What Is Perimenopause and How Is It Different from Menopause?

If you’ve been told ‘you’re not menopausal yet’ but feel nothing like your old self, that mismatch is exactly what perimenopause can feel like.

One of the biggest sources of confusion in midlife is the difference between perimenopause and menopause. Many assume menopause is the problem, when in reality it’s perimenopause that causes the most disruption to mood, energy, sleep, confidence and daily functioning.

Recognising the difference helps explain why your body feels unpredictable, why symptoms shift and why test results can seem misleading.

What Is Perimenopause?

Perimenopause means “around menopause”. It is the transitional phase leading up to menopause, when ovarian hormone production becomes erratic rather than simply declining.

This stage can begin years before your final period, often in your early to mid‑40s, sometimes earlier.

According to Professor Susan Davis, Director of the Women’s Health Research Program at Monash University, perimenopause is characterised not by low hormones, but by hormonal instability, particularly fluctuating oestrogen levels.

“It is the variability in hormone concentrations, rather than absolute deficiency, that drives many perimenopausal symptoms.”- Prof Susan Davis

What’s happening hormonally?

• Oestrogen rises and falls unpredictably

• Progesterone production declines earlier and more consistently

• The brain’s hormone‑sensing centres struggle to adapt to this instability

This hormonal “noise” affects not just the reproductive system, but the brain, nervous system, metabolism and sleep regulation.

Common Symptoms of Perimenopause

Perimenopause is often mistaken for stress, burnout or anxiety especially in women juggling busy lives.

Common symptoms include:

• Mood swings, irritability or sudden anxiety

• Poor sleep or early‑morning waking

• Brain fog or reduced concentration

• Fatigue that doesn’t improve with rest

• Changes in menstrual cycle length or flow

• New or worsening PMS

• Hot flushes or night sweats

• Reduced stress tolerance or emotional resilience

Dr Jen Gunter, gynaecologist and menopause educator, emphasises that perimenopause is frequently under‑recognised, despite being when symptoms are often most severe.

“Perimenopause can be far more symptomatic than menopause itself, yet women are often told nothing is wrong.”
- Dr Jen Gunter

What Is Menopause?

Menopause is not a phase; it is a single point in time.

You are considered menopausal when you have gone 12 consecutive months without a menstrual period, with no other medical cause.

The average age of menopause in the UK is 51. After this point, you are described as postmenopausal.

Hormonal changes in menopause

• Oestrogen levels are consistently low

• Progesterone production has ceased

• Hormone fluctuations settle, but deficiency remains

This distinction is important because many symptoms ease after menopause, while others (such as bone density changes, cardiovascular risk and urogenital symptoms) become more relevant.

Perimenopause vs Menopause: Why the Difference Matters             

Perimenopause                       Menopause

Hormones fluctuate unpredictably                        Hormones are consistently low

Symptoms can be intense and erratic                   Symptoms may stabilise

Periods continue (but change)                               Periods have stopped

Blood tests are unreliable                                      Diagnosis is retrospective

Often misunderstood or dismissed                       More widely recognised

Professor Davis and colleagues have shown that vasomotor symptoms (hot flushes and night sweats) that newly appear are highly specific to perimenopause, making them an important diagnostic clue rather than something to ignore  (PMID: 37902335).

Why Blood Tests Often Don’t Help in Perimenopause

Many women find it frustrating to be told their hormone tests are “normal” when their symptoms clearly aren’t.

This is not because symptoms aren’t real, it’s because perimenopause is defined by fluctuation, not steady levels.

Hormone levels can appear normal one day and very different the next. For this reason:

• Blood tests cannot rule out perimenopause

• Diagnosis is based on age, cycle changes and symptoms

This position is supported by menopause societies worldwide, including the British Menopause Society and international researchers such as Prof Susan Davis.

Is Perimenopause a Mental Health Issue?

Perimenopause is not a mental health disorder, but hormonal fluctuations can significantly affect:

• Neurotransmitters such as serotonin and GABA

• Stress response and emotional regulation

• Sleep quality and recovery

Research shows increased vulnerability to anxiety and low mood during the menopausal transition, particularly in women with previous sensitivity to hormonal change (PMID: 30766689).

This is why support needs to look at the whole person, not just individual symptoms.

Where I Fit In as a Menopause Health Coach

I don’t diagnose, prescribe or replace medical care and I dont need to.

My role is to help you make sense of what’s happening and crucially, what to do next.

I support women to:

• Understand what’s changing in their body, so symptoms feel less frightening and less random

• Translate credible menopause science into everyday actions that fit real lives, not ideal ones

• Build sustainable habits around sleep, movement, nourishment and stress, without perfection

• Navigate behaviour change with consistency, especially when energy, motivation or confidence are low

• Rebuild trust in your body, after months or years of feeling like it’s let you down

For many women, perimenopause is the moment when strategies that once worked suddenly don’t.

Not because you’re doing anything wrong but because your physiology is playing by different rules.

That’s the gap I help you bridge.

The Most Important Takeaway

Perimenopause and menopause are not the same and confusing them often leads women to doubt themselves.

If you feel unsettled, emotionally reactive, exhausted or “not like yourself” in your 40s or early 50s, perimenopause may be the missing piece of the puzzle.

Support during this stage should be informed, compassionate and evidence‑based, never dismissive.

I work with women to make sense of midlife changes, build steady routines that support energy and mood and regain a sense of confidence and control, without extremes, judgement or medicalising normal transitions.

You can explore working with me here: themenopausehealthcoach.com/contact

References

• Thurston, RC et al. Vasomotor symptoms. PMID: 3185243

• Davis SR, et al. The 2023 Practitioner's Toolkit for Managing Menopause. PMID: 37902335

• Gunter J. 2021. The Menopause Manifesto. Evidence‑based menopause education.

• Freeman EW et al. Mood symptoms during the menopausal transition.PMID: 30766689