Posted on: May 5, 2026
What is the difference between perimenopause and menopause? The term perimenopause might be new to some people. In the media, a woman in menopause is portrayed having a hot flash, but this is technically perimenopause and not menopause. The terms perimenopause and menopause are different. So, what is the difference and what are the different stages?
Menopause: 3 different stages:
Did you know that there are three stages, perimenopause, menopause, and post-menopause. The stages aren’t often talked about.
Stage 1: Perimenopause:
So, what is perimenopause? Perimenopause is the phase of time before menopause and it can vary in length. Perimenopause starts with changes in the menstrual cycle. In the early stages of perimenopause, the menstrual cycle length begins to vary by as much as 7 days from your normal cycle. For example, if you typically have a 28-day cycle, the next cycle could be 21 days. In the later stages of perimenopause, you start to see two or more missed periods in a year. Perimenopause can last anywhere from 2-15 years, so there is quite a bit of variation. Typically, perimenopause lasts 4-8 years.
Perimenopause is characterized by random symptoms that occur from a changing hormonal landscape. In perimenopause, there are erratic fluctuations of hormones instead of a slow steady decline. These hormone fluctuations are mostly driven by ovarian function. Estrogen levels will spike up and then dip down, whereas progesterone tends to steadily decline. These hormone fluctuations lead to the various perimenopause symptoms such as menstrual cycle changes, mood concerns, hot flashes, trouble sleeping, memory loss, etc.
Stage 2: Menopause:
The average age of menopause is estimated to be between 48-52. The age range is generally from 40-58, although some women could reach menopause in their thirties or as late as in their sixties. There are factors that will influence menopause age: smoking, familial factors, and genetic factors, increased BMI, more than one pregnancy, toxic chemical exposures, and radiation. Despite the fact that people are living longer, the age of menopause hasn’t changed in the last few centuries. Menopause isn't a sign of aging. You don't hit menopause early because you are aging faster. When you will reach menopause is something you have when you're born. You are genetically programmed to reach menopause (periods completely stopped) approximately when your mother or other female relatives reached menopause.
Menopause is defined as the cessation, stopping, of your period for 12 months. I've had patients where they had no period for 11 months then had their period. A lab test can also be useful to show that a person has reached menopause. If you have two FSH lab readings that are high (find number) at least one month apart then that is defined as menopause. Testing thyroid stimulating hormone (TSH) is sometimes done because thyroid function changes can mimic menopause.
Stage 3: Post Menopause:
Post menopause begins after the time of the final menstrual period and continues until the end of life. Women will no longer be ovulating and haven’t had a period for 12 consecutive months. Post menopause is defined as stage +1, or early post-menopause, and stage +2, or later post-menopause. The early post-menopause is 5 years long. In post menopause, many symptoms will subside like hot flashes, but some symptoms can linger such as vaginal dryness, weight gain, urinary issues, etc.
Postmenopausal women are at an increased risk of certain concerns such as osteoporosis and cardiovascular disease. Decreased estrogen levels in postmenopausal women can lead to more rapid loss of bone density. Following menopause, bone density can decrease dramatically. Estrogen is protective for the cardiovascular system and less estrogen leads to an increased risk of developing high blood pressure, high cholesterol, stroke, and heart attacks.
Early Menopause
Early menopause, also called premature menopause or premature ovarian insufficiency (POI). Early menopause is also not about aging. POI may be caused by metabolic factors, systemic disease, chromosome abnormalities, immunologic, and infections. In many women with POI, no apparent reason is found (though I like to think we just need to keep looking to see if we can uncover a reason). The removal of both ovaries (bilateral oophorectomy) can cause surgical menopause. Medications, pelvic radiation and chemotherapy can also cause early menopause (sometimes a temporary menopause).