Hi, I'm Dr. Bianca!


I’m a menopausal woman. I write about what it's like to get through the hormonal transition we’ve come to know as menopause. My intent is to help us all age together in the best and healthiest way possible. Let’s not suffer in silence. Let’s normalize the conversation. 


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The perimenopause vs menopause differences are subtle in the beginning.

Hot flushes, night sweats, mood swings, brain fog.... 

You begin to wonder, "what is going on with my body!?" 

Did it come on suddenly, or has it been ramping up gradually? Have I even made the connection?

These symptoms can feel like a tsunami of chaos...where does peri begin, and when does menopause end? 

Every woman has her own individual story. 

Usually, during a woman's 40s, changes start to happen, both physically and emotionally. Of course, the physical symptoms are more obvious. However, the emotional changes can make you feel like you are a stranger to yourself

Most women I speak with going through this transition don't really understand what is happening.

They can't always connect the dots. 

In addition, they don't know how to discuss their issues because menopause has never been a topic of normalized conversation

Until now.

Perimenopause vs Menopause

Even though we typically talk about common symptoms like hot flashes, we are still not making the connections of other, more unfamiliar feelings


  • burning tongue
  • itchy skin
  • joint pain 
  • sudden frozen shoulder
  • chronic insomnia
  • brain fog

Knowledge is power. The more you know, the better off you are to discuss what you are going through to your healthcare providers, family and intimate partner.

Yet, there still tends to be a lot of confusion about the differences between perimenopause and menopause.

So, if you want some clarification on some of these symptoms, read on!

What Is Perimenopause 

The prefix 'peri' means around. So the term perimenopause refers to the time around menopause. There is no set date or age when perimenopause will happen, although it generally begins in your 40s. 

There is no fixed duration for it either, unfortunately.

It would be nice to know if there is an actual end date.

During this time, your ovaries will stop producing hormones as your reproductive time ends. These hormones include estrogen, progesterone, testosterone, follicle-stimulating hormone (FSH levels), and luteinizing hormone (LH).

According to the Mayo Clinic, the average age of menopause in the United States is 51. 

However, it affects different ages at different times. 

Once a woman has gone through menopause, she can no longer become pregnant.

What Determines Menopause

  • Once you have gone 12 consecutive months, or one full year  without a period, you are officially in menopause.

Perimenopause vs Menopause Symptoms

Due to the hormonal changes in your body, you might notice your weight, hair, or even changes in your skin.

Many of these symptoms happen to perimenopausal women.

By entering menopause, your body had some to adjust to these now-permanent changes.

Let's look at the more common perimenopausal symptoms you can expect.

Keep in mind, many of these feelings can begin during perimenopause and continue long after you no longer have a monthly period. 

Hot Flushes and Night Sweats

perimenopause vs menopause hot flashes

Women often experience hot flushes, also known as hot flashes, or medically known as vasomotor symptoms.

These intense feelings of heat can 'come out of nowhere.'

They can be triggered by food,  made worse in hot environments, and can occur with or without anxiety.

They can continue for years and are one of the most common symptoms of menopause.

It is difficult to distinguish between a hot flush and severe hot flashes because it's  a subjective experience

A woman experiences hot flushes as: 

  • Feeling clammy
  • Excessive sweating
  • Hot and reddened face and chest
  • Fast heartbeat or racing heart

Night sweats can occur out of nowhere and without warning. 

Hot flashes can be worsened by being in a hot environment; however, even on a cold winter night, blankets, shirts and pajamas can be suddenly ripped off in the middle of the night in any attempt to to cool down. 

Sometimes hot flushes can lead to embarrassing moments. Boob, pits and upper lip sweat is never a cute look.

  • Consider carrying a cooling towel throughout the day! These cloths can quickly reduce skin temperature during a hot flash. Adding 1-2 drops of pure peppermint essential oil to the fabric can also help cool the skin. As with any essential oils, do a patch test to ensure you do not have any adverse skin reactions.

After a hot flush, it is also normal to feel a period of coolness or intense chills due to the heat rapidly escaping from your body. 

Declining Hormones

Hot flashes result from declining estrogen levels in the body as we age. 

Estrogen affects the hypothalamus, which regulates body temperature. At the same time, your pituitary gland will produce higher levels of FSH (follicle-stimulating hormone).

As your hormone levels fluctuate, your body temperature will fluctuate too.

Before, hot flushes were thought to last three to five years once you have entered menopause.

Still, with more research in this field, there is evidence to show that hot flushes can continue for many years.

perimenopause vs Menopause: Vaginal Dryness

perimenopause vs menopause vaginal dryness

Another physical symptom some women experience during perimenopause is pain during sexual intercourse.

Vaginal tissue secretes a thin layer of mucous inside the vagina, providing lubrication during sex.

The decrease in estrogen leaves the vaginal tissue less lubricated, causing dryness.

