Perimenopause vs menopause: what's the difference, and what are the stages?

People use the words perimenopause and menopause as if they mean the same thing. Your GP might say one, a friend the other, and a magazine both in the same sentence. It's no wonder it gets confusing.

So what is the difference between perimenopause and menopause? In short, perimenopause is the run-up, when your periods become irregular and symptoms often start. Menopause is a single point: the day you reach 12 months without a period. After that comes postmenopause, which is the rest of your life.

This guide explains each stage in plain words, how you can tell where you are, and whether perimenopause really is worse than what comes after.

The NHS says bleeding after menopause is not usually serious, but it does need checking. It can sometimes be a sign of cancer, which is easier to treat when found early. See our page on bleeding after menopause.

Perimenopause vs menopause: the short answer

	Perimenopause	Menopause	Postmenopause
What it is	The years leading up to your last period	One point in time: 12 months with no period	Everything after that point
Periods	Irregular, then further apart	Stopped for a full year	Stopped
Hormones	Rising and falling unpredictably	Low	Low, then settle
Symptoms	Often start here, and can be at their most noticeable	Can carry on	Many ease over time, some carry on

Many people say "the menopause" to mean the whole change, from the first symptoms onwards. That's fine in everyday talk. But when you're trying to work out where you are, the three stages help.

What is perimenopause?

The NHS describes perimenopause as the time when your periods become irregular. Women's Health Concern, the patient arm of the British Menopause Society, says it can start in your late 30s or early 40s.

During perimenopause, your hormone levels go up and down rather than falling in a neat line. Women's Health Concern says this is often when symptoms are at their most noticeable. As your store of eggs runs down, oestrogen levels drop. This takes several years, which is why symptoms can come and go.

Menopause researchers split perimenopause into two parts. These come from STRAW+10, a set of stages agreed by menopause experts (see the STRAW+10 summary).

• Early perimenopause. Your cycle length starts to change by 7 days or more from one cycle to the next, and this keeps happening.
• Late perimenopause. You start to go 60 days or more without a period. This stage lasts around 1 to 3 years on average, and hot flushes and night sweats are likely.

For more on the later stage, see signs perimenopause is ending.

What is menopause?

Menopause is when your periods stop for good. The NHS says it's when you haven't had a period for 12 months and you're not using hormonal contraception. It usually happens between the ages of 45 and 55, but it can happen earlier.

A few things to know about it:

• It's one moment, not a stage. Strictly speaking, menopause is the point you reach 12 months after your last period.
• You only know looking back. A period could still turn up after a long gap, so your last period is only "the last" once a full year has passed.
• You usually don't need a blood test. Women's Health Concern says that if you're over 45, your symptoms and changes in your periods are the best guide. If you're under 40, or you've had a hysterectomy or an ablation (a treatment for heavy periods), blood tests may be used, because your periods can no longer show what's happening.
• Surgery can bring it on straight away. If your ovaries are removed, Women's Health Concern says your menopause is immediate.

What is postmenopause?

Once you've gone 12 months without a period, you're postmenopausal. The NHS uses this name for the time after that point. It doesn't end. It's simply the rest of your life.

STRAW+10 splits it into two parts:

• Early postmenopause. For about the first two years, hormone levels are still changing fast, and this is when hot flushes and night sweats are most likely. Then levels settle. This early stage lasts around 5 to 8 years in all.
• Late postmenopause. Hormone changes are more limited now. Vaginal dryness and other changes in that area become more common.

Lower oestrogen after menopause can also affect your long-term health. Women's Health Concern says it can lead to thinner bones (osteoporosis) and a higher risk of heart disease. That's why the years around menopause are a good time to look after your bones and heart.

Our guide to post menopause symptoms looks at this stage in more detail.

The stages of menopause at a glance

Putting it all together, the stages of menopause run like this:

1. Early perimenopause: your cycle becomes less regular.
2. Late perimenopause: gaps of 60 days or more between periods.
3. Your final period: you can only name it a year later.
4. Menopause: the 12-month point.
5. Early postmenopause: hormones settle over the next few years.
6. Late postmenopause: the rest of your life.

