What is Menopause and Perimenopause? Understanding the Key Differences

Menopause is defined as the cessation of menstruation for 12 consecutive months following the exhaustion of ovarian follicles. As the ovarian follicles get depleted, ovarian function starts to go down, fertility declines, and periods get irregular till the time they completely stop. 

Menopause is not a sudden event, but a transition that occurs over several years; a transition that begins with perimenopause. Perimenopause is the time before menopause that may last from 2 to up to even 10 years, when the ovarian follicles start getting depleted leading to fluctuations in the hormones estrogen and progesteron,e leading to symptoms arising due to the same. 

Common Symptoms During Perimenopause and Menopause

People often make the mistake of assuming that menopause is simply associated with changes in periods or the cessation of periods. But the menopause transition entails way more than that. In fact, a woman’s periods may even be regular in her perimenopause when she may start having symptoms of the menopause transition like hot flashes, brain fog, anxiety, mood swings, wrinkles on the skin or sleep disturbances. While these are the commonly known symptoms around this time, there are more than 35 listed symptoms that a woman might have in her menopause transition including hair loss and thinning, skin pigmentation, itchy ears, bloating, constipation, extreme fatigue, recurrent urinary infections, vaginal dryness, low libido and so on. 

Hormonal Changes During Perimenopause and Menopause: Estrogen and Its Role

The reason why menopause can have symptoms going way beyond just period abnormalities is that the hormones estrogen and progesterone that are secreted by the ovaries in the menstrual cycle have receptors all throughout the body that take care of functions that go beyond reproduction. 

Estrogen has receptors all throughout the body from head to toe- starting from the hair, skin, brain, heart, digestive tract, urinary system, and the musculoskeletal system. And estrogen deficiency arising from the low levels of estrogen at menopause and the fluctuating levels of estrogen in perimenopause lead to symptoms that can affect all these systems.

Want to understand hormonal fluctuations better? Read our complete guide on How to Deal With Hormonal Imbalance for practical tips.

Diagnosing Menopause and Perimenopause:  How to Know If You’ve Reached Menopause:

The time when you may reach your menopause can be hereditarily linked to the time your mother or your elder sister had their menopause. And while the average age of menopause all over the world is between 48 to 51 years, the average age for Indian women to have their menopause, for reasons as yet unknown, is 46 years. 

And since perimenopause can begin from 2 up to 10 years before menopause, you may begin your perimenopause even in your late 30s. So symptoms like tiredness, mood swings or brain fog happening in the late 30s or early 40s may be attributed to the menopausal transition. 

These symptoms begin way before the actual, measurable hormonal dips can be ascertained through blood tests. So very often, blood tests done at this time to measure the hormonal levels may turn out to be normal. And so, we prefer to use the symptoms as a guide to diagnosing perimenopause rather than any blood tests.

Want to know more about early menopause? Check out our detailed guide on Early Menopause.

Blood Tests

Blood tests are required for the diagnosis of menopause only when the menopause occurs prematurely, before 40 years of age, when it is called POI, or premature ovarian insufficiency.

At other times, menopause is a good time to get yourself tested by doing a round of routine blood tests that test for your liver and kidney function, your cholesterol and sugar levels and your vitamin D and B12 levels. Some period dysfunctions happening due to menopause can mimic those due to thyroid dysfunction as well. Hence we also prefer to get those done. 

Can you still get pregnant during perimenopause?

Menopause is a time that sees the gradual shutdown of the function of the ovaries. It is a time when your ovarian reserve has gone down and also when the present ovarian follicles are aged follicles, which are more likely to give rise to a chromosomal dysfunction if a pregnancy does occur. 

All the same we do advise you caution and also advise you to use contraception for a year after your menopause date. Instances of an unusual freak ovulation resulting in a pregnancy haven’t been unheard of!

The hidden risks of menopause: Heart, Bone and Joint Health and Metabolism

Apart from the symptoms that menopause brings along, it also causes changes in your body that may stay hidden till the time they cause serious damage — which could be bone density loss leading to osteoporosis which can cause a fracture even after simple falls, or memory loss that seems harmless till it progresses to severe dementia or changes in the heart and circulation and metabolism which can lead to a heart attack or a stroke. 

When to See a Doctor?

While the symptoms of menopause may be inevitable, suffering is not. It is always prudent for you to talk to a doctor when the symptoms affect your quality of life negatively. So whether it is the hot flashes that are causing you distress, anxiety that is disrupting your life, or heavy bleeding in periods that leads to anemia and a lowered immunity; it is always good to talk to your doctor to understand the options you have to manage these issues.