This dryness can lead to pain during penetration.

Besides the dryness, the decreased estrogen levels cause the pH levels of the vagina to change from an acidic environment to a more alkaline one.

Some women experience higher incidences of urinary tract infections (UTIs) when their vaginal environment changes.

This opens the way for irritation and an increased risk of vaginal infection. 

These symptoms can lead to a decreased sex drive, which could damper intimacy with your partner.

  • Vaginal lubrication can help women find intercourse to be more pleasurable at the time of perimenopause. There are many types of lubes on the market. Water, silicon, and oil-based lubes can be used; however, beware of fragrances or tastes, as the ingredients can further irritate the vaginal lining.

Urinary Incontinence

perimenopause vs menopause urinary incontinence

Urinary incontinence is another symptom that can feel like it's taking control of your life. Many women don't feel confident straying too far from the bathroom if leaking is a problem. 

The health and muscle strength of the vaginal area and pelvic floor weakens over time.

Estrogen nourishes connective tissue, so our muscles become weaker and less supportive when it declines. Leading to dribbling or leaking urine. 

Having a weak bladder from childbirth can cause leaking when you least expect it. 

Sneezing, coughing, running, or jumping exercises can put a lot of pressure on the pelvic floor, leading to soggy underpants. 

How To Reduce the Incidences of Urinary Incontinence

  • Practice pelvic floor exercises, such as Kegel exercises, throughout the day. You can do these while working or in line at the store.
  • Use a biofeedback device to train your vaginal muscles. 
  • Reduce your fluid intake and limit the amount you get closer to turning in for the night.
  • Use panty liners, pads, or period underwear to prevent leaks through your clothes.
  • Adjust your diet to reduce foods that irritate the bladder, such as sugar, salty or spicy foods
  • "Sling Surgery" is a medical procedure performed if you have exhausted all other options. 

Speaking to your healthcare professional can reduce your concerns.

In addition, making simple lifestyle changes can help you be more comfortable.

perimenopause vs menopause: Irregular Periods

perimenopause vs menopause irregular periods

The most tell-tale sign of perimenopause is the changes in your menstrual periods.

Your menstrual bleeding might change, and you can experience the following:

  • Your typical 28-day cycle might shorten or lengthen in length 
  • You might spot or have some mid-cycle bleeding
  • The amount of blood might become very light or "crime scene like" heavy bleeding
  • Changes in texture (more blood clots) or the color of your blood (dark purple or red) can occur 

It's advisable to keep a period journal, or download a tracking app, to monitor the changes in your monthly cycle. The more details you can give your healthcare provider and yourself, the better. You don't want to spend your days worrying about being pregnant if you skipped a month. 

At the same time, although rare, women can become pregnant if they are still ovulating in their late 40s or even early 50s. 

Abnormal bleeding is significant to note during this time. Clotting and heavy increases in volume are typically due to hormonal changes. Leading to irregularities in how the lining is being shed from your uterus. 

During late-stage perimenopause, you will start to skip your periods. This is part of 'the change of life.' 

Seeking advice and assistance from your healthcare provider at this time is essential for your well-being. 

Finally, once you are in full menopause, you will no longer have a monthly period.

Weight Gain

perimenopause vs menopause weight gain

On average, a woman will gain five or more pounds during menopause, even if nothing changes her diet or lifestyle.

Fat accumulates throughout the midsection instead of around the body as we age. It gathers around the abdomen, totally responsible for that muffin top or menopot. 

Fat accumulation in the abdomen can take a toll on your heart and, if left untreated, can lead to heart disease and even cause a heart attack

These fat deposits can lead to further complications, such as:

  • Type 2 diabetes
  • Raised cholesterol levels
  • Difficulty breathing/ sleep apnea
  • As we age, a woman's metabolism decreases by approximately 5% per decade. This means we need to take in fewer calories in our 40s than we needed in our 20s. Constipation and GI distress can also increase during the (peri)menopausal years leaving us feeling bloated and heavy. 

This doesn't mean you'll be dieting for the rest of your life!

You can, however, start making some slight adjustments such as:

  • Following a nutritious eating plan and ensuring you're following a healthy diet (try this tricolor quinoa salad recipe to power up your protein!)
  • Keeping a log of the food that you eat daily and making adjustments where you can see you're falling short
  • Take up exercise, whether walking, jogging, running a 5k, or yoga - just do something 4 - 5 times a week for at least 30 minutes a day. Not only is it good for your body, but it's also essential for your state of mind. The CDC notes that over 1 in 4 adults in the USA do not do any form of exercise.
  • Includes foods in your diet that prove to burn fat. Foods high in soluble fiber are legumes, nuts, fresh fruit, and vegetables. 

Taking care of yourself, exercising, and eating nutritious foods are essential. 

I made it my mission when I was 43 to lose 25 pounds, get fit, and set myself up for menopause in the healthiest way possible! 

