What is the Difference between Premenopause and Perimenopause?

August 1, 2011

Before I delve into the difference between these terms I want you to know that I do not like labels or diagnoses. I believe we are all unique and our symptoms and lives are so individual that no one can do justice by transposing one person’s experience to another’s.
 
Giving people labels only serves to confuse and throw us into fearful states that have little bearing on our reality. Labels and diagnosis often create impediments to us leading normal lives.
 
Having said this, I must share with you the fact that a day doesn’t go by a patient doesn’t walk into my office and says: “Doc, do you think I am premenopausal, or perimenopausal?” Or maybe, “I am too young to be in menopause, but I’ve seen another doctor who has told me I am there because my FSH is very high.”
 
Fact is, we live in a culture that encourages us to define ourselves by the presence of a label, diagnosis, personality type, religious affiliation, club, etc. I don’t want to disparage the concept of belonging, but I do want you to understand that the labels of Premenopause and Perimenopause are not something you need to enhance your life.
 
For the purpose of this article, I will use them just to help you better understand how they are used by healthcare practitioners and literature dealing with menopause.
 
First, I’d like to eliminate the confusion surrounding the terms Premenopause and Perimenopause.  Before I elaborate, please understand the two are essentially the same and they refer to variable periods of time around menopause. They are often used interchangeably.
 
Premenopause is defined as a period of time before menopause. The word Pre means before in Latin. So basically anything that happens before menopause belongs under this heading.
 
It could last years or months. During premenopause you still have a period. Only the period has changed from what your period used to be during your 20s and 30s. It may be irregular, either too long or too short, unusually heavy or unusually light. The blood quality may have changed as well. You may have lots of clots or it may last for weeks and be brownish and thin in quality. Everyone is different and so are the changes in their periods.
 
Other symptoms that may appear during premenopause and become more consistent in the following years include hot flashes, night sweats, insomnia, loss of libido, weight gain, itching, PMS that lasts most of the month, anxiety attacks, mood swings, palpitations, and fatigue  During premenopause your blood tests may occasionally reflect high levels of FSH (the pituitary hormone that is used to diagnose menopause) alternating with times when the levels are normal.
 
Perimenopause is the period of time around menopause. It includes premenopause as well as early menopause. Literally in Latin the word Peri means around so anything that happens around the time of menopause fits into it.
 
Now that we have removed the uncertainty caused by labels we do not understand, I hope the next time you have a hot flash, your period is irregular, your mood is a bit out of control or the PMS associated cravings kick in, all you do is shrug it off as part of life and do not fear something more onerous.
 
During perimenopause or premenopause, when your hormone equilibrium is off, you may want to consider bioidentical hormones to help you feel in better balance. Trading unhealthy foods for hormone friendly foods, exercising more and getting a better handle on dealing with stress are also ways to help you feel more balanced.
 
While you are looking at all these little pieces of your life that affect the whole, focus on creating a positive outcome and steer clear of drowning in labels. My patients and I find this approach works a lot better than you would think. 

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