Are perimenopause and menopause the same? Not quite

Perimenopause and menopause often get lumped together as the same stage of life. But they’re actually different—and there’s a phase that happens after menopause, too. Let’s set the record straight about the many shifts your body experiences in these years, so you know exactly what’s happening and what to do.

Perimenopause: the changes begin

Perimenopause (and menopause!) can be frustrating and leave you wondering what’s up with your body. During this time, your ovaries—a reproductive organ that stores eggs and makes hormones like estrogen and progesterone—start to gradually slow down. Some months they’ll produce enough hormones for you to have the kind of cycle and period you’ve come to know. But sometimes they won’t. You may notice that your periods come more or less often. Also, your flow may be heavier or lighter than what you’re used to.

What perimenopause feels like

Perimenopause usually starts in a woman’s forties, but it can happen as early as your thirties. Wondering when it’ll start for you or how long it will last? Ask your mom, grandma, or an aunt. Genetics give a few clues. However, it’s good to remember that every woman is different. Yours could last anywhere from a few months to 8 to 10 years. (Sorry.) Take heart, though: on average, this phase lasts 4 years.

Some symptoms of perimenopause are:

• Irregular periods (timing and flow)
• PMS, including mood swings
• Decreased sex drive
• Tiredness or low energy
• Hot flashes
• Tender breasts
• Headaches
• Weight gain
• Fertility may be less but can still get pregnant

How to stay healthy in perimenopause

Perimenopause is a great time to re-evaluate how you’re feeling about your overall health. Taking steps to quit smoking, limit alcohol, increase exercise, and reduce caffeine can all help your body deal with estrogen swings. Good habits like these also play a role in reducing cortisol, which is important for keeping progesterone levels in a healthy range.

• Go for omega-3s. Think: fatty fish, like salmon, tuna, or mackerel, along with nuts and seeds. Omega-3s are also available as a supplement (fish oil). Vegetarians can go for algal oil, which comes from algae.
• Eat whole foods. Focus your shopping list on the perimeter of the grocery store. Instead of boxed goods, fill up on protein, fruits and vegetables, and complex carbohydrate sources, like whole-wheat bread and sweet potatoes.
• Use salt sparingly. Salt really brings out the flavors in foods, but it also promotes water retention. Perimenopause exacerbates bloating because progesterone, a natural diuretic, is often low in relation to estrogen.
• Think twice about alcohol. Perimenopause happens at such a busy time of life. With families, work outings, and social gatherings, limiting alcohol can seem near impossible. Instead of having a glass of wine or cocktail nightly, plan out your week. Save a drink or two for when you’re at moms’ night or on a date.

Not sure if you’re in perimenopause or menopause?

If you’re not sure which stage you’re in, schedule some time with your provider and talk it over. Thyroid issues and estrogen dominance/low progesterone can cause similar symptoms to perimenopause and may need to be treated a different way.

Lab tests that can help

Tests usually aren’t needed to confirm perimenopause or menopause. Tracking periods is enough. However, if your cycles have long been absent for other reasons, labs may help shed light as to what’s going on. Along with asking about your cycle and checking estrogen and progesterone, your doctor might test luteinizing hormone (LH). Declining and low levels of estrogen cause an increase in LH during menopause.

It’s also possible he or she will check follicle-stimulating hormone (FSH) several times and look for levels greater than 30 mIU/mL. Why test more than once? FSH levels vary during your cycle, but, in menopause, FSH is raised and stays high.

Menopause: when your periods have stopped

Menopause is defined as 12 consecutive months without your period (with no other cause). Your ovaries have stopped releasing eggs. The average age for this phase is 52, but it’s possible to be younger or older.

What to expect in menopause

Menopause can be hard for many women—physically and emotionally. Remember: your body’s had higher amounts of estrogen your entire life. Getting used to low levels is a big adjustment. Give yourself some grace, and make plans to talk with your doctor or a nurse practitioner. There are hormone replacement and lifestyle options that may be able to help.

Symptoms of menopause include:

• Night sweats
• Hot flashes followed by chills
• Insomnia
• Weight gain, especially around the mid-section
• New depression or worsening
• Prone to irritability or crying
• Dryness (vaginal, skin, mouth, and eyes)
• Thinning hair
• Low sex drive
• Headaches
• Intermittent memory problems

How to stay healthy in menopause

With all of the changes it brings, menopause can leave you feeling like you’re just trying to keep up. But making a few lifestyle tweaks may help reduce symptoms and will go a long way toward keeping you healthy in the years to come.

• Stay hydrated with water, and reduce hot drinks. Really need to have coffee? Go for iced over piping-hot. Warm beverages can raise your body temperature temporarily, which could equal a hot flash.
• Reach for ice. Menopausal headaches are tough. Ice can help. Stretch a cool compress over painful areas of your neck, shoulders, or head. Close your eyes, and focus on breathing deeply, which helps with pain and stress.
• Go for edamame. Foods with phytoestrogens may have a slight effect on estrogen levels. Because estrogen is low during menopause, adding soy products to your diet could help raise your levels.
• Ditch fad diets. Aim to eat smaller portion sizes of a wide variety of foods. Go for color in your diet, and prepare old favorites different ways. For example, if you always steam broccoli and carrots, try roasting them in a pan with garlic and olive oil. Or, if you love bruschetta over bread or crostinis, pile it on grilled chicken instead.
• Head to acupuncture. A recent study, Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms, showed acupuncture offered a significant reduction in symptoms over the course of 6 weeks, with no adverse reactions reported. Don’t like needles? There’s only a small prick when they’re put in, and after that most people don’t even feel them.

Postmenopause: focus on heart health

The time followed by menopause often offers a lot of relief from bothersome symptoms. But experts warn that it’s wise to turn your focus toward improving your overall health. Because estrogen helps maintain bone density, low levels brought on by menopause raise your risk for other conditions. One of those conditions is osteoporosis.

You’ll also want to work hard on heart health. Studies show estrogen may play a part in keeping your artery walls flexible, which is important for blood flow and pressure. Another good reason to focus on your heart? All sex hormones, like estrogen, are made from cholesterol. Since your body isn’t producing as much estrogen, your cholesterol levels may rise. Cholesterol can build up in your arteries, blocking blood flow to your heart and increasing your risk for heart attack.

Other ways to maintain health in postmenopause

• Exercise. Go for the trifecta: aerobic exercise (like water aerobics, Zumba, or walking); strength training; and mind-body activities, like yoga. Aerobic exercise is great for heart health, and resistance workouts help maintain bone density. Yoga keeps you flexible, improves range of motion, and promotes balance.
• Increase calcium. Less estrogen makes it harder for your body to absorb calcium from your diet. But you still need it just as much. Ask your doc how much calcium supplementation is right for you.
• Discuss vitamin D. Vitamin D has a long list of benefits, like aiding calcium absorption. However, too much vitamin D can cause kidney stones, so don’t try to make dosage decisions on your own. Bring it up at your next appointment.

Don’t let perimenopause and menopause get you down

Life is full of enough stress, and shifts in our bodies understandably add to that. If you’re feeling unusually blue or depressed about the changes you’re going through in perimenopause and menopause, lean on family and friends for support. Also, be sure to reach out to your doctor right away, too.

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