Perimenopause vs Menopause: How to Tell Which Stage You're In

Your period tracker app sends a notification: period late by 12 days. You stare at it. You buy a pregnancy test on the way home, heart racing. Negative. Relief, then confusion. Then next month, your period comes twice. At lunch you mention it to a colleague, and she laughs, welcome to the club. You laugh too, but inside you think: I am only 42. Surely it is too early for this?

If you are wondering about perimenopause vs menopause, and which one you are in, you are asking exactly the right question. Knowing your stage changes how you understand your body.

Think of a train pulling into a station

Picture a long-distance train coming into a big station. It does not stop suddenly: first it slows down, it jerks a little, the announcements start. Then, at one exact moment, it stops. After that, you step out onto the platform into a new city.

Menopause works the same way. Perimenopause is the slowing down and the jerks. Menopause is the exact moment the train stops. Postmenopause is the new city where you will live for many years.

Perimenopause is the transition before your final period. International guidelines describe its early part as a noticeable change in your cycle, where the length of your cycles differs by seven days or more again and again. Later in perimenopause, you may go 60 days or more without a period.

Common perimenopause symptoms

Irregular periods, heavier or lighter bleeding, hot flashes, poor sleep, mood swings and trouble concentrating. Because hormones swing up and down rather than simply dropping, symptoms can come and go from month to month.

When it starts

Perimenopause age varies from woman to woman. Indian women reach menopause at about 46 on average, based on a nationwide survey by the Indian Menopause Society. So the slowing down often starts in the early forties, and irregular periods at 40 can be a normal early sign. Remember that notification from your tracker app? That jerky schedule is the train starting to slow down.

Pregnancy is still possible

You may still release an egg some months, so speak to your doctor about contraception if you need it.

Stage two: menopause, the moment the train stops

Menopause is technically just one day. It is confirmed when you have gone 12 months in a row without a period, with no other cause. You only know it looking back.

That average age of about 46 is a few years earlier than in many Western countries, which is why Indian women sometimes feel caught off guard.

Stage three: postmenopause, the new city

Postmenopause is every year after that one day. For many women, hot flashes gradually settle in the years after the final period. Other symptoms, such as vaginal dryness, tend to stay and may need ongoing care. Heart health also deserves closer attention in this stage, because cholesterol and blood vessels change around menopause.

“You are not too young, and you are not too old. You are right on time for the next chapter.”

Perimenopause vs menopause: how do I know which stage I am in?

Track your cycles for three to six months, noting dates, flow and symptoms, and share this with your gynaecologist. Blood tests for hormones such as FSH can be confusing in perimenopause because levels change from week to week, so your cycle pattern and symptoms often tell the clearer story.

If you have very heavy bleeding, bleeding between periods or any bleeding after menopause, see a doctor promptly.

Support that starts early

Perimenopause is the best time to start caring for yourself, not after years of struggling. No Pause in you was designed for these years. Its 600 mg of KSM-66 ashwagandha supports you through stress and sleep changes, Soy Life isoflavones provide gentle plant-based support, and 30 mg of saffron supports mood. Hyaluronic acid, vitamin E and two probiotic strains round out a pomegranate-peach flavoured sachet that fits easily into your morning.

The notification, a few months later

Your tracker app pings again. This time you smile. You know what is happening. You have spoken to your doctor, you have a routine that supports you, and you have friends who laugh with you about it.

Today, open your period tracker, or a notebook, and add three things to each entry from now on: flow, sleep quality and mood. In three months, you will have a clear map of your own stage to share with your doctor.

Written by: Dr. Indraneel

Disclaimer

This article is for general information only and is not a substitute for medical advice. No Pause in you is a nutraceutical supplement and is not intended to diagnose, treat, cure or prevent any disease. Speak to your doctor before starting any supplement, especially if you have a medical condition or take regular medication. Individual results may vary.

References

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3. Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.

4. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-8.

5. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;142(25):e506-32.