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Menopause is clinically defined as a stage reached when a woman has not menstruated for 12 months, have had no pregnancy or other medical condition that could explain the lack of periods. Perimenopause is the entire time leading up to this event and it can begin 10-15 years before true menopause is reached. Distinctions between menopause and perimenopause are often confusing, and many inaccurately believe that menopause is the beginning of the symptoms that accompany declining hormones. In actuality, this is perimenopause, though the last year when periods have ceased may be referred to as being “in menopause.” Another way to define the difference is to view perimenopause as a stage when periods are still occurring, no matter how irregularly, and menopause as a time when periods have completely ceased.
It is fairly easy to diagnose perimenopause. Decline in hormones can be evaluated by a series of blood tests. Symptoms, including decreased fertility, greater irregularity in periods, changes in skin and hair, tendency toward mood swings, difficulty with temperature control, and hot flashes, are also fairly obvious, more so as true menopause is approached. It’s important to note the more uncomfortable symptoms may be culturally linked, and in some cultures the experience of perimenopause is accompanied by few symptoms except fertility decline and irregularity in periods; the transition to menopause is much more gentle.
A big contrast exists between menopause and perimenopause diagnostically. Unless menopause is induced surgically by removal of ovaries and uterus, the condition can only be diagnosed retroactively, after a year has passed since menstruation last occurred. This distinction is vital for women to understand.
As periods grow more irregular, perhaps not occurring for several months at a time, women may believe they are infertile. Although fertility is increasingly compromised during perimenopause, the belief in total infertility has lead to many unintended pregnancies, and the births of what are euphemistically termed “change babies.” Until menopause is verifiable under the clinical diagnosis, women wishing to avoid pregnancy should continue to use birth control, and some doctors recommend birth control be continued for a year after diagnosis.
Differences between menopause and perimenopause may be noted by age. Many doctors now view the beginning of perimenopause as in the 30s, when periods may first begin to be irregular. Most women don’t reach menopause until their mid-40s or early 50s. Definition by age varies among women, and the greatest predictor of time of menopause is the menopause onset age of a woman’s mother.
It’s also valuable to understand that the lengths of time of menopause and perimenopause aren’t equal. Menopause is essentially one year of time, and perimenopause occurs for years. This may make some women worried that they’ll suffer hot flashes and mood swings for many years, but this usually doesn’t occur. As perimenopause moves closer to menopause, symptoms tend to increase, but in the beginning, symptoms are minimal. Most women won’t experience regular hot flashes or mood swings until they’re very close to entering menopause.
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