Recognising this hormonal transition at an early stage can make it easier to understand symptoms and take targeted action.
What is perimenopause?
Menopause receives far more attention today than it did just a few years ago. What is less widely known is that hormonal changes in women naturally begin many years beforehand. This transitional stage is known as perimenopause. It can cause symptoms that have a significant impact on everyday life and overall well-being.
Key terms at a glance:
· Perimenopause: The years leading up to the final menstrual period, characterised by irregular cycles and hormonal fluctuations.
· Menopause: The time of the final menstrual period. Menopause is considered to have occurred once a woman has had no menstrual bleeding for 12 consecutive months.
· Postmenopause: The stage of life from menopause onwards.
At what age does perimenopause begin?
For most women, the first changes occur in their mid-40s. However, they may begin in the late 30s or not appear until the late 40s. The duration and course of perimenopause therefore vary considerably from one woman to another and are influenced in particular by genetics and lifestyle factors. Smoking, alcohol consumption, chronic stress and micronutrient deficiencies may, for example, contribute to an earlier onset of perimenopause. The average age of menopause in Europe is approximately 51.
Common perimenopausal symptoms such as fatigue, sleep disturbances, irritability and difficulty concentrating are non-specific. As a result, perimenopause is not always considered as a possible cause, and many women do not receive a diagnosis until much later.
Better public awareness and targeted training for healthcare practitioners are therefore important in helping to prevent misdiagnosis and inappropriate treatment. They can also support the development of personalised strategies that improve women’s well-being during this stage of life.
What happens to your hormones?
During perimenopause, the number of ovarian follicles capable of maturing gradually declines. Ovulation becomes less regular, which means that progesterone, the hormone produced by the corpus luteum, is no longer released in the same amounts during every cycle. At the same time, estradiol levels may initially fluctuate considerably and can even be temporarily elevated. Lower estradiol levels become more common only during the later stages. Estradiol, also known as E2, is the most potent and biologically active form of oestrogen in the human body.
Symptoms therefore result not only from lower progesterone and oestrogen levels, but above all from the changing interaction between the hormones. Perimenopause can consequently be described as a period of hormonal instability.
Common symptoms during perimenopause
The symptoms listed below may occur individually, in varying combinations and with very different levels of intensity. Some women notice hardly any changes, while others experience significant discomfort over many years.
Changes to menstruation
Typical changes during perimenopause include shorter or longer cycles, heavier or lighter bleeding, bleeding between periods and longer gaps without a period. Premenstrual symptoms may also become more pronounced.
Hot flushes and night sweats
Sudden sensations of heat, facial flushing and sweating are among the best-known symptoms. When they occur at night, they can significantly disrupt sleep.
The US-based SWAN study followed biological, psychological and social changes in more than 3,000 middle-aged women over many years. It found that classic symptoms such as hot flushes and night sweats lasted for an average of 7.4 years. In women whose perimenopause began earlier, these symptoms continued for approximately 12 years on average (1).
Sleep and emotional well-being
Difficulty falling asleep or staying asleep, irritability, mood swings, inner restlessness, anxiety and low mood also affect many women during perimenopause. Chronic sleep deprivation can additionally impair both physical and mental performance.
Emotional and psychological symptoms should always be taken seriously. Hormone-related mental health problems during perimenopause and clinical depression arising from other causes may occur at the same time.
Intimate health and sexuality
Declining oestrogen levels can affect the mucous membranes of the genital and urinary tracts. Possible consequences include vaginal dryness, pain during sexual intercourse, recurring urinary symptoms and changes in libido.
Concentration and other physical changes
Many women report forgetfulness, difficulty finding words and “brain fog” – a feeling of mental cloudiness. Other possible symptoms include breast tenderness, headaches, migraines, muscle and joint discomfort, heart palpitations, and changes to the skin, hair and body composition. Waist circumference often increases even when overall body weight changes very little.
How is perimenopause diagnosed?
There is no single laboratory test that can definitively confirm the onset of perimenopause. For most women, the assessment is based primarily on their symptoms. One possible indicator is an elevated FSH level (follicle-stimulating hormone) at the beginning of the menstrual cycle, ideally between cycle days two and five. This may suggest declining ovarian function, which causes the brain to produce more FSH.
To support the diagnostic process, it can be helpful to record cycle length, bleeding intensity, hot flushes, sleep, mood and other symptoms over several months. It is also important to investigate other possible causes of the symptoms. These may include thyroid disorders, polycystic ovary syndrome (PCOS), chronic fatigue syndrome following a viral infection, insulin resistance, type 2 diabetes and various micronutrient deficiencies, such as low levels of iron, magnesium, B vitamins or vitamin D.
