The Problem: Why Does No One Explain This?
If you’ve spent the last few years feeling like your body is betraying you—experiencing mood swings, crushing fatigue, or periods that have gone completely rogue—you are not alone. And the biggest source of confusion isn’t the symptoms themselves, but the terminology.
So many women get dismissed because they are told they are “too young for the menopause.” As a UK Registered Nurse, I’m here to tell you that this often happens because we are mixing up two distinct stages: Perimenopause and Menopause.
Menopause is one single day; perimenopause is the chaotic, unpredictable journey leading up to it. Understanding the difference is the first step toward taking control of your health.
1. Perimenopause: The Hormonal Rollercoaster (The Chaos)
Perimenopause literally means “around menopause.” This is the transitional phase, typically beginning in a woman’s 40s (but sometimes earlier), where your ovaries start slowing down and your hormones—primarily oestrogen and progesterone—begin to fluctuate wildly.
This fluctuation, not the final drop, is what causes the most intense and often weirdest symptoms.
What’s Happening in Your Body:
Your periods are still happening, but the delicate ballet of ovulation is becoming irregular. Because ovulation is inconsistent, the production of progesterone (our calm-down, sleep-friendly hormone) drops first. This leaves you with relative oestrogen dominance, leading to symptoms like:
- Mood Swings and Anxiety: Often misdiagnosed as Generalised Anxiety Disorder.
- Insomnia: Waking up at 3 or 4 am and struggling to fall back asleep.
- Irregular Bleeding: Cycles become shorter, longer, heavier, or lighter.
- Worsening PMS: Increased irritability, breast tenderness, and migraines.
Why this matters: If you present to your GP with anxiety and irregular periods, you need to understand that these are classic perimenopause symptoms. Being able to connect these dots is empowerment.
2. Menopause: The Retrospective Diagnosis (The Marker)
Unlike perimenopause, menopause is not a phase; it’s an event.
Menopause is officially diagnosed after you have gone 12 consecutive months without a menstrual period.
The average age for a woman in the UK to reach menopause is 51. Once you hit that 12-month mark, your body’s hormone levels—oestrogen and progesterone—have settled at a consistently low level. You are now considered postmenopausal.
What Changes at This Stage:
While the hormonal chaos of perimenopause is over, new health considerations arise:
- Symptoms Often Persist: Hot flashes, vaginal dryness, and joint pain can continue for many years, though often less intensely than during the fluctuating perimenopause years.
- Long-Term Health: Lower oestrogen levels increase the long-term risk of conditions like osteoporosis and heart disease. This is why regular checks and lifestyle adjustments are crucial post-menopause.
| Feature | Perimenopause (The Chaos) | Menopause (The Marker) |
| Hormone Levels | Wildly Fluctuating (oestrogen spikes, progesterone drops). | Consistently Low (oestrogen and progesterone). |
| Menstrual Cycle | Irregular, shorter, longer, heavier, or lighter. | Absent for 12 consecutive months. |
| Emotional State | Often characterised by anxiety and mood swings. | Can involve low mood and cognitive changes (“brain fog”). |
| Fertility | Reduced, but still possible. | Ended. |
Taking the Next Step: Knowledge is Your Power
If you are reading this and ticking off the perimenopause symptoms, your next step is not panic, but preparation.
You have a right to evidence-based care in the UK. When you next speak to your healthcare provider, go in with data, not just anxiety.
Your Action Plan:
- Start Tracking: Begin monitoring your symptoms, moods, and cycle length right now. This concrete data is the most valuable tool you can bring to your appointment.
- Know the NICE Guidelines: Familiarise yourself with the basic NHS/NICE guidance on menopause so you can advocate for yourself with confidence.
Useful Links
NHS Guidince
NICE Guidelines