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.

In fact, it is the years surrounding menopause that constitute the true hormonal transition phase. Perimenopause refers to this transitional period, which encompasses the various stages from premenopause through postmenopause. Premenopause is the period leading up to menopause. Postmenopause refers to the period that begins immediately after menopause and can last for many years.

During the premenopausal phase, estrogen and progesterone levels do not decline in a linear fashion: they fluctuate, rising and falling, creating irregular cycles and symptoms that can sometimes be confusing. These fluctuations, although often imperceptible, are felt in everyday life. They can affect the menstrual cycle, sleep, mood, libido, energy levels, and even stress management.

Menopause is followed by postmenopause. This period, which begins once menstrual cycles have permanently ceased, marks the establishment of a “new hormonal balance, ” characterized by a lasting and drastic decline in ovarian hormones (estrogen and progesterone). Some women continue to experience physical or emotional symptoms, while others navigate 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.

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The main hormonal fluctuations during perimenopause

Estrogens Throughout the Perimenopause Phase

Estrogens are produced by the ovaries and influence the menstrual cycle, body temperature regulation, bone health, mood, and libido. During perimenopause, their production becomes erratic: in some months it may be higher than before, while in others it may drop. This creates a hormonal “roller coaster” effect that is characteristic of this phase. However, as perimenopause progresses, there is a general, gradual decline in estrogen levels (which usually begins shortly after the drop in progesterone)leading up to a drastic and lasting decline at menopause.

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Progesterone Throughout the Perimenopause Phase

During perimenopause, progesterone is often produced in lower amounts due to reduced-quality ovulation. This decrease in progesterone disrupts a woman’s hormonal balance and can contribute to symptoms such as irregular menstrual cycles, more painful and/or heavier periods, and premenstrual syndrome, which may be characterized by breast tenderness, increased irritability, or sleep disturbances before menstruation (during the luteal phase).The decline in progesterone levels generally begins before the decline in estrogen levels. After menopause, as with estrogen, there is a drastic drop in progesterone.

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FSH and LH

FSH and LH are two hormones produced by the brain (by the pituitary gland) that regulate ovarian function and the menstrual cycle.

**FSH (Follicle-Stimulating Hormone):** Its role is to stimulate the ovaries at the beginning of the cycle. It enables the maturation of ovarian follicles—the small sacs that contain the eggs. These follicles also produce estrogen (estradiol, E2).

**LH (Luteinizing Hormone):** LH plays a key role during ovulation. A sharp increase in LH triggers the release of the egg from the ovary. After ovulation, it also helps form the corpus luteum, which produces progesterone.

During the premenopausal phase, the hormones FSH and LH, produced by the pituitary gland, undergo changes in their function in an attempt to compensate for the gradual decline in ovarian production. FSH often begins to rise well before menopause. In fact, this is one of the first biological signs of entering premenopause. The ovaries gradually become less responsive to signals sent by the brain, and to compensate, the pituitary gland increases FSH production. The rise in FSH is therefore simply a reflection of slightly less effective hormonal communication between the brain and the ovaries.

This transition phase can last several years. During this time, hormone levels may fluctuate: FSH levels may be normal one month, higher the next, and then drop again. These hormonal fluctuations explain why menstrual cycles often become irregular: ovulation may occur less frequently, and periods may sometimes be heavier—or, conversely, lighter.

LH (luteinizing hormone) behaves differently ; it often remains relatively stable at the onset of perimenopause. Its increase occurs later and is generally less pronounced than that of FSH.

During menopause, FSH and LH levels become persistently elevated. Elevated LH levels, especially when FSH is even higher, are typically indicative of menopause. FSH generally exceeds 30 IU/L and can reach much higher levels—several hundred IU/L.

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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 can lead to shorter or longer cycles—or even missed periods—and these cycles are often difficult to predict.
• Hot flashes and night sweats: sudden drops in estrogen levels disrupt the body’s internal thermostat.
• Sleep Disorders: Progesterone has a calming effect on the brain; when its levels drop, falling asleep and sleep quality may be affected.
• Mood swings, anxiety, irritability: Hormones influence neurotransmitters such as serotonin, which can affect one’s emotional state.
• Decreased libido, vaginal dryness: linked to declining estrogen levels and their impact on vulvovaginal tissues.
• Weight gain, changes in body composition: Hormonal changes also affect metabolism and insulin sensitivity, and can also lead to water retention issues.

These symptoms can sometimes be severe and disrupt daily life, as they involve both physical and emotional effects.

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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 declines: As women age, their ovaries have fewer follicles capable of releasing eggs and producing hormones.
• Endocrine feedback loops become disrupted: lower estrogen levels cause the brain to release 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.

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How can we manage these hormonal fluctuations?

Hormone therapy

When the symptoms of perimenopause or menopause become difficult to manage, a healthcare professional (doctor, gynecologist, or midwife) may recommend hormone replacement therapy (HRT).

This treatment is designed to compensate for the natural decline in female hormones, primarily estrogen and progesterone, whose production gradually decreases with age.

Unlike hormonal contraception, which blocks ovulation and creates an artificial cycle, hormone therapy for menopause is designed to replace the hormones that the body no longer produces in sufficient quantities. It can thus help reduce certain symptoms (hot flashes, sleep disturbances, fatigue, etc.) and contribute to the body’s overall balance.

Today, some treatments use so-called bioidentical hormones, which have the same structure as the hormones naturally produced by the body.

Furthermore, scientific understanding has evolved in recent years. U.S. health authorities (the FDA) have recently reevaluated certain recommendations regarding hormone therapy, recognizing its potential benefits for women’s health when prescribed appropriately and tailored to the individual.

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Nonhormonal solutions

There are also many non-hormonal approaches that can help you cope better with perimenopause.

A healthy lifestyle also plays a major role. There are several factors that can make a real difference:

• Balanced Diet: Adopting a balanced diet can help you cope better with menopause. It is recommended to prioritize foods rich in fiber (vegetables and root vegetables, fruits, legumes, and semi-whole-grain cereals) to support the gut microbiome and help regulate blood sugar levels. A sufficient intake of protein as well as key nutrients such as calcium, vitamin D, and vitamin K (particularly K2) also helps preserve muscle mass and bone health. Finally, choosing healthy fats (especially omega-3s) and limiting ultra-processed foods, refined sugars, and alcohol can help support metabolic and cardiovascular balance.
• Regular physical activity is beneficial for energy levels, mood, weight management, and bone health
• Stress Management and Sleep Quality: Establish calming evening routines, such as meditation or cardiac coherence, and limit screen time and exposure to blue light at the end of the day.

Certain dietary supplements may also be considered to support hormonal balance.

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When should you consult a doctor?

It is recommended that you consult a healthcare professional when:

• the symptoms become severe or affect quality of life
• unusual, very heavy bleeding or severe pain occurs
• You would like to discuss hormone therapy or alternative approaches

A professional trained in hormonal health can assess your situation, offer personalized support, and, if necessary, order additional tests.