Perimenopause, the transitional phase before menopause, often goes unnoticed despite its significant impact on women’s health.
Menopause generally occurs between the ages of 45 and 55 and is characterized by well-known symptoms such as hot flashes, urinary incontinence, and sleep disturbances. Before this, there is a transition period between so-called “normal” ovarian activity and its cessation. Its name is perimenopause (or premenopause).
Caused by the depletion of ovarian follicles, it manifests through a series of clinical and/or biological warning signs that are sometimes overlooked and restrictive. In a document published by Formathon, a general medicine conference, Dr Geoffroy Robin even describes it as “hormonal anarchy.” A period that can last “between two and four years,” warns medical gynaecologist Brigitte Letombe, author of the book Women, Wake Up! (Éd. First).
Symptoms of perimenopause
Perimenopause occurs when the ovaries become too depleted of follicles and gradually stop secreting estrogen and progesterone. FSH, the follicle-stimulating hormone, will work at full speed in an attempt to recruit an egg, while estradiol, one of the estrogens, will be at its lowest level.
This hormonal shift explains the first sign of impending menopause: irregular periods, which can sometimes be very heavy. “At times, the ovaries will work too hard, causing a woman to menstruate every 20 days, for example, and at other times, they will stop altogether, and she won’t have a period for three months,” the gynaecologist explains.
These irregular cycles can also be accompanied by an intensified premenstrual syndrome (PMS), she adds. Indeed, hormonal fluctuations can lead to mood disorders or even a “depressive syndrome,” according to Dr Letombe, as well as breast pain, weight fluctuations, water retention, or bloating.
In addition to urinary leaks, vaginal dryness, joint pain, and hot flashes can already appear during perimenopause. Dr. Letombe also highlights another lesser-known symptom, yet one reported by many women approaching fifty: cognitive issues. Doctors refer to this as “brain fog.” “They say they often feel tired, less responsive, and struggle with memory problems,” she describes.
Treating perimenopause when it is difficult to handle
Although perimenopause generally occurs around the age of 47, according to the French health insurance authority Assurance Maladie, it can also affect younger women. This includes those experiencing early menopause, which is characterized by ovarian function ceasing before the age of 40.
Because early menopause increases the risk of heart disease and osteoporosis, it is treated with hormone replacement therapy (HRT) to compensate for low estrogen levels. “A treatment that all women approaching menopause should be aware of, especially those who struggle with these hormonal fluctuations,” the gynaecologist emphasises.
“There is a real taboo around menopause because women mistakenly believe it marks the beginning of old age. We must not dismiss these symptoms, and it is important to consult a doctor, as treatments can genuinely help women during this transition period,” says Dr Letombe.
“When menopause fully sets in, the roller coaster ride ends,” she continues. “One in four women will feel much better afterwards. Two in four women will feel they can manage, with or without treatment. The others, however, have a very difficult time with the symptoms. So, from the age of 45, if a woman seeks medical advice for memory problems or depression, we should not disregard menopause as a possible cause. We must absolutely inform them about the available treatments that can truly help them through this phase.”
HRT, which can consist of estrogen, progestin, or a combination of both, helps relieve the symptoms of perimenopause and menopause by replacing the sex hormones that the ovaries no longer produce. It can be administered via a patch, gel, oral or vaginal tablets, or a vaginal ring.
This article was originally published by Claire Pian on the Marie Claire France website
