© Freepik
Perimenopause usually begins in the fourth decade of life and then lasts for several years.
March 10, 2025
Sharon Burbat
Perimenopause is the time that could be referred to as the actual "transition" during menopause - and yet it is usually not properly recognized due to its nonspecific symptoms.
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Perimenopause is the transitional phase to menopause (Greek "peri" = around). It is the second of the four phases of menopause. Because what many people don't know: already years before the cessation of menstruation, hormonal balance is severely disrupted, which in turn leads to a number of symptoms.
Most of the time, perimenopause first becomes noticeable in the fourth decade of life and then lasts for several years. Since the changes – mentally as well as physically – usually appear gradually and diffusely, they are often not directly attributed to perimenopause.
The symptoms mentioned are due to fluctuations in sex hormones during perimenopause, which interact in women during the cycle. During the fertile phase of life, LH (luteinizing hormone) and FSH (follicle-stimulating hormone) stimulate the ovaries.
This leads to an increase in estrogen production in the first half of the cycle - before ovulation. In the second half of the cycle, the estrogen level drops, while progesterone production increases.
Because the function of the ovaries gradually declines with perimenopause, there are strong changes between the hormones and their levels. The decreasing ovarian function initially causes an increase in FSH. The increased levels, in turn, lead to increased production of estrogen. Estrogen dominance occurs while progesterone remains relatively low.
At some point, the follicles that can be stimulated are depleted, so the ovaries no longer respond to FSH stimulation. As a result, estrogen and progesterone levels drop. Because the usual hormonal interplay of the cycle is absent, menstruation does not occur. Menopause begins.
It is primarily the ups and downs of estrogen and progesterone during perimenopause that lead to complaints, rather than a specific deficiency of a particular hormone.
© Mert Coskun
It is primarily the fluctuations of estrogen and progesterone that lead to symptoms during perimenopause.
It is generally advisable to know your cycle well and, for example, track it with apps. The symptoms of perimenopause often come on gradually and are not specific, which is why affected women may not immediately connect their complaints to perimenopause and therefore do not necessarily know which expert to consult about it.
If a woman has had regular cycles so far, newly occurring fluctuations can indicate perimenopause as the cause of the symptoms. Clarification by the doctor - whether gynecologist or endocrinologist - is advisable. In addition to the cycle history, a blood test for specific hormones may also provide information.
There are several options to alleviate symptoms that can significantly impair quality of life in some women:
Sometimes a lifestyle change with more exercise, balanced and healthy nutrition, and abstaining from alcohol and nicotine may be sufficient. In addition, hormone replacement therapy in the form of a gel, spray, or vaginal ring is an option.
Since it is generally possible to become pregnant during perimenopause, it may be practical for some women to use a low-dose estrogen preparation for contraception, which additionally alleviates menopausal symptoms.
If the symptoms of perimenopause relate to vaginal dryness and bladder infections, a local hormone therapy in the form of vaginal creams or vaginal tablets might be the right solution.
Dietary supplements are becoming increasingly popular, especially in connection with menopause. For example, soy and red clover are attributed beneficial properties. It should be noted that the use of dietary supplements without a specific need is discouraged, and they should only be indicated in case of a deficiency.
During menopause, the risk of osteoporosis increases. Vitamin D can slow down this process, which is why the combination of Vitamin D and calcium can be useful for preventing osteoporosis. Furthermore, Vitamin D is said to have a mood-enhancing effect.
Phytoestrogens are secondary plant compounds found particularly in soybeans, red clover, and kudzu. They resemble estrogens in their structure, which is why a gentle hormonal stimulation is hoped from them, even though they are much weaker than natural or bioidentical estrogen.
However, the effectiveness is not proven, and the Federal Institute for Risk Assessment clearly points out a limited intake period for isoflavones.
Perimenopause does not mean that one can no longer become pregnant. It is not the end of fertility but marks the transition to it. Women who do not wish to become pregnant should continue to use contraception during perimenopause – until menopause and for some time after.