Researchers count the first 12 months after your final period as part of perimenopause too, which is why you'll sometimes see slightly different timelines.

Do the symptoms change between the stages?

The symptoms are mostly the same. The NHS says they can happen during perimenopause, during menopause, or after it. Common ones include:

• changes to your periods (perimenopause only), which may come more or less often and be heavier or lighter
• hot flushes and night sweats
• trouble sleeping
• mood swings, low mood and anxiety
• problems with memory or concentration
• heart palpitations
• joint pain and muscle aches
• vaginal dryness and needing to wee more often

The NHS says symptoms can change over time. Some may get better and be replaced by others. Joint pain and vaginal dryness can carry on after menopause. For the full list, see our guide to perimenopause symptoms.

Is perimenopause worse than menopause?

For many women, perimenopause and the first couple of years after the last period are the hardest stretch. Women's Health Concern says the swinging hormones of perimenopause are often when symptoms are most noticeable. STRAW+10 says hot flushes are likely in late perimenopause and most likely in the first two years after the final period.

Mood can be affected too. A US study followed nearly 3,000 women for ten years. Women who hadn't been anxious before were more likely to report high anxiety in perimenopause and after menopause than they had been before (Bromberger and others, 2013).

But there's no single answer, because everyone is different. Women's Health Concern says some women have no symptoms at all, while others find them very disturbing. And some changes, like vaginal dryness, tend to become more common later rather than sooner.

There is some hopeful news. A Women's Health Concern factsheet on CBT notes that after the menopause, women in general tend to report better wellbeing than they did in their 40s.

How long it all lasts varies a lot too. The NHS says symptoms usually last 7 to 9 years, sometimes longer. Our guide to how long menopause lasts breaks this down.

How do I know which stage I'm in?

Your periods are the best clue.

• Still having periods, but they've changed? You may be in perimenopause, especially if you also have symptoms like hot flushes or poor sleep.
• Going two months or more without a period? That's a sign of late perimenopause.
• No period for a full year? You've reached menopause, and you're now postmenopausal.

Some things make it harder to tell. Hormonal contraception, a hysterectomy or some treatments for heavy periods can hide or stop your periods. If that's you, ask your GP or nurse. They may go by your symptoms, and sometimes use a blood test.

Keeping a note of your periods and symptoms for a few months helps a lot. Our free perimenopause symptoms checklist lets you tick off what you've noticed and print it to take to your GP.

Do I still need contraception?

Yes, while you're in perimenopause, and for a while after your last period. Women's Health Concern gives this guide:

• If you're under 50, keep using contraception until you've gone two years without a period.
• If you're 50 or over, you can stop after one year without a period.

If your contraception hides your periods, talk to whoever prescribes it about when to stop. Women's Health Concern says HRT and contraception can be used together, and warns against stopping contraception too soon.

What if it happens early?

If your periods stop before 45, it's called early menopause. If it happens before 40, Women's Health Concern says it's called premature ovarian insufficiency (POI).

The NHS says a GP may do blood tests if you're under 45. It also says replacing the missing hormones is important when menopause comes early, because of a higher chance of problems with your bones and heart. So if you think this might be you, please don't wait. Book a GP appointment.

When to see your GP

You don't have to wait until you know which stage you're in. See your GP if:

• you have any bleeding after 12 months with no period, even once
• you're under 45 and your periods have changed or stopped, or you have menopause symptoms
• symptoms are getting in the way of your sleep, work, relationships or mood
• you feel low most of the time, or anxious in a way that's new for you
• you're not sure about contraception

Women's Health Concern describes HRT as the most effective treatment for menopause symptoms, and low-risk for most. It also mentions CBT for mood and sleep. Whether either suits you is something to talk through with your GP. Our guide to menopause without HRT explains the main options, hormonal and not.

Related: signs perimenopause is ending, how long menopause lasts and post menopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.