In many women, one or more of these accompanying factors occur alongside perimenopause and may worsen or mask the overall pattern of symptoms.
What can help with perimenopausal symptoms?
The following measures may help to relieve symptoms during perimenopause and support long-term health and well-being.
Hormone replacement therapy
Hormone replacement therapy using bioidentical hormones may already be beneficial during perimenopause and can have a significant positive effect on well-being. Depending on the individual situation, treatment may include progesterone, estradiol and testosterone.
Hormone therapy must always be prescribed and monitored by a doctor. Possible contraindications include a personal history of hormone-dependent breast or uterine cancer.
Nutrition as a long-term foundation
The focus should be on natural, minimally processed foods. Two particularly important aspects that are often overlooked are adequate protein and fibre intake. Both play an important role in metabolic, hormonal and digestive health. Experts recommend approximately 1.5 to 2 grams of protein per kilogram of body weight. A daily intake of at least 30 grams is generally considered a useful target for dietary fibre.
Refined sugar, white flour, other highly processed foods, alcohol and soft drinks should be limited as much as possible. These products may promote chronic inflammation, insulin resistance and micronutrient deficiencies, potentially worsening existing symptoms or contributing to additional health problems.
More detailed information on nutrition and dietary fibre can be found in our blog articles “Prebiotics: Food for the gut flora” and “Stable blood sugar levels thanks to a healthy diet”.
Exercise for muscles, bones and metabolism
Regular physical activity supports muscle mass, bone health, cardiovascular health and stress reduction. An effective routine combines endurance exercise, at least two strength-training sessions per week, more movement in everyday life, and mobility and balance exercises.
Strength training with heavy weights is particularly important for bone health and the prevention of osteoporosis. Bodyweight exercises or training with light weights do not provide a sufficiently strong stimulus to improve or maintain bone density. Our article “A holistic approach to osteoporosis” explores this topic in greater detail.
Sleep and stress management
Consistent sleeping times, a cool and dark bedroom, and a relaxing evening routine without screens can help improve sleep quality. Relaxation techniques, breathing exercises, yoga and meditation help many women manage inner restlessness and stress more effectively.
Persistent sleep problems should nevertheless be investigated, as they may also be caused by sleep apnoea or another sleep disorder.
Supplements during perimenopause
Various Allvital products may provide valuable support during perimenopause. As a general principle, we recommend discussing supplement use with an integrative healthcare practitioner and arranging regular laboratory tests to determine whether the selected products and dosages remain appropriate.
Meno Balance Complex
Meno Balance Complex combines 21 carefully selected botanical ingredients and micronutrients. It was developed to provide targeted support for women during perimenopause and beyond.
It contains plant extracts from sources including soya, red clover, maca, flaxseed, wild yam and chasteberry. These extracts are commonly used in naturopathic practice in connection with the female hormonal system. The formula also contains micronutrients such as B vitamins, vitamin C, vitamin D and coenzyme Q10. Detailed information about the ingredients can be found in our Meno Balance Complex product blog.
Additional micronutrients
Depending on a woman’s individual micronutrient status, further supplements may also be important. The following are often particularly relevant during perimenopause:
- Vitamin D3 and K2: Vitamin D3 supports the absorption and utilisation of calcium and, together with vitamin K2, contributes to the maintenance of healthy bones. Meeting individual requirements therefore becomes especially important with regard to long-term bone health. Our Vitamin D3 + K2 supplement combines both fat-soluble vitamins in a convenient liquid formula.
- Omega-3: The omega-3 fatty acids DHA and EPA are important components of cell membranes. Among other functions, they contribute to normal heart function. DHA also supports normal brain function and vision. Our DHA plus EPA supplement provides both fatty acids from high-quality microalgae oil.
- Calcium and magnesium: Both minerals are important for the maintenance of normal bones. Magnesium is also required for muscle function, energy metabolism and many other physiological processes. Our CalMag 2:1 supplement combines both minerals in a balanced ratio.
- Antioxidants: A varied diet rich in vegetables, fruit, nuts and seeds provides the foundation for a good intake of antioxidant compounds. The Allvital range also includes several supplements containing plant-based antioxidants. One particularly popular product is Curcumin Plus, which combines extracts of turmeric, grape seed, pomegranate, blueberries and medicinal mushrooms with a wide range of other valuable ingredients.
Conclusion: Take symptoms seriously and choose an individual approach
Perimenopause can begin many years before the final menstrual period and may progress very differently from one woman to another. Its symptoms often overlap with other health conditions.A healthy diet, regular exercise, restorative sleep, effective stress management and a good supply of essential micronutrients provide an important foundation for supporting long-term health and well-being.
Sources
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539.
