Hormonal imbalances and menopause: Everything you should know

What are perimenopause, menopause and the menopausal transition?

Perimenopause

Perimenopause is the transitional period before menopause, during which hormone production from the ovaries begins to fluctuate and gradually decline. This phase can last for several years and may occur even while periods are still regular.

The most common symptoms are changes in the menstrual cycle, such as variations in bleeding volume or cycle length, followed by sleep disturbances, fatigue and mood changes. Many women also experience joint and muscle pain, which can be pronounced and is associated with changes in oestrogen levels and inflammatory activity. Vasomotor symptoms such as hot flushes and night sweats may also occur, although they are not necessarily the first signs.

Later in the process, periods typically become more irregular until they eventually stop completely at menopause.

Menopause / the menopausal transition

Menopause is the point in a woman’s life when menstruation stops permanently. The diagnosis is made retrospectively after 12 consecutive months without a menstrual period and with no other underlying cause. It typically occurs between the ages of 45 and 55 and marks the end of the reproductive phase, as hormone production from the ovaries, particularly oestrogen and progesterone, gradually declines and eventually reaches very low levels.

When hormone production stabilises at a low level after menopause, symptoms that often begin during perimenopause may not only continue but may become more constant and, in some cases, more troublesome. This can affect sleep, energy levels and cognitive function, as well as cause persistent joint and muscle pain. For some women, the symptoms become significant enough to affect their ability to work, social relationships and overall quality of life.

At the same time, symptoms affecting mucous membranes and tissues, where oestrogen normally has a protective effect, may become more pronounced and cause additional discomfort in everyday life.

For some women, this phase is relatively mild, but for a significant proportion, the symptoms are severe enough to require targeted treatment and individual assessment.

How do you know if you are going through menopause?

Early signs of menopause may include irregular periods, hot flushes and night sweats. Other symptoms include vaginal dryness, reduced sex drive and mood swings. If you experience these symptoms, it may be a good idea to speak with a doctor to determine whether you are entering or going through menopause.

Symptoms of hormonal changes during menopause

Hormonal changes during menopause, sometimes referred to as hormonal imbalance, can lead to a wide range of symptoms. The most common include:

• Hot flushes: A sudden feeling of heat, often accompanied by facial flushing and sweating.
• Sleep problems: Many women experience insomnia or interrupted sleep.
• Mood changes: Irritability, restlessness or low mood may occur.
• Changes in the menstrual cycle: Periods may become irregular, heavier or lighter before stopping completely.
• Fatigue and reduced energy levels: Many women experience persistent tiredness that does not necessarily improve with rest.
• Cognitive symptoms: Reduced concentration, memory difficulties or a feeling of mental “fog”.
• Joint and muscle pain: Diffuse or more pronounced pain that may affect daily functioning.
• Night sweats: Episodes of heavy sweating at night that can disrupt sleep.
• Mucosal symptoms: Dryness and irritation, particularly vaginally, but also affecting the eyes and mouth.

These symptoms vary from woman to woman and can affect quality of life to different degrees.

Long-term consequences of hormonal changes

In addition to the immediate symptoms, hormonal changes may contribute to longer-term health issues such as osteoporosis and an increased risk of cardiovascular disease. It is therefore important to take symptoms seriously and consider treatment when appropriate.

Treatment options for women in perimenopause or menopause

Treatment for hormonal changes and menopausal symptoms depends on the individual woman’s needs and health status. Hormone replacement therapy (HRT) is one of the most effective treatments for relieving symptoms associated with menopause.

For women who do not wish to use hormone therapy, other options may include lifestyle changes, dietary supplements and herbal remedies. Regular exercise, a healthy diet and stress management may also help reduce symptoms and improve quality of life.

Benefits and disadvantages of hormone replacement therapy (HRT)

Recent Danish recommendations from the Danish Society of Obstetrics and Gynaecology emphasise that hormone therapy may be considered already during perimenopause when relevant symptoms are present.

Hormone therapy is the most effective treatment for symptoms related to oestrogen deficiency during menopause and can have a significant positive effect on both quality of life and daily functioning.

Benefits

Treatment can effectively reduce symptoms such as sleep problems, fatigue and joint and muscle discomfort. Many women also experience improved mental well-being and cognitive function. In addition, hormone therapy helps prevent bone loss and reduces the risk of osteoporosis and fractures.

When started early in the menopausal transition, particularly in women under the age of 60 or within approximately 10 years of menopause, HRT is also associated with favourable effects on cardiovascular health.

Hormone therapy is generally well tolerated. There may be a slightly increased risk of blood clots, particularly with tablet-based treatment.

For women with an increased individual risk, for example a history of breast cancer or a strong family history, hormone therapy may be less suitable and requires individual assessment.

For the vast majority of women without significant risk factors, treatment is considered safe when used appropriately and followed up correctly.

When should you seek help?

If symptoms related to menopause or hormonal changes are affecting your quality of life, you should consider seeking professional advice. A doctor or gynaecologist can help assess your symptoms and recommend the most appropriate treatment plan. Early intervention may also help reduce the risk of longer-term health problems.

Frequently Asked Questions

What is the difference between perimenopause and menopause?

Menopause is officially defined as the point at which you have gone 12 consecutive months without a menstrual period. Perimenopause is the transitional phase leading up to menopause, often lasting several years, during which hormone levels begin to fluctuate and cause a range of physical and emotional symptoms.

What are the most common symptoms of menopause?

The most common symptoms include hot flushes, sleep problems, mood changes and vaginal dryness.

Can hormone replacement therapy help with menopausal symptoms?

Yes. Hormone replacement therapy can effectively relieve many menopausal symptoms, but it is important to discuss the potential benefits and risks with a doctor.

When should I contact a doctor about menopause?



If your symptoms affect your quality of life or persist over a longer period, you should contact a doctor for advice and treatment.