Menopause vs perimenopause: what each term means

The NHS now covers both under one heading, "menopause and perimenopause", and describes them as a natural part of life that happens when your periods change and eventually stop due to lower hormone levels. It usually affects women between 45 and 55 but can happen earlier, and affects anyone who has periods.

The distinction is the one that matters for definitions. Perimenopause is the time leading up to menopause, when symptoms and period changes begin. Menopause is the moment you reach 12 months without a period. The NHS says perimenopause ends when you reach menopause, and that menopause is when you have not had a period for 12 months, after which it is called postmenopause.

Because menopause is defined by 12 months without a period, it is only recognised once that time has passed, whereas perimenopause is the period of change before it.

The table brings together the NHS and NICE descriptions.

The NHS notes that symptoms can happen during perimenopause and menopause, and also after menopause has ended. It says experiences differ a great deal: some people have symptoms with a big impact on relationships, social life, family life and work, while others hardly have symptoms at all.

It lists changes to periods as usually one of the first signs of perimenopause: periods may come more or less often, and bleeding may get heavier or lighter, until they stop altogether. Other symptoms include hot flushes and night sweats, sleep problems, mood changes, poor memory and brain fog, weight gain, vaginal dryness, burning, irritation or itching, more UTIs or UTI-like symptoms, palpitations, bone density loss that can lead to osteoporosis, headaches and migraines, muscle aches and joint pains, hair thinning, skin changes, reduced sex drive and mouth problems.

Symptoms usually last for 7 to 9 years, sometimes longer, and can change. The NHS gives the example that hot flushes and night sweats may improve and be replaced by low mood and anxiety, and that some symptoms such as joint pain and vaginal dryness may continue after menopause. It also says women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer.

NICE guidance on menopause says that in otherwise healthy people aged 45 or over with menopause-associated symptoms, perimenopause should be identified without laboratory tests, if they have vasomotor symptoms that have recently started and any changes in their menstrual cycle. Menopause is identified if they have not had a period for at least 12 months and are not using hormonal contraception. In people who have had a hysterectomy, it is identified based on the type and combination of symptoms.

NICE says not to use tests such as anti-Müllerian hormone, inhibin A, inhibin B, oestradiol, antral follicle count or ovarian volume to identify perimenopause or menopause in people aged 45 or over, and not to use an FSH blood test in people using combined oestrogen and progestogen contraception or high-dose progestogen. It says to consider an FSH level only to confirm menopause in people aged 40 to 45 with menopause-associated symptoms including a change in their menstrual cycle, and in people under 40 in whom menopause is suspected.

The NHS notes that hormonal contraception can make it harder to tell if you have reached perimenopause or menopause because it affects periods: the progestogen-only pill, hormonal coil, contraceptive implant and injection can make periods irregular or stop, while the combined pill causes monthly bleeds for as long as it is taken. NICE similarly says it can be difficult to identify menopause in people taking hormonal treatments.

The NHS says it is possible to get pregnant during perimenopause, and that you still need contraception for 1 year after your final period if you are aged 50 or over, and for 2 years after your final period if you are aged 40 to 49. The combined pill is not recommended if you are aged 50 or over because the risks generally outweigh the benefits, and a GP may recommend progestogen-only contraception instead.

On bleeding, the NHS says that during perimenopause periods may become irregular, lighter or heavier, and that taking HRT can make periods more regular, with some irregular bleeding or spotting that should settle within 6 months. It says to contact your GP if you are on HRT and still having irregular or heavier bleeding after 6 months, or if you still have periods but are bleeding more than before. After menopause the position is different: if you have not had a period for more than 12 months and you get any vaginal bleeding, even once or a small amount, it needs to be checked. The NHS says postmenopausal bleeding is not usually serious but can be a sign of cancer, which may be easier to treat if found early.

The NHS says that if you have symptoms of perimenopause or menopause you can talk to a doctor, nurse or pharmacist about HRT and other options. The type of HRT depends on whether you still have periods or have had your womb removed. Oestrogen is the main type, taken as tablets, patches, spray or gel, or as a cream or pessary for vaginal dryness. If you have not had a hysterectomy and take oestrogen you need progestogen to protect the womb, as tablets, part of a combined patch or the hormonal coil. Testosterone may help low libido for some people and may be prescribed by a menopause specialist.

If HRT does not work, is not suitable or is not wanted, the NHS says non-hormonal treatments are available: antidepressants for low mood, depression or anxiety caused by perimenopause or menopause, and cognitive behavioural therapy for hot flushes and night sweats, or clonidine or an antidepressant if CBT does not help. It says herbal remedies and complementary medicines such as red clover and black cohosh have very little evidence of how well they work or how safe they are, and can cause serious side effects with other medicines.

The NHS advises contacting your GP if you think you have symptoms and want to know your options, if you have palpitations, if your pattern of bleeding changes, or if you have had no period for 12 months and have any vaginal bleeding. It says early advice can help reduce the effects on your health, relationships and work.