The years leading up to menopause can be a period of significant, and often overlooked, change for women. These changes typically begin around age 45, but can start several years before menstruation stops. Understanding the signs of this transition, known as perimenopause, is crucial for proactive health management.
Many women experience subtle shifts in their bodies that are tough to pinpoint. “The word menopause refers to a symptom, the cessation of menstruation for 12 consecutive months. It doesn’t describe the biological reality of the phenomenon,” explains Dr. Michel Mouly, a gynecologist and surgeon. What’s actually happening is “a progressive hormonal transformation, linked to the decrease and then deficiency of estrogen.” The average age of menopause in France is 51, but “the hormonal transition most often begins between 45 and 50 years old.” This transition is called “perimenopause” and begins gradually in a woman’s forties with a variety of symptoms. Recognizing these changes can empower women to seek appropriate care and support.
During this phase, “the ovaries are still functioning, but irregularly,” our source explains. “Estrogen levels become unpredictable.” This instability can last from 2 to 10 years. “The most typical sign is a hot flash. It manifests as a sudden feeling of heat, redness, sweating, and sometimes palpitations,” the gynecologist details. However, “for some women, the onset can be more subtle: sleep disturbances, unusual irritability, fresh anxiety, difficulty concentrating, and brain fog.” Other potential symptoms include fatigue, decreased libido, joint pain, abdominal weight gain, or vaginal dryness. Women often seek help for stress or insomnia without realizing a hormonal cause, and perimenopause goes undetected.
Family History and Other Factors Can Influence Timing
Perimenopause can be identified through a blood hormone test, but only when it’s already advanced and menopause is imminent. “Hormone levels are unreliable during the fluctuating phase because levels vary greatly,” Dr. Mouly explains. A normal blood test at age 40 or 45 doesn’t rule out perimenopause. In addition to the signs of perimenopause, a woman can also consider her family history: if her mother experienced early menopause, “the risk is higher” of entering the transition earlier. Other factors can also accelerate the process: “Smoking, significant thinness, certain ovarian surgeries, or medical treatments.”
Perimenopause isn’t limited to the symptoms a woman feels. Estrogen deficiency silently affects bone mass (osteopenia and then osteoporosis), lipid profiles, cardiovascular risk, skin, mucous membranes (including the mouth), muscles, and tendons. “Bone can demineralize for years without symptoms,” Dr. Mouly warns. These invisible signs are “essential” to identify, which is why he performs a pelvic ultrasound and prescribes a reference biological assessment (plasma FSH estradiol (ovarian function and hormonal balance), TSH (thyroid), total testosterone, lipid-glucose profile) around ages 45-50, depending on the patient’s symptoms, and “systematically at age 50.” The doctor also recommends a bone density scan at that age.
Solutions are available when perimenopause symptoms affect quality of life. “Hormone therapy, when indicated and individualized, remains the most effective” for hot flashes, sleep, and bone health, Dr. Mouly affirms. Natural approaches can relieve some mild symptoms, but “do not correct the hormonal deficiency or its profound effects on organs.” The gynecologist also emphasizes the importance of a healthy lifestyle for better managing this stage: regular muscle activity, adequate protein intake, healthy fats, limiting sugar, quitting smoking, moderating alcohol consumption, and managing stress. The earlier a woman addresses these factors, the smoother the transition is likely to be.
