Menopause vs. Perimenopause
- Dr. Stephanie McNally, Medical Director for Katz Institute of Women’s Health at Northwell Health, explains that menopause is defined as 12 months without a period, while perimenopause is the transition leading up to it, often marked by more erratic hormonal changes and fluctuating cycles.
- She notes that symptoms can affect the entire body—from mood, sleep, and cognition to metabolism, skin, and pelvic health—because estrogen receptors are present throughout the body, making the experience highly unique for each person.
- Dr. McNally emphasizes that perimenopause can last two to 10 years and vary widely based on genetics, ethnicity, medications, and health factors, while menopause reflects a state of sustained sex hormone depletion.
There is often confusion about the difference between perimenopause and menopause. Dr. Stephanie McNally, Medical Director for Katz Institute of Health at Northwell Health, clarifies the difference: Menopause is the point at which a woman has gone 12 months without a period, while perimenopause is the transition leading up to it.
“For a woman going through a natural hormonal transition, menopause, and I say natural meaning there’s no chemicals, there’s no surgery, there’s no chemotherapy, which obviously affects your patients differently,” says the leading OB/GYN to SurvivorNet. Read MoreDr. McNally notes that irregular periods are only one small part of what’s happening during perimenopause and menopause.
“Hormones are not just from your ovaries, they’re from your brain,” she says. “They’re circulating through your body. So the way that your body changes from perimenopause to menopause, it’s going to be individualized, it’s going to vary, and it’s going to affect every single aspect of your body.”
What to Expect: Signs of Menopause and Perimenopause
When it comes to the changes that arise in menopause and perimenopause, Dr. McNally says those changes can affect “everything.”
“It is starting at the head from mood to energy, to cognition, brain fog,” she says. “There could be a decline in word recall or the quickness in that perimenopausal transition—very well studied. It can lead to poor sleep, poor libido, poor coping mechanisms and hot flashes [a vasomotor symptom]. And that is actually a trigger from your brain.”
“As the estrogen declines, it becomes erratic where your brain is craving estrogen and your ovaries are like, ‘Yeah, I’m done. It’s not happening.'”
Dr. McNally further explains that perimenopause can last anywhere from two to 10 years and varies widely between individuals, with research showing differences in duration and symptom severity across ethnic backgrounds, making it a highly individualized process.
“It’s based on other medications, comorbidities—there’s a lot of factors, but for a small percentage of women, a premature menopause occurs before the age of 40,” she adds. “And a early menopause is between 40 and 45. So after 45 and beyond is considered normal. Average age is 51, below 40 is premature.”
Dr. McNally says symptoms can begin in a woman’s early 30s, especially if she is on track for an earlier menopausal transition.
Understanding The Signs
Early and common perimenopause symptoms, according to Dr. McNally, may include:
- Breast tenderness
- Headaches
- Menstrual cycle changes
- Mood changes
Other physical, metabolic, and weight-related changes women may experience:
- Skin changes and itchiness (including itchy ears)
- Hair changes
- Changes in breast density
- Slower metabolism
- Belly weight gain despite healthy habits (diet, supplements, hydration, fiber, protein)
As for pelvic and urinary changes, as well as broader body effects, these may include:
- Urinary leakage
- Incontinence
- Vaginal dryness
- General pelvic health changes
- Joint discomfort
“All of the things from head to toe, front to back joints included, can be affected,” Dr. McNally emphasizes. “Any body part can be affected because based on our biology, there’s an estrogen receptor everywhere in a female body. So as these hormones are changing, it can affect us all differently. And no body part is off limits.”
To reiterate, Dr. McNally says it is important to understand that it’s difficult to precisely predict what will happen during perimenopause versus menopause because each person’s experience is shaped by factors such as their body, ethnic background, and medications.
She concludes, “The menopausal state is really a depletion of our sex hormones, the estrogen, progesterone, and a portion of our testosterone, because testosterone is made not only in the ovaries, but in the adrenal glands.”
“So there are other sources of testosterone in our body, but essentially we’re talking about those main sex steroid hormones that are gone at any significant levels in that menopausal transition. That’s the difference, erratic and then absent in the menopausal state.”
Contributing: SurvivorNet Staff
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