Menopause and Perimenopause: What really happens in a woman’s body

Menopause is a natural transition in every woman’s life. It is not a disease, but a shift into a new biological phase-much like puberty. However, many women begin to feel that “something isn’t quite right” even before their period stops completely. This stage is known as perimenopause-the transitional period before menopause, when hormone levels start to fluctuate.

What is Perimenopause?

Perimenopause usually begins in the mid to late 40s (sometimes earlier) and lasts for several years. During this time, estrogen-the main female hormone-gradually declines.

The most common symptoms include:

• Hot flashes or night sweats
• Sleep disturbances
• Mood swings or irritability
• Vaginal dryness
• Decreased libido
• Weight gain, bloating, or irregular periods

Once 12 consecutive months have passed without a period, a woman is considered to have reached menopause. The average age is around 50, though it can occur earlier or later.

What Causes These Symptoms?

Estrogen and progesterone influence many systems of the body-the brain, skin, bones, heart, and even mood regulation. When their levels drop, the body attempts to adapt, and this adjustment period is what causes most menopausal symptoms.

How Your Gynecologist Can Help

Your gynecologist is the most qualified professional to guide you through this transition.

Treatment may include:

• Lifestyle modifications
• Maintain a consistent sleep schedule
• Eat a balanced diet rich in fruits, vegetables, protein, calcium, and vitamin D
• Exercise regularly (ideally a mix of walking, Pilates, yoga, or resistance training)
• Manage stress effectively
• Hormone Replacement Therapy (HRT)

For women with intense symptoms, hormone therapy can offer significant relief. Today’s treatments are safer and more personalized than ever before. HRT may be prescribed in the form of pills, patches, gels, or sprays.

If you have a uterus, progesterone is combined with estrogen to protect the endometrium. If you don’t, estrogen alone is sufficient.

Studies show that for most healthy women under 60-or within 10 years of menopause-the benefits of HRT outweigh the risks, as long as it is monitored by a doctor.

•  Local Therapy for Vaginal Dryness (GSM)

If vaginal dryness, pain during intercourse, or recurrent urinary infections are your main concerns, topical estrogen treatments (creams, rings, or tablets) can provide targeted relief and are considered very safe.

Even women with a history of breast cancer may be able to use them after medical evaluation.

• Non-Hormonal Options for Hot Flashes
• Brain-targeting medications (SSRIs/SNRIs such as venlafaxine, paroxetine)
• Gabapentin for night sweats

New-generation treatments such as Fezolinetant-the first non-hormonal medication specifically approved by the FDA and EMA for hot flashes.

How Long Does Menopause Last?

Symptoms may last from a few months to several years, with the most intense phase typically occurring during the first 1-2 years after the last period. Both duration and intensity vary widely among women.

Bone and Heart Health

Estrogen naturally protects the heart and bones. When levels drop, the risk of osteoporosis and cardiovascular disease increases.

A healthy diet, regular exercise, sufficient vitamin D, and-when appropriate-hormone therapy can all help maintain long-term well-being.

In Conclusion

Menopause is a natural life stage-arguably the longest one-and it symbolizes continuity, not an ending. With proper knowledge, medical guidance, and self-care, it can become a period of true renewal, where you redefine your sense of self with optimism, strength, and confidence.