Hormonal imbalances and menopause: Everything you should know

What is perimenopause and menopause?

Perimenopause

Perimenopause is the transitional period before menopause, when hormone production from the ovaries begins to fluctuate and gradually decline. The period can last for several years and can occur even if menstruation continues to be regular.

The most common symptoms are changes in menstrual patterns (e.g., variation in bleeding volume or cycle length), followed by sleep disturbances, fatigue, and mood swings. Many also experience joint and muscle pain, which can be severe and is related to changes in estrogen and inflammatory activity. Vasomotor symptoms such as hot flashes and night sweats also occur, but are not necessarily the first signs.

Later in the course, menstruation typically becomes more irregular until it stops completely at menopause.

Menopause

Menopause is the time in a woman's life when menstruation ceases permanently. The diagnosis is made retrospectively after 12 months of cessation of menstruation without any other cause. It typically occurs between the ages of 45–55 and marks the end of the reproductive phase, when the production of hormones from the ovaries (estrogen and progesterone) gradually decreases and eventually becomes very low.

When hormone production stabilizes at a low level after menopause, the symptoms that often begin in perimenopause will not only continue for many women, but will also be experienced as more constant and in some cases more distressing. This can affect sleep, energy levels and cognitive functions, as well as cause persistent pain in joints and muscles. For some women, the symptoms become so severe that they significantly affect work capacity, social relationships and overall quality of life.

At the same time, increasing discomfort is often seen from mucous membranes and tissues, where estrogen normally has a protective effect, which can cause further discomfort in everyday life.

For some women, this phase is relatively mild, but for a significant proportion, the symptoms are so pronounced that they require targeted treatment and individual assessment.

How do you know you are in menopause?

The first signs of menopause may include irregular periods, hot flashes, and night sweats. Other symptoms include vaginal dryness, decreased sex drive, and mood swings. If you experience these symptoms, it may be a good idea to talk to a doctor to confirm whether you are going through menopause.

Symptoms of hormonal changes during menopause

Hormonal changes during menopause (often referred to as hormonal imbalances) can lead to a variety of symptoms. The most common include:

• Hot flashes: A sudden feeling of heat, often accompanied by facial flushing and sweating.
• Sleep problems: Many women experience insomnia or interrupted sleep.
• Mood changes: Feelings of irritability, restlessness, or depression may occur.
• Changes in menstrual pattern: Menstrual periods may become irregular, heavier, or lighter before stopping completely.
• Fatigue and reduced energy levels: Many people experience persistent fatigue that does not necessarily improve with rest.
• Cognitive symptoms: Experiencing decreased concentration, memory problems, or mental “fog.”
• Joint and muscle pain: Diffuse or more pronounced pain that can affect daily functioning.
• Night sweats: Episodes of heavy sweating at night that can disrupt sleep.
• Discomfort from mucous membranes: Dryness and irritation, especially vaginally, but also from the eyes and mouth.

These symptoms vary from woman to woman and can affect quality of life to a greater or lesser extent.

Long-term consequences of hormonal disruptions:

In addition to the immediate symptoms, hormonal imbalance can lead to long-term health problems such as osteoporosis and an increased risk of cardiovascular disease, so it's important to take symptoms seriously and consider treatment if necessary.

Treatment options for women in perimenopause or menopause:

Treatment of hormonal disorders and symptoms of menopause depends on the individual woman's needs and health status. Hormone replacement therapy (HRT) is one of the most effective methods for relieving symptoms such as hot flashes and osteoporosis.

For women who do not want hormone therapy, alternative solutions such as lifestyle changes, dietary supplements and herbal remedies are available. Regular exercise, a healthy diet and stress management can also help reduce symptoms and improve quality of life.

Advantages and disadvantages of hormone replacement therapy (HRT)

Newer Danish recommendations from the Danish Society of Obstetrics and Gynecology emphasize that hormone therapy can be considered already in perimenopause if there are relevant symptoms.

Hormone therapy is the most effective treatment for symptoms related to estrogen deficiency during menopause and can have a significant impact on both quality of life and everyday functioning.

Benefits

The treatment effectively reduces symptoms such as sleep problems, fatