Yes, there is a difference between menopause and perimenopause. Menopause, which literally means cessation of menstruation, is the most notable manifestation of the end of a woman’s reproductive life.

It is a one day event that usually occurs between ages 48-51 years. It is defined as the day when the woman has had no menstrual period for one full year. Menopause is a normal phase in a woman’s life that marks the end of fertility, the end of the childbearing years.

Normally, a woman does not go into menopause abruptly. There is a transition period of about six years during which the production of the female hormones by the aging ovaries — which governs the woman’s menstrual and reproductive cycle — gradually diminishes. This transition period plus the year or so after menopause is referred to as perimenopause.

You have not menstruated the last six months, does this mean you have gone into menopause? If you do not menstruate in another six months then you are definitely in menopause, but at the moment, the only thing we can say with certainty is that you are in perimenopause.

The female hormones — estrogen and progesterone — exert profound effects not just on a woman’s childbearing capacity but on many of her other bodily functions. The host of signs and symptoms that perimenopausal women experience are the effects of the fluctuations and decline in the production of the female hormones by the ovaries during this phase of a woman’s life.

What are the common signs and symptoms of perimenopause? Irregularity in menstrual periods is one. The menstrual irregularity may be in the length of the period (several days longer or shorter than usual and sometimes absent), interval between periods, and amount of menstrual flow (sometimes scanty, sometimes profuse).

Other common manifestations of perimenopause include headaches, dizziness, nervousness, night sweats, mood swings (e.g., irritability and depression), vaginal dryness resulting in painful sexual intercourse, urinary incontinence, decreased sexual desire or libido, forgetfulness, insomnia and fatigue.

The declining estrogen levels during perimenopause also results in some unfavorable changes in many metabolic processes of a woman. Notably, she loses bone mass more quickly than she can replace, increasing her risk for osteoporosis. Her blood cholesterol levels likewise get affected resulting in an increase in low-density lipoprotein (LDL) cholesterol or "bad" cholesterol and a decrease in high-density lipoprotein (HDL) cholesterol or "good" cholesterol and these increase her risk of developing coronary heart disease.

Hormonal replacement therapy (HRT), which consists of regular intake of pills containing estrogen and progesterone or estrogen alone, is very effective not only in relieving the signs and symptoms of perimenopause such as hot flashes and vaginal dryness but also in preventing osteoporosis and heart disease. Until 2002, HRT had been the standard therapy for treating perimenopausal symptoms.

However, studies whose results were released from 2002 onwards have indicated that HRT increases a woman’s risk for breast cancer, stroke, blood clots, dementia and even heart disease. The risk for these diseases is higher for combination estrogen and progesterone therapy than for estrogen therapy alone.

Hence, the popularity of HRT has waned considerably but for some women with moderate to severe symptoms, the benefits of short-term therapy outweigh the potential risks. At any rate, HRT should be utilized only on prescription and under the supervision of a physician, preferably an obstetrician.

By the way, there are certain selfcare measures that can ease the perimenopausal syndrome. Regular exercise strengthens the bones and improves mood and sleep. Likewise, a healthy diet that is low-fat and high fiber reduces the risk of heart disease. Also, perimenopausal women are best advised to avoid alcohol and cigarettes and to consider taking calcium supplements to help prevent osteoporosis.