Premenopause can set in several years before menstruation stops, generally around age 45. How to recognize it? What signs to watch for? Dr. Michel Mouly, gynecologist, helps us see things clearly.
Something has changed in your body, but you don’t understand what. It may be the start of menopause. But behind this term, the transition that is taking place remains largely unknown. “The word menopause designates a symptom, the cessation of periods for 12 consecutive months. It does not describe the biological reality of the phenomenon”immediately corrects Dr. Michel Mouly, gynecologist and surgeon. What is at stake is “a progressive hormonal transformation, linked to the decrease and then the deficiency of estrogens”. The average age of menopause in France is 51 years, but “the hormonal transition most often begins between the ages of 45 and 50”. This transition is called “premenopause” and therefore begins slowly in midlife through different signs.
During this phase, “the ovaries still function, but irregularly”explains our interlocutor. “Estrogen becomes unpredictable.” This instability can last 2 to 10 years. “The most typical sign remains the hot flash. It manifests itself by sudden heat, redness, sweating, sometimes palpitations” the gynecologist explains to us. Knowing that “In some women, the onset may be more discreet: sleep disturbances, unusual irritability, new anxiety, difficulty concentrating, brain fog.” Sometimes added to this are fatigue, reduced desire, joint pain, abdominal weight gain or vaginal dryness. Result: women consult for stress or insomnia without suspecting a hormonal cause, and premenopause goes under the radar.
If your mother had early menopause, “the risk is higher”
Premenopause can be demonstrated by a hormonal blood test but only when it is already advanced and menopause is finally very close. “Hormonal dosages are unreliable in the fluctuation phase because the levels vary greatly” explains Dr. Mouly. A normal blood test at 40 or 45 years old therefore does not rule out premenopause. In addition to the signs of premenopause, the woman can also rely on her family history: if your mother had an early menopause, “the risk is higher” to enter into transition earlier. Other factors also speed up the process: “Tobacco, significant weight loss, certain ovarian surgeries or medical treatments”.
Premenopause is not limited to the symptoms experienced. Estrogen deficiency acts silently on bone mass (osteopenia then osteoporosis), lipid profile, cardiovascular risk, skin, mucous membranes (including oral), muscles and tendons. “The bone can demineralize for years without symptoms”warns Dr. Mouly. Invisible signs but “essential” to identify, this is why he performs a pelvic ultrasound and prescribes a reference biological assessment (plasma FSH estradiolemia (function of the ovaries and hormonal balance), TSH (thyroid), total testosterone, carbohydrate-lipid balance) around 45-50 years old depending on the patients’ symptoms and “systematically at 50”. The doctor also recommends a bone densitometry at this age.
Solutions exist when premenopausal symptoms affect quality of life. “Hormonal treatment, when indicated and individualized, remains the most effective” on hot flashes, sleep and bone health, says Dr. Mouly. Natural approaches can relieve some mild symptoms, but “do not correct hormonal deficiency or its profound effects on the organs”. The gynecologist also emphasizes the essential bases of a healthy lifestyle to better live this stage: regular muscular activity, sufficient protein intake, good lipids, limitation of sugar, stopping smoking, moderation of alcohol and stress management. The sooner you act, the better you will get through this period.
