What changes in the body during perimenopause and the menopause
Perimenopause and menopause: the common complaints, the long-term effects on bone and heart, and why waiting for periods to stop before considering treatment costs time.
The menopause is as natural and expected a stage in a woman's life as puberty. It happens as the ovaries gradually lose their reproductive function and the production of oestrogen and progesterone falls. A woman is considered to have reached the menopause once 12 consecutive months have passed without a period.
The body does not cross into this new stage in a single day. The transition that begins years earlier, when hormones fluctuate and periods become irregular, is called perimenopause. It usually begins in the mid-forties, can last anywhere from 1 to 10 years, and is a clinical diagnosis — you do not have to wait for periods to stop completely before it counts.
Common complaints in this period
- Hot flushes and night sweats. The most frequent of all. A sudden sensation of heat and sweating that also lowers the quality of sleep.
- Sleep and mood. As progesterone, which has a calming effect, declines, it can become harder to fall asleep, and anxiety, irritability or unexplained tearfulness may appear.
- Forgetfulness (brain fog). Difficulty focusing, or short-term memory lapses such as not being able to find a word.
- Dryness and sensitivity. Falling oestrogen thins the skin and the vaginal tissues, causing dryness and, with it, discomfort during sex.
The long-term risks
The permanent fall in oestrogen weakens the body's protection against certain conditions.
- Bone health (osteoporosis). Oestrogen is the most important support keeping bone strong. As it falls, bone breakdown accelerates and the risk of osteoporosis rises.
- Heart and vascular health. Oestrogen keeps blood vessels flexible and plays a protective role against heart disease. When that protection disappears, cardiovascular risk increases.
Why waiting costs time
One of the most widespread misunderstandings is that hormone therapy cannot begin until periods have stopped completely and a year has passed. Current evidence shows that waiting is a disadvantage, both for quality of life and for long-term health.
- The transition itself becomes easier. Balancing hormones during perimenopause, when the complaints are at their most intense, makes the passage into the menopause considerably more comfortable and controlled.
- Timing matters (the timing hypothesis). Studies have established that menopausal hormone therapy started during the transition, or within the first 10 years of the menopause and before the age of 60, markedly reduces the risk of coronary heart disease, arterial stiffening and overall mortality — by 30-50%. When treatment is started more than 10 years after the menopause, these cardiac benefits disappear.
- Bioidentical hormones. Treatment favours bioidentical hormones — chemically identical to those the human body produces. Unlike the older synthetic preparations, bioidentical hormones (particularly oestrogen applied to the skin, together with natural micronised progesterone) do not raise the risk of clotting and have a more favourable profile for breast tissue.
What you can do
Perimenopause and the menopause are not an illness; they are a new stage of life. Moving to a diet rich in calcium and vitamin D and doing regular resistance exercise are the first steps.
But if you have complaints that are disrupting your sleep, your energy or your state of mind, do not lose time waiting for your periods to stop or assuming it will pass. Discuss the options — including bioidentical hormone therapy — with your doctor from the early part of perimenopause onwards.