  • Drinking water mixed with cayenne pepper every day will increase your metabolic rate. Cayenne pepper contains capsaicin which burns fat and increases your metabolism. 

Perimenopause vs Menopause: Sleep disturbances

perimenopause vs menopause sleep disturbances

Your much-needed sleep is likely to be disturbed by hot and/or cold night sweats, and both can be accompanied by anxiety . 

Estrogen is responsible for the rise and fall of two critical hormones that harmonize our sleep/wake cycle: melatonin and cortisol

When estrogen declines, these important sleep hormones fluctuate wildly, leaving us "wired and tired." Too wired at night and too tired during the day.

Other sleep disturbances could include:

  • Difficulty falling asleep
  • Trouble staying asleep
  • Insomnia
  • Restless Legs Syndrome 

Being overtired and fatigued can affect your overall sleep health. 

Night sweats are excessive flares of heat during the night when your body starts to sweat excessively.

Cold night sweats are similar, except they cause you to wake in a cold sweat, rather than the feeling of heat.

Night-time anxiety can occur when you can't "turn off your brain" once you are awake and hyper-focus on trying to fall back asleep. 

How To Improve Your Ability To Sleep Through The Night

  • Ingest some protein or foods high in tryptophan before bedtime (e.g., turkey breast slices, tart cherry juice)
  • Avoid sugary foods after 6pm. 
  • Sleep in a dark room (use black-out shades, and an eye mask, and remove all nightlights or electrical devices from the room that might give out light)
  • Sleep on cooling sheets 
  • Make sure the room temperature is cool. 
  • Sleep in organic cotton cooling pajamas 
  • Turn on a guided meditation or perform a Yoga Nidra.
  • Take Magnesium threonate or indulge in an Epsom salt bath before bed.
  • Hair Changes

    perimenopause vs menopause changes in hair

    Not one of the most common symptoms, but it does happen. 

    Hair that is greying changes in texture and becomes wiry. There are natural products on the market (I personally use AREY GREY to keep my unruly curls from losing their luster and color.)

    Women notice changes in their hair growth, although it is not always as evident as men, who tend to be bald. 

    Thanks again to the decrease in your levels of estrogen and progesterone, your hair will start to thin and grow slower as you age.

    Also, some women's hormones change to produce higher levels of testosterone. Unfortunately, this has the opposite effect and can lead to facial hair growth and thicker hair growing on your arms, back, and even your chest.

    Perimenopause vs Menopause: Mood Changes

    perimenopause vs menopause mood changes

    Looking after your mental health is as important as taking care of your physical health. 

    Many women undergoing perimenopause experience mood swings, often anxiety and depression. 

    Women often say that these mood swings 'come out of nowhere and are much more severe than any others they have been through before.

    As estrogen levels decrease and during perimenopause, so does its effect on the mood-regulating hormone, serotonin, also known as the 'happiness' hormone. 

    Because our mood stabilizer isn't working as before, many women will see-saw between crying, laughing, and feelings of anger for no apparent reason.  

    Some women also report becoming quite forgetful. Brain fog, difficulty concentrating, and trouble recalling words can all occur. 

    Severe anxiety episodes can lead to panic attacks, so check what is happening with your moods. Some women have reported going from zero to depressed in seconds.

    Do you feel more out of control at certain times of the month? Is this during ovulation or right before your period is supposed to start? At the risk of sounding redundant, track your moods in a journal! These might all be due to hormonal fluctuations. 

    • 60% of middle-aged women deal with concentration difficulties and forgetfulness problems. In fact, studies show that women with cognition symptoms are the ones often also dealing with sleep disturbances and severe hot flashes.

    In Conclusion

    blood test to determine if you are in perimenopause or menopause is ineffective because its results will come back skewed. 

    If you are tested on a day when your hormone levels are low, you might have a false positive. Likewise, you might get a false negative if you have high hormone results. 

    Hormones fluctuate wildly at this time. Therefore it is best to stay mindful of all symptoms that seem either out of the ordinary or extreme and note them. 

    Always discuss changes in your body with your healthcare providers. Gynecologists, Endocrinologists, DO's, Homeopaths, Naturopaths, and Acupuncturists can all be of great value in assisting you through this time, whether you take a conventional or integrative approach to healthy aging. 

    Some women begin hormone replacement therapy (HRT) or use bioidentical hormone treatment to relieve some symptoms. However, as with all interventions, there are risks and potential side effects with any ingested drugs or herbal combination. 

    Besides medical interventions, homeopathic options, exercise, and changes to your diet can help reduce perimenopausal symptoms and possibly assist in a smoother menopausal transition

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    Dr. Bianca Beldini

    I’m your Doctor of Physical Therapy, Acupuncturist, Master Dry Needler, and Triathlon and Running Coach. I’ve been in the health, wellness and fitness industry for over 25 years, and I’m here to help you reach your optimal health.