Hormones during perimenopause

Menopause is often thought of as a long period of change and upheaval. However, medically speaking, it is a specific event that occurs on a specific day: it is defined retrospectively as the moment when a woman has not had a period for 12 consecutive months.

It is actually the years surrounding menopause that constitute the true hormonal transition phase. Perimenopause corresponds to this transition period, which encompasses the various stages from premenopause to postmenopause. Postmenopause corresponds to the period that begins immediately after menopause and can last for many years.

During the premenopausal phase, estrogen and progesterone do not decrease in a linear fashion: they fluctuate, rising and falling, creating irregular cycles and sometimes confusing symptoms. These variations, although often invisible, are felt on a daily basis. They can influence the menstrual cycle, sleep, mood, libido, energy levels, and even stress management.

After menopause comes post-menopause. This period begins once menstrual cycles have stopped permanently and corresponds to the establishment of a "new hormonal balance," with a lasting decrease in ovarian hormones (estrogen and progesterone). Some women continue to experience physical or emotional symptoms, while others go through this phase with greater stability.

Understanding these different stages helps you cope better with this transition and adapt your lifestyle, diet, and routine to this new hormonal reality.

The main hormonal fluctuations during perimenopause

Estrogens during perimenopause

Estrogens are produced by the ovaries and influence the menstrual cycle, temperature regulation, bone health, mood, and libido. During perimenopause, their production becomes erratic: some months it may be higher than before, while other months it may drop dramatically. This creates a hormonal "up and down" pattern that is characteristic of this phase.

Progesterone during perimenopause

During perimenopause, progesterone is often produced in smaller quantities due to increasingly irregular ovulation. This decrease disrupts the balance with estrogen and can promote the onset of symptoms such as unpredictable menstrual cycles, increased irritability, or sleep disturbances.

FSH and LH

During perimenopause, the hormones FSH and LH, produced by the pituitary gland, undergo changes in their functioning in an attempt to compensate for the gradual decline in ovarian production. Faced with fluctuating estrogen levels, FSH tends to increase, often irregularly, reflecting the body's efforts to maintain hormonal balance.

What are the effects of hormonal changes?

The hormonal fluctuations characteristic of perimenopause result in a variety of symptoms that vary greatly from person to person:

• Irregular cycles: Fluctuations in estrogen and progesterone cause shorter, longer, missed, or unpredictable periods.
  
  
• Hot flashes and night sweats: sudden drops in estrogen disrupt the body's internal thermostat.
  
  
• Sleep disorders: progesterone has a calming effect on the brain; when levels drop, falling asleep and sleep quality can be affected.
  
  
• Mood swings, anxiety, irritability: hormones influence neurotransmitters such as serotonin, which can affect emotional state.
  
  
• Decline in libido, vaginal dryness: linked to a drop in estrogen and its impact on vulvovaginal tissue.
  
  
• Weight gain, changes in body composition: hormonal changes also alter metabolism and insulin sensitivity.
  

These symptoms, although normal, can sometimes be intense and disrupt daily life, as they combine physical and emotional effects.

Why do these hormonal changes occur?

Perimenopause is not a disease: it is a biological transition towards the end of fertility. It occurs because:

• Ovarian reserve decreases: with age, the ovaries have fewer follicles capable of releasing eggs and producing hormones.
  
  
• Endocrine feedback loops become disrupted: lower estrogen levels mean that the brain sends more FSH, which, paradoxically, is not always enough to stabilize hormone production.
  
  
• Hormonal signals become erratic: the interaction between estrogen, progesterone, FSH, and LH becomes less consistent, leading to unpredictable ups and downs.
  

In short, it is not just a linear decline in hormones: it is a gradual change in the regulatory system itself.

How can we manage these hormonal fluctuations?

Experiencing perimenopause does not mean suffering through every symptom without help. Here are some proven approaches:

1. Change your lifestyle habits

• Sleep and stress management: establishing routines, reducing screen time before bedtime.
  
  
• Balanced diet: focus on foods rich in phytoestrogens, fiber, and nutrients essential for hormone metabolism.
  
  
• Regular physical activity: helps regulate weight, stabilize mood, and maintain bone density.
  

2. Medical options

• Hormone therapy: sometimes offered to relieve symptoms, after assessing the risks and benefits with a professional.
  
  
• Non-hormonal therapies and psychological support: particularly useful for mood or sleep disorders.
  
  

Every body is different: what works for one person may not be the ideal solution for another.

When should you consult a doctor?

It is always advisable to consult a healthcare professional if:

• your symptoms are severe or interfere with your daily life;
  
  
• you notice very heavy bleeding, abnormal pain, or unusual symptoms;
  
  
• you wish to explore hormonal or alternative options tailored to your medical profile.
  

A professional specializing in hormonal health or perimenopause can help sort through the options, personalize support, and assess whether additional tests are useful.