- Reduced sex drive
- Thinning hair
- Dry or itchy skin
- Weight gain
- Muscle and joint pain
- Headaches
- Bone loss
Overlapping symptoms
Hot flashes, night sweats, mood changes, sleep problems, brain fog, vaginal dryness, weight gain, and reduced sex drive appear in both phases. The major difference is that perimenopausal symptoms are inconsistent day-to-day, while menopause symptoms are more stable and predictable.
During menopause, your body gradually attunes to lower hormone levels. Reaching this new baseline is why many women find menopause more manageable than perimenopause.
You’ll still benefit from relief strategies that fit your lifestyle and goals during both phases. We’ll cover treatment options for managing these symptoms below.
How to know where you are in menopause
Knowing where you are in menopause helps you make informed treatment decisions and prepares you for the changes ahead.
Track your patterns
If you suspect you may be starting perimenopause, tracking your cycles and symptoms with apps or journals shows trends over time, which is more useful than a single blood test. While FSH and estradiol labs can provide helpful information, they’re not always definitive during perimenopause because hormone levels fluctuate daily. Combining test results with your symptom tracker gives a fuller understanding of where in the transition you are.
Want to see the full picture? Learn why menopause is more than just a lab result.
Share your data
Bring your tracking app or journal to appointments so your provider can spot patterns and tailor care to your specific phase.
When to call your provider
While perimenopause and menopause are natural seasons within a woman’s life, there are some symptoms that aren’t normal and merit prompt medical attention. Reach out to your provider if you experience:
- Pelvic pain or pressure
- Symptoms that interfere with your daily life
- Any bleeding that returns after menopause
Questions to expect during your appointment
Your provider may ask you some questions to get a better pulse on where you’re at on your journey. They might ask:
- What’s your family history of menopause, osteoporosis, or hormone-sensitive conditions?
- When was your last period? How regular have your cycles been?
- What symptoms are you experiencing, and how long have they lasted?
- Are any of your symptoms preventing you from doing your daily activities?
- Have you had any irregular or heavy bleeding?
- Are you using any hormonal or non-hormonal treatments?
Managing the transition through each stage
You have more control than you think over your symptoms. You can’t stop menopause from coming, but you can manage how hormonal changes affect your daily life. From lifestyle adjustments to medical treatments, here are some evidence-based strategies for feeling your best and staying healthy through perimenopause and menopause.
Lifestyle tips
Making adjustments to your daily routine can help you deal more effectively with some of the symptoms of perimenopause and menopause.
- Support bone health: Get enough calcium (1,000 mg for those 50 and younger, 1,200 mg for those 50+) and vitamin D (400–800 IU for those 50 and younger, 800–1,000 IU for those 50+) through supplements and diet.
- Move your body: Exercising, particularly strength training with weights, can help preserve muscle mass, support bone density, and stabilize mood.
- Focus on good nutrition: Eat a diet rich in omega-3 fatty acids, leafy greens, and nuts to support brain health. Reduce processed foods and sugars to prevent blood sugar spikes that cause energy crashes and changes in mood.
- Build good sleep habits: Limit screens and caffeine before bed, keep your bedroom cool (65-68°F), and stick to a consistent sleep schedule.
- Manage stress: Reduce emotional strain with mindfulness practices, yoga, deep breathing exercises, or taking some dedicated quiet time each day.
Studies have shown that 20 minutes of aerobic exercise per day, along with a daily mindfulness practice, can reduce cortisol, the stress hormone that aggravates many menopause symptoms.
Non-hormonal options
If you can’t take hormonal therapy or would rather not, these options can help relieve some of the frustrating symptoms of menopause and perimenopause.
- Cognitive behavioral therapy (CBT): Studies have shown that CBT is effective for hot flashes, night sweats, sleep problems, anxiety and stress, and depressed mood.
- Antidepressants (SSRIs and SNRIs): These medications are sometimes prescribed at low doses to reduce hot flashes and improve mood, even if you’re not depressed.
- Cooling products: Specialized bedding, clothing, and fans can help you stay cool and comfortable when night sweats happen.
- Vaginal moisturizers: Over-the-counter products provide ongoing relief from dryness and discomfort.
Hormonal therapies
Every woman’s journey to menopause is different. That’s why menopause hormone therapy (MHT) is individually tailored based on your symptoms. Working with a licensed provider can help you find the right balance to feel more like yourself again. MHT can include:
- Estrogen therapy: Relieves hot flashes, night sweats, brain fog, and prevents bone loss.
- Progesterone: Added to estrogen if you have a uterus to protect against uterine cancer.
- Delivery methods: These medications come as pills, patches, rings, and vaginal inserts, among others. Your provider will help you choose the best option based on your health profile and personal preferences.
Like any medication, hormonal therapies come with benefits and risks. Have an open and honest conversation with your provider about your personal and family health history if you’re considering hormonal therapy. Understanding the potential risks will help you make an informed decision about whether MHT is right for you.
Emotional well-being
Menopause and perimenopause don’t just come with physical and hormonal changes. They also affect your mental and emotional health. This is partly due to hormonal shifts, but also because “the change of life” signals an end to one part of your life. Big changes in anyone’s life can trigger big feelings, making it all the more important to tend to your emotional health. Some tips include:
- Journaling: Writing down how you feel each day or each week helps process emotions, reduce stress, and manage anxiety.
- Therapy: A licensed counselor or psychologist can provide strategies for coping with depression, anxiety, and irritability.
- Support groups: Offer a place to share experiences and support with people going through the same transition.
Mood changes are completely normal during perimenopause and menopause. Even just talking to someone about the things bothering you can lower stress hormones and improve your mood.
Menopause next steps with QuickMD
You don’t have to deal with menopause on your own or figure things out by yourself. Track your cycles and symptoms, come prepared with questions for your provider, and explore resources for support and answers. Taking control of your symptoms starts with understanding what’s happening and knowing what help is available.
QuickMD’s licensed providers specialize in menopause care at every stage. We’ll take the time to understand your symptoms and how you’re feeling to build a personalized plan that works for your goals. Have questions about hormone therapy? Worried about long-term effects? Not sure if what you’re feeling is normal? We’re here for you through it all.
Frequently asked questions about the stages of menopause
Can you get pregnant during perimenopause?
Yes. Although fertility declines, you can still ovulate, which means pregnancy is possible. Use contraception if you’re not trying to get pregnant.
Do menopause symptoms start before your period stops?
Yes, they do. This transitional phase is called perimenopause, and you may experience hot flashes, brain fog, night sweats, mood swings, and irregular periods. Perimenopause typically lasts 4 to 8 years.
How do you know when it’s your last period before menopause?
You won’t know it’s your last period and you’ve hit menopause until after you’ve gone 12 consecutive months without a period. If you experience any bleeding after that 12-month period, you should make an appointment with your provider right away.
What is the average weight gain during menopause?
Weight gain may start during perimenopause. Then, as women go through their 50s, they gain an average of 1.5 pounds each year.
Do you still ovulate in perimenopause?
Yes, but ovulation is less predictable. You may not ovulate in the months you have a period or ovulate during the months you don’t have a period. Ovulation doesn’t stop until you reach menopause.
