What happens to our hormones in perimenopause?

One day, your periods become irregular. The next month, you wake up drenched in sweat. Then come insomnia, forgetfulness, the feeling of losing your footing. What if it wasn't "stress," but the beginning of a new hormonal phase? Perimenopause affects all women, but few know what's happening in their bodies. It's not a breakdown, nor is it an inevitability. It's a transition — powerful, complex, hormonal. So, what's the link between perimenopause and hormones? In this article, we explain what really changes and how to navigate this stage with awareness.

Before we talk about hormones, what is perimenopause?

Perimenopause is a natural hormonal transition phase in women's lives that precedes the famous menopause. It can begin as early as the late thirties or early forties, although most of us start to feel its effects around the age of 45. Contrary to popular belief, it's not a sudden event! It's a gradual process, often spanning several years.

During this menopausal transition period, hormonal fluctuations can hit hard. Indeed, the ovaries begin to slow down their hormone production — especially estrogen and progesterone. But beware: this decline is neither linear nor constant! It happens in waves, with sometimes unsettling variations. This explains why symptoms can appear irregularly and vary from one woman to another.

Perimenopause thus corresponds to the time when the menstrual cycle begins to become irregular, before menopause (which is defined as the definitive cessation of periods for 12 consecutive months) has set in. Flows become more irregular, sometimes heavier. The duration of cycles becomes increasingly spaced out. Some women don't even notice it immediately! And they attribute the first signs of perimenopause to stress, fatigue, or mental overload.

However, what we feel is not "in our head" but is indeed linked to a hormonal reality. Accepting this phase means allowing ourselves to live it better. And that's an essential first step in this transition in women's lives.

 

Which hormones change during perimenopause and how?

Perimenopause is primarily a hormonal transition. Contrary to the idea of hormones "running dry," it's more of a progressive imbalance — with highs, lows, and rollercoasters. We explain the main hormones involved.

Progesterone: the first to decline

Which hormone kicks off the hormonal fluctuations? Progesterone. Its decrease results in menstrual cycles without ovulation, which become more frequent from the age of forty. While this hormone plays an essential role in regulating the menstrual cycle, it also influences:

• sleep;
• mood;
• emotional stability.

So, naturally, when it's lacking... We observe:

• heavier periods;
• anxiety;
• severe irritability;
• lighter sleep.

Often, this decrease can go unnoticed in standard hormone tests, because progesterone still fluctuates significantly throughout the cycle.

Estrogen: erratic fluctuations

Estrogen levels don't drop suddenly; they fluctuate. Some months, their levels are abnormally high, causing:

• breast pain;
• water retention;
• migraines.

Other times, the decrease in levels is drastic, leading to:

• vaginal dryness;
• night sweats/hot flashes;
• a decrease in libido.

In any case, this hormonal transition makes perimenopause confusing: you feel great one month, then overwhelmed the next. In short, the body tries to compensate, but... it doesn't always find the right balance!

FSH and LH: the hormones that go wild

FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are the "orchestra conductors" of the menstrual cycle. When the ovaries become less responsive, the brain increases their production to get the system going again.

As a result, their levels climb, sometimes significantly. High FSH levels are also an indicator of perimenopause, although they are not sufficient for a diagnosis alone, because these hormones do not directly cause symptoms... But they indicate an imbalance or a potential transition phase in progress.

DHEA, testosterone, cortisol: the silent but essential ones

We less often talk about androgens (like DHEA or testosterone). And yet, their decline affects women's comfort, particularly:

• their energy;
• their concentration;
• their libido;
• their muscle strength.

Cortisol, the stress hormone, also tends to rise if the body struggles to adapt to all these changes. When the endocrine system is under pressure, the body prioritizes stress management at the expense of reproductive functions. This phenomenon is known as "cortisol priority," which amplifies fatigue and sleep disturbances.

Quite a hormonal puzzle, isn't it? But understanding it is already a first step, because it allows you to better decode its symptoms and move beyond the idea that "it's all in your head." We repeat: it's your body speaking in its own way.

What are the concrete impacts of hormone variations during perimenopause on the body?

While hormones orchestrate perimenopause behind the scenes, their variations have very visible... and sometimes unsettling... repercussions. Beyond irregular periods, the entire body reacts to this transition phase.

