Women's Health
MENOPAUSE & PERIMENOPAUSE
A complete guide to understanding the transition—what's happening in your body, what to expect, and what you can do about it.
WHAT IS MENOPAUSE?
Menopause isn't a disease—it's a natural biological transition. But "natural" doesn't mean you have to suffer through it without support.
Menopause is officially diagnosed after 12 consecutive months without a menstrual period. The average age is 51, but it can occur anywhere from 45-55 for most women.
Perimenopause is the transition phase leading up to menopause. This is when most symptoms occur, and it can last 4-10 years. Hormone levels become unpredictable—rising and falling erratically before eventually declining.
Postmenopause is everything after menopause. Hormone levels stabilize at lower levels, and many symptoms improve, but new considerations emerge (bone health, cardiovascular risk, cognitive changes).
THE THREE STAGES
Stage 1
Perimenopause
Typically begins mid-40s (can start late 30s). Periods become irregular. Hormones fluctuate unpredictably.
Duration: 4-10 years
Key changes: Progesterone drops first, estrogen fluctuates wildly, testosterone gradually declines
Stage 2
Menopause
Defined as 12 months without a period. Average age 51. A single point in time, not a phase.
Duration: One moment
Key changes: Ovaries stop releasing eggs, estrogen production drops significantly
Stage 3
Postmenopause
Everything after menopause. Hormone levels stabilize at lower levels. New health considerations emerge.
Duration: Rest of life
Key changes: Increased cardiovascular risk, bone density loss accelerates, metabolic changes
COMMON SYMPTOMS
Symptoms vary widely. Some women sail through with minimal issues. Others experience significant disruption. Both are normal.
Vasomotor (Hot Flashes)
Hot flashes, night sweats, flushing. Affects 75-80% of women. Can last 7+ years for some.
Sleep Disruption
Difficulty falling asleep, staying asleep, or waking unrefreshed. Often linked to night sweats.
Mood Changes
Irritability, anxiety, depression, brain fog. Estrogen affects neurotransmitters including serotonin.
Body Composition
Weight gain (especially abdominal), muscle loss, difficulty maintaining previous fitness levels.
Genitourinary
Vaginal dryness, painful intercourse, urinary symptoms. Affects up to 50% of postmenopausal women.
Other
Joint pain, headaches, heart palpitations, skin changes, hair thinning, low libido.
WHAT'S HAPPENING HORMONALLY
Estrogen (Estradiol)
The primary female sex hormone. During perimenopause, estrogen doesn't just decline—it fluctuates wildly, sometimes spiking higher than normal before eventually dropping. This instability causes many perimenopausal symptoms. After menopause, estrogen stabilizes at about 10-20% of premenopausal levels.
Progesterone
Often the first to decline, even before perimenopause symptoms begin. Progesterone is produced after ovulation—as ovulation becomes irregular, progesterone drops. Low progesterone relative to estrogen ("estrogen dominance") can cause heavy periods, breast tenderness, and mood changes early in the transition.
Testosterone
Women produce testosterone too—about 1/10th the amount men do, but it matters. Testosterone affects energy, libido, muscle mass, and mood. It declines gradually throughout adulthood, with a steeper drop after menopause. Many symptoms attributed to estrogen loss are actually testosterone-related.
FSH & LH
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are produced by the pituitary to stimulate the ovaries. As the ovaries become less responsive, FSH rises—the body is "shouting louder" to try to trigger ovulation. Elevated FSH is often used to confirm menopause.
TREATMENT OPTIONS
Hormone Replacement Therapy (HRT)
The most effective treatment for menopausal symptoms. Modern HRT has evolved significantly from what was studied in the early 2000s.
Important: The 2002 Women's Health Initiative study that caused widespread fear of HRT has been re-analyzed and largely reversed. For most women under 60 or within 10 years of menopause, benefits outweigh risks.
- • Estrogen: Most effective for hot flashes, sleep, mood. Can be delivered via patch, gel, pill, or pellet.
- • Progesterone: Required if you have a uterus (protects against endometrial cancer). Also helps with sleep and mood.
- • Testosterone: Often overlooked for women. Can help with energy, libido, muscle mass, and cognitive function.
- • Bioidentical vs Synthetic: Bioidentical hormones are molecularly identical to what your body produces. Many women prefer them, though both can be effective.
Non-Hormonal Options
- • SSRIs/SNRIs: Can help with hot flashes and mood (paroxetine is FDA-approved for hot flashes).
- • Gabapentin: Sometimes used for hot flashes, especially at night.
- • Vaginal estrogen: Very low-dose, localized treatment for genitourinary symptoms. Minimal systemic absorption.
- • Lifestyle: Exercise, stress management, avoiding triggers (alcohol, caffeine, spicy food).
What We Do at Moonshot
We take a comprehensive approach. That means:
- • Full hormone panel (not just FSH and estrogen)
- • Metabolic markers (thyroid, insulin, inflammation)
- • Symptom assessment alongside labs
- • Individualized protocols based on your specific situation
- • Ongoing monitoring and adjustment
WHEN TO SEEK HELP
Consider evaluation if you have:
- • Hot flashes disrupting sleep or daily life
- • Mood changes affecting relationships or work
- • Brain fog impacting cognitive function
- • Weight gain despite unchanged habits
- • Low libido or painful intercourse
- • Irregular periods (before menopause)
- • Family history of osteoporosis or heart disease
Seek prompt attention for:
- • Bleeding after menopause
- • Severe depression or anxiety
- • Symptoms before age 40 (premature menopause)
- • Chest pain or palpitations
References & Further Reading
- 1. The Menopause Society (formerly NAMS). menopause.org
- 2. Manson JE, et al. "Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality." JAMA. 2017.
- 3. Hodis HN, Mack WJ. "The timing hypothesis and hormone replacement therapy." Climacteric. 2014.
- 4. Santoro N, et al. "Perimenopause: From Research to Practice." Journal of Women's Health. 2015.
- 5. Davis SR, et al. "Testosterone for women: the clinical evidence." Lancet Diabetes Endocrinol. 2015.
READY TO GET CLARITY?
Start with comprehensive testing. Understand where you are in the transition and what your options are.