Premature Menopause and Perimenopause: What's The Difference?

Medically reviewed by Dr Bruce Oran
Written by Our Editorial Team
Last reviewed April 6, 2021
2 minute read
Medically reviewed by Dr Bruce Oran
Written by Sonya Neville
Last reviewed April 6, 2021
5 minute read
Early menopause & Perimenopause: What’s The Difference?

It’s winter. But the thought of putting on another layer is enough to make you sweat.  

You’ve had another really productive day. So why can’t you sleep again? 

For as long as you remember, you’ve always been a well put together sort-of person. But now your mood is all over the place. 

These are just some of the symptoms of menopause. It’s a wide topic of continued focus among those in the medical community. For some, symptoms are mild to moderate and manageable. For others, symptoms can be more serious and have a debilitating impact on everyday life. 

Menopause usually begins between the ages of 45 and 55. The average age to experience it in the US is 51.

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It’s defined as the cessation of menstruation. Having had no periods or spotting for up to 12 months. This happens because of changes to natural hormone balances with age. The ovaries slow down and stop producing as much estrogen over time. The body reaches a point where it can no longer produce eggs.  

However, menopause doesn’t always come as and when you’d expect. 

Sometimes, it arrives early. 

We’re talking specifically about early menopause and perimenopause. What are they? What’s the difference? And what can you do about them?

The difference between premature and early menopause

There is an important distinction to make about any menopause that occurs before the average age range of 45-55.

  • Menopause which happens before the age of 45 is known as early menopause.
  • Menopause which happens before the age of 40 is known as premature menopause.

Typically, the younger a woman is, the less likely she is to experience menopause. But for some, it can strike at any time. 

Some people are even affected as teenagers or into their twenties, though this is a small proportion of people who experience premature menopause. As many as one in 1000 women are post-menopausal before the age of 30. 

The big question is: Why? Why do some women experience menopause early or prematurely? 

Some of the reasons are not fully understood. But it is thought one or more of the following may play a role.

Treatments and surgeries that cause early menopause

Certain medical treatments can kickstart perimenopausal symptoms (we’ll talk a bit more about perimenopause in the next section).  

Breast cancer treatment, chemotherapy or radiotherapy can all bring about early or premature menopause.

The removal of certain organs in a surgery can also send the body into menopause. Surgery to remove the ovaries, for example, if someone is at risk of developing ovarian cancer.

Underlying health conditions that cause early menopause

Research by Menopause, the journal of The North American Menopause Society (NAMS) showed there could be a link between fatigue syndromes and early menopause. Symptoms of chronic fatigue or related syndromes can include weakness, pain in the joints or muscles, headaches or even loss of memory.  

People with fewer than 46 individual chromosomes, or people who have problems with their chromosomes, are more likely to experience early or premature menopause. 

HIV which is not controlled by medication may lead to premature or early menopause. It’s not been studied enough to form a complete medical consensus. But the evidence is growing. Furthermore, according to NAM, a charity in the UK, “HIV or the immune system’s response to it may also have an impact on the ovaries and the production of hormones that affect the experience of menopause.”

Other autoimmune diseases can bring about early menopause too. In some cases, the immune system may “attack” certain organs, like the ovaries, as part of a defensive immune response. This can impact hormone production, which can impact when and how menopause happens.

Premature menopause and family history

There is thought to be a link between early and premature menopause and your family history.  

One study found that 37.5% of people suffering from early menopause reported at least one case of family history where menopause occurred before the age of 46. “Family history” includes a mother, sister, aunt or grandmother.

Smoking and premature menopause

There is also thought to be a link between smoking and premature menopause. According to a study, “cigarette smoke exposure in adulthood is an established risk factor for earlier age at natural menopause and may be related to age at menopausal transition.”

What’s perimenopause?

It all starts when hormone levels begin to fluctuate. The body is struggling to produce them as regularly as it once did. Sometimes they rise, sometimes they fall. The more sharply, the more adverse symptoms may be. 

This includes all the old familiars. Hot flashes, headaches, changes to the mood, night sweats. 

These are common and well-publicised. Most people could probably name at least one symptom of perimenopause. 

But there is a long list of perimenopause symptoms, many of which are less well-known and understood. Some are quite serious, some are less so. Some are experienced by a lot of women, some are very rare.

What are the symptoms of perimenopause?

Even women who have never suffered with mental health problems in the past can begin to experience things like depression and anxiety, seemingly out of nowhere, as they begin perimenopause. 

Women who previously suffered from premenstrual syndrome (PMS) can be more adversely affected during perimenopause. Many women feel extremely vulnerable, both mentally and physically, when they begin to experience perimenopause. 

It’s really important that you make time to talk to your doctor about the perimenopause if you think you’ve started to experience it. Even if you develop certain symptoms and you’re unsure, it’s better to check it over with a medical professional.

Early menopause or endometriosis?

Endometriosis is a condition which involves tissue growing in places it shouldn’t. This can include the womb or ovaries. It can impact women of any age. 

Symptoms include pain on your period, pain during or around the time you have sex, pain while going to the toilet, feeling sick, constipation, diaorrhea, blood in the urine, lower abdominal pain or problems getting pregnant. 

Endometriosis can be a difficult condition to diagnose. It has come under controversy in the media in recent years, because it has either been mis-diagnosed or assumed to be natural symptoms more associated with the menstrual cycle. 

According to a government enquiry, despite one in 10 women suffering with endometriosis, it takes an average of eight years to be diagnosed with the condition. It’s widely believed actual cases of endometriosis are far higher than that which is reported. 

There’s no established treatment for endometriosis. A doctor may recommend painkillers, hormone medication or contraceptives, surgery to remove tissue or hysterectomy. 

The latter treatments can and may induce early menopause, particularly if organs like the ovaries have to be removed as a consequence of endometriosis. 

How to identify perimenopause and when to see a doctor. Why your menopause matters.

The symptoms that kickstart the entire process, perimenopause, can last for up to four years on average. Every one in 10 women will experience the symptoms of menopause for up to 12 years. 

Knowing whether you’re suffering with perimenopause or something else can be really difficult. Sometimes, medical professionals need to monitor you closely over a period of time before they’re comfortable making a firm diagnosis.

Premature Menopause vs. Perimenopause: What's The Difference?

Menopause isn’t always straightforward and sometimes it can come early. Having a basic understanding of early menopause, and perimenopause which will precede it, doesn’t hurt. 

Millions of women experience menopause every year. Regardless of the age this happens, some level of perimenopausal symptoms is to be expected. 

Just reading up on perimenopause and having a basic understanding of what it might look and feel like can be of benefit. Be open with your friends and family — menopause is nothing to be ashamed of. 

Though it can be distressing if it comes early, particularly if prematurely. So never hesitate to come forward and talk to a health professional about your symptoms and concerns.

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