The menstrual cycle becomes unpredictable

The duration of periods in premenopause is a whole story! Menstrual cycles lengthen, shorten, disappear for several months, then come back strong. Some women experience hemorrhagic periods, others vaginal bleeding between cycles. In short, it's hard to keep up – and this lack of predictability doesn't help.

Aches and pains, from head to toe

Breast pain (often linked to estrogen peaks, as a reminder) can become more frequent. In addition, there may be joint pain: we rarely identify it as hormonal, and yet, it is very present! Some women report a feeling of morning stiffness or persistent discomfort in their knees, hips, shoulders... In short, we hurt a little everywhere, and it's no fun.

The urinary and pelvic system on the front line

Estrogen also influences the tone of pelvic muscles and the elasticity of the urinary tract. The result:

• mild urinary incontinence;
• a feeling of a more fragile bladder;
• more uncomfortable sexual intercourse.

These are some intimate symptoms, rarely discussed, but which weigh heavily on daily life.

The famous "brain fog"

If only perimenopause was just about the body... But no, that would be too easy! Many women also report experiencing a kind of "brain fog." This means difficulty concentrating, remembering information, or finding their words. This is not a sign of depression or burnout: it is a very real hormonal manifestation!

A fatigue that goes beyond simple "mental load"

Hormonal fluctuations, disturbed sleep, emotional and physical overstimulation... All of this can lead to profound fatigue, not always relieved by a good night's sleep. Some women speak of a loss of drive, a need to withdraw, without being able to put words to it.

Invisible risks in the background

This period is also accompanied by an increase in:

• the risk of cardiovascular diseases;
• the risk of fractures...
  

Nothing automatic, of course! But this transition should be seen as a pivotal moment to review overall health, lifestyle habits, and prevention.
That's why regular medical follow-up is recommended from the first signs of perimenopause.

Perimenopause: how to support your body and hormones?

Are your symptoms becoming overwhelming? Is your quality of life deteriorating? Don't stay inactive! Because, even if perimenopause is not a disease, it may require targeted support. Hormonal treatment or natural alternatives? Here are the options, their benefits, their limitations, and the potential risks to be aware of.

Hormone Replacement Therapy (HRT)

Still too little known — even feared — hormone therapy remains the most effective option, according to available data, for relieving symptoms such as:

• hot flashes;
• night sweats;
• sleep disturbances;
• or genitourinary syndrome (discomfort during intercourse, dryness, recurrent infections...).

It generally relies on hormonal substitution: estrogens alone or combined with progesterone, depending on the case. It can be taken orally, cutaneously (patch, gel) or vaginally (ovules, cream, vaginal ring).

The most recent studies (including that by Manson JE within the framework of the Women's Health Initiative) have helped to nuance fears related to the risk of cancers and cardiovascular diseases. How? By showing that these risks mainly depend on:

• the age of initiation;
• the treatment regimen;
• and health history.

Hence the importance of a personalized approach that assesses the benefit-risk for each woman.

Alternative and complementary treatment

Some women cannot — or do not want to — use hormone replacement therapy. And we understand them. In this case, other solutions can help relieve the symptoms of premenopause:

• herbal supplements (black cohosh, sage, red clover, maca...);
• phytoestrogens, with medical supervision;
• targeted micronutrition;
• low-dose antidepressant treatment (sometimes prescribed for mood or sleep disorders);
• relaxation techniques (yoga, breathing, heart coherence...).

Caution: natural doesn't mean harmless! We advise you to always refer to medical advice, especially in cases of family history of hormone-dependent cancers or venous thrombosis.

The importance of lifestyle

Whether there is treatment or not, lifestyle habits play a central role during this period. Regular physical activity helps to:

• contribute to cardiovascular health;
• preserve bones (and limit the risk of fracture);
• participate in better stress management.

Also try to adopt a balanced diet. This way, you will better manage your caloric intake and avoid the decrease in energy expenditure typical of this phase.

Of course, we also don't forget emotional support, which is crucial during these years of transition!

In short, perimenopause marks an important hormonal transition in women's lives — sometimes silent, often confusing, but never insignificant. Understanding its mechanisms and recognizing its signs is already taking back power over this period! Because no, it's not "all in your head." It's in your body, in your hormones, and you have the right to be informed, supported, and accompanied.