What exactly happens during perimenopause, and what helps with it?
Perimenopause brings a wide range of symptoms, from hot flushes and sleep problems to bone loss. Hormone therapy is the best-supported approach, especially if you are under 60. Discuss your symptoms proactively with your doctor, as treatment is in practice left aside too often.
During perimenopause, sex hormones fluctuate considerably before declining in a more structural way. Oestrogen plays the central role in this. These hormonal fluctuations disrupt the brain's temperature regulation, resulting in hot flushes and night sweats. These symptoms are most severe in the first four to seven years, but in some women they can persist for more than ten years.
In addition to hot flushes, many women report sleep problems, mood swings and anxiety symptoms, which become more pronounced as the transition progresses. Cognitive complaints, such as difficulty with verbal memory, concentration and processing speed, are also frequently reported. Sleep deprivation, depression and hot flushes appear to worsen these cognitive problems, but the precise cause-and-effect relationship has not yet been fully clarified. Vaginal dryness and pain during intercourse affect around one third of women in the later stages, and these symptoms do not resolve on their own without treatment.
Over the longer term, perimenopause is also associated with accelerated bone loss, increased abdominal fat and unfavourable changes in metabolism, which raises the risk of cardiovascular disease.
For women who are affected, oestrogen-based hormone therapy is the most effective approach for hot flushes and most other symptoms. For women under 60 who start within ten years of menopause and have no contraindications, the benefits outweigh the risks in most cases. Nevertheless, menopause symptoms remain significantly undertreated by healthcare providers. Hormonal contraceptives are an alternative that can also address irregular bleeding, mood problems and bone loss during perimenopause, but the choice depends on your individual health history.
Women who cannot or do not wish to use hormones also have non-hormonal and behavioural options. The available studies note that these options exist, but provide no concrete details about which work best or for which symptoms. Creatine supplementation has been studied in relation to muscle strength, mood and cognition in women in general, but there is very little research specifically in perimenopausal women, so no conclusions can be drawn from it.
The claims about symptoms and hormone therapy are based on multiple published reviews and guidelines (PMID 37553173, 26653408, 39081162). Cognitive complaints are based on one review (PMID 37755656). For non-hormonal options and creatine, the evidence is thin or lacks specificity.
How do you get your hormone levels tested during perimenopause?
Hormone tests during perimenopause are difficult to interpret: AMH is the most practical option, but does not reliably predict your fertility. Always have results interpreted with the guidance of a doctor.
How does the lipid profile change after menopause, and what can you do about it?
After menopause, the lipid profile demonstrably worsens due to the decline in oestrogen. Regular exercise and moderately eating less help to counteract this; if cholesterol remains high, also discuss cholesterol-lowering treatment with your doctor.
Does menopause increase a woman's risk of joint pain or joint complaints?
Menopause increases the risk of joint pain and osteoarthritis in most women; it helps to avoid excess weight, stay active, and take sleep and stress management seriously as contributing factors.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
What does the transition or menopause do to your gut microbiome?
Menopause is accompanied by measurable shifts in the gut microbiome, but how large these are and what they mean in practice has not yet been well established. There is currently nothing concrete you can do with this information, as proven interventions via the gut microbiome are lacking.
Does menopause accelerate skin ageing?
Menopause noticeably accelerates the loss of collagen, moisture retention and skin thickness, but spots and skin cancer are almost certainly caused by sunlight. If you are experiencing skin complaints around menopause, discuss with your doctor whether HRT makes sense for you as an overall package.