The menopausal transition can begin well before the age of 50. This period, known as climacteric or perimenopause, can appear years before menopause itself, causing gradual hormonal changes that affect the body and emotions. Changes in the menstrual cycle, hot flashes, mood changes, difficulty sleeping and changes in libido are some of the signs that may appear during this phase, which vary from woman to woman.

“Perimenopause, as this phase is known, is already marked by important hormonal fluctuations and can begin in the late 30s or early 40s. Recent discussions at international conferences on menopause have reinforced that perimenopause does not just begin when the menstrual cycle becomes irregular”, explains gynecologist Dr. Igor Padovesi, a menopause specialist certified by the North American Menopause Society (NAMS).

According to the doctor, in many cases, menopause begins to show signs years before, through more discreet symptoms that are not always easily identified. These manifestations, associated with a lack of knowledge about this stage of life, can make early recognition difficult and delay the diagnosis.

Symptoms that arise in perimenopause

According to the expert, symptoms that commonly appear in perimenopause are cognitive changes, such as memory lapses and difficulty concentrating, which is known as brain fog or mental fog. “Many women report that they feel more distracted, with less ability to reason and concentrate, even describing the feeling that they have become ‘less intelligent’. These symptoms are common in perimenopause, but are rarely recognized”, he points out.

Others early signs include sleep changes, greater anxiety and irritability, decreased libido and the feeling that “they are not the same as before”. “Extreme fatigue is another common complaint. It is very common for women to wake up tired and feel exhausted when carrying out the same routine that previously did not generate this impact”, he adds.

From a hormonal point of view, this phase is marked by large fluctuations, and not by a progressive and linear drop in hormones. “The fluctuations are intense and irregular, which explains why the symptoms vary so much from one woman to another and even in the same woman over time”, explains Dr. Igor Padovesi.

Difficulty diagnosing perimenopause

One of the biggest challenges in diagnosing perimenopause is precisely the fact that there is no specific test capable of confirming it. “Like menopause, it is a clinical syndrome, based on a set of signs and symptoms”, says the gynecologist.

In perimenopause, menstruation continues to occur. “And what makes the diagnosis even more difficult is that many women at this stage maintain menstrual cycles regular. Therefore, both patients and professionals end up ruling out the possibility of perimenopause, even in the face of clear symptoms”, he adds.

The lack of knowledge about this phase means that many women are surprised to realize that they are already in perimenopause, especially those with intense routines. “Work overload, childcare, family and professional responsibilities end up masking the symptoms and making it difficult to perceive that these changes have a hormonal origin”, explains Dr. Igor Padovesi.

Therefore, it is important that the conversation about perimenopause starts earlier. “Recognizing this phase early allows symptoms to be treated appropriately and preserve quality of life in a period that many women still go through without diagnosis”, highlights the doctor.

Main forms of treatment

Regarding the treatment of perimenopause, Dr. Igor Padovesi explains that it basically consists of hormonal therapy. “This is the standard treatment, both for perimenopause and menopause. Measures such as physical activity, improving sleep and reducing stress are important as adjuvants, but do not replace hormonal therapy”, he states.

In this sense, it is important to consult a doctor when you notice symptoms. “Many women are still surprised to learn that hormonal therapy It can and should be started even when menstruation is still regular, as long as the symptoms are compatible with perimenopause and there are no contraindications, which are few”, he concludes.

By Maria Claudia Amoroso