A Comprehensive Guide to Perimenopause and Menopause

AJ Shek
Jun 14
3 min read

With rising conversations about perimenopause in various media and everyday discussions, we believe it’s essential to provide straightforward guidance for understanding this important life stage.

What is Perimenopause?

Perimenopause is the transitional phase before menopause, typically beginning in a woman's late 30s or early 40s, though symptoms can start earlier or later.

This period is characterized by hormonal fluctuations, notably in estrogen and progesterone, causing a range of physical and emotional changes. Consider this stage as puberty in reverse, and like puberty, everyone's experience will differ. As your body prepares for menopause, you might notice missed periods or cycles that come too frequently. Hormonal changes during this time can bring about various symptoms, including:

Hot Flashes & Night Sweats: Sudden feelings of heat can cause sweating and discomfort. According to the North American Menopause Society, around 75% of women experience hot flashes during this time. Additionally, excessive sweating during sleep can be disruptive. Nearly 50% of women report having night sweats, often leading to sleep deprivation.
Brain Fog: Many individuals feel confused or forgetful, impacting daily tasks significantly.
Anxiety and Mood Swings: Heightened emotional sensitivity is common. Studies have shown that nearly 40% of women experience mood issues during perimenopause.
Sleep Issues: Difficulty falling asleep or staying asleep is frequently reported. Sleep disturbances affect about 60% of women during this period.
Changes in Libido: Shifts in hormonal levels can lead to variations in sexual desire, which may affect intimate relationships.
Irregular Periods: You might experience heavier or lighter menstrual flows. Tracking these changes is essential for understanding your body's unique patterns.

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Understanding Menopause

Menopause is defined as the point when you have gone 12 consecutive months without a menstrual period. The average age for menopause is around 51, but this varies greatly among individuals. After reaching menopause, your ovaries stop releasing eggs, leading to a significant drop in estrogen and progesterone levels.

Estrogen and progesterone levels remain low, which can lead to changes in skin, bones, and heart health, which is why preventative health during perimenopause is important. Interestingly, many individuals find that symptoms associated with perimenopause stabilize after menopause, often leading to a phase filled with renewed energy. A survey showed that more than 50% of women feel relief from symptoms post-menopause.

Top 5 Health Risks

Menopause isn’t just about hot flashes; it brings real, increased risks across heart, bone, brain, metabolic, genitourinary, and cancer health. But with proactive prevention, regular screenings, and healthy lifestyle habits, many risks can be managed or even reversed.

1. 🫀 Cardiovascular disease

Estrogen declines after menopause, potentially leading to increased LDL (“bad”) and reduced HDL (“good”) cholesterol, artery stiffness, and higher blood pressure — all elevating risks of heart attack and stroke.
Studies show women’s cardiovascular risk equals men’s post-menopause—and early menopause (before age 35–45) can increase the risk of myocardial infarction (heart attack) by 2–7×.

2. 🦴 Osteoporosis & Bone Fractures

Estrogen is critical for bone density. Loss in midlife leads to rapid bone breakdown—up to 20 % in the first 5–7 years—and significantly increases fracture risks in the hip, spine, and wrist.

3. 🧠 Cognitive Decline & Mental Health

Declining estrogen is associated with “menopause brain”: memory lapses, “brain fog,” insomnia, mood shifts, and increased PTSD/depression/anxiety risk.
Postmenopausal cognitive risks are higher when hypertension, diabetes, poor sleep, or hot flashes coexist.

4. 🧬 Metabolic Syndrome, Weight Gain & Type 2 Diabetes

As metabolism slows, leading to weight gain be particularly careful about increase in visceral fat, which can lead to increases insulin resistance, hypertension, and the risk of type-2 diabetes.