Peri-menopause and menopause: clarifying this chaotic chapter in a woman’s life!

Menopause  

Let’s start with some definitions:

Menopause, the natural “pause of menstruation”, is defined as occurring after 12 consecutive months without a period, for which there is no other obvious medical or surgical cause.

Therefore, menopause is one point in a continuum of life stages for women and marks the end of their reproductive years, an important biological and social landmark. The worldwide average age range for menopause is 45-55 years.

The Perimenopause refers to the period leading up to the menopause, when ovarian function starts to decline, leading to reduced circulating blood oestrogen levels. The perimenopause can begin in the late 30s or 40s and can last from several months to over a decade. 

What are the symptoms and signs of perimenopause?

During the perimenopause, oestrogen and progesterone levels fluctuate dramatically, often creating hormonal (and subsequently mood and health) chaos!

Classical symptoms, which vary from woman to woman, include:

• Irregular periods (variable time between periods and variable flow)
• Hot flashes and night sweats (“vasomotor” symptoms as a result of blood vessels opening and closing chaotically)
• Sleep issues
• Mood changes (mood swings, irritability, depression)
• Bladder and vaginal problems
• Joint pains
• Hair thinning
• Palpitations
• Fatigue
• Headaches
• Weight gain (the dreaded “middle-age spread!”)
• Changes in bowel habits
• Cognitive changes: brain fog (impaired verbal memory)

However, despite these annoying and sometimes debilitating symptoms, the perimenopausal and postmenopausal stages also carry with them several important health risks as the result of declining oestrogen levels. If the peri- and postmenopausal changes are not managed well, important medical risks include:

1. Cardiovascular risk: Women’s advantage over men in terms of cardiovascular disease gradually disappears with the significant decline in oestrogen levels after menopause.

2. Body composition change: Increased central abdominal fat accumulation can lead to consequent cardiometabolic risk and increased risk of certain cancers such as breast, colon and endometrial cancers. 

3. Loss of bone density: This is a significant contributor to higher rates of osteoporosis and fractures.

4. Loss of muscle mass: this has important potential consequences for strength and mobility, as well as for glucose metabolism.  

5. Weakening of pelvic support muscles: This can cause bladder issues and increased risk of pelvic organ prolapse.

6. Change in cholesterol profile: An increase in the “bad” cholesterol, LDL, can occur with declining oestrogen levels.

How do we manage this menopausal mayhem?

This is an opportune time to discuss and undergo necessary midlife health screenings with a healthcare professional. 

Management needs to be individualised to each women based on symptoms, body composition, pre-existing health conditions and risk factors. Management includes the following:

1. Lifestyle Adjustments are imperative across the board!

Reducing caffeine and alcohol, quitting smoking, and practicing stress-reduction techniques like yoga can help manage symptoms. 

Regular exercise, if possible, is a priority! This should include regular strength training to optimise muscle retention.

An adjustment in the diet is recommended, with an increase in protein intake, a reduction in processed foods, and general healthy eating. Aim for STRONG, not skinny!

Some supplements may be helpful- these need to be individualised after discussion with your healthcare practitioner and possible blood tests. Commonly used supplements include balanced omega oils, vitamin D, magnesium and creatine, but should be “bespoke” to each woman.

2. Hormone Therapy

The most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits. Suitability and types of hormone therapy need to be discussed with your healthcare practitioner.

3. Non-Hormonal Therapies

For those who cannot or choose not to use hormones, other symptomatic therapies are available to alleviate symptoms and should be discussed with your healthcare practitioner.

The bottom line:

The peri-menopausal years should not be trivialised in terms of their possibly debilitating symptoms and also medical consequences!

How we aim to help:

At SSISA, we have planned an informative and fun session on the perimenopause on the 15^TH November 2025. This will inlude talks by expert doctors, dieticians, Biokineticists and stress management specialists, with a bit of fun on the side! Come and join us! 

 
Reference List 

1. Davis SR, Pinkerton J, Santoro N, Simoncini T. Menopause- Biology, consequences, supportive care and therapeutic options. Cell 2023; 186: 4038-58.
2. Cunningham A, Hewings-Martin Y, Wickham A et al. Perimenopause symptoms, severity, and healthcare seeking in women in the US. Nature Npj Women’s Health 2025;3: 12.
3. Santoro N. Perimenopause: from research to practice. Journal of Women’s Health 2016; 25: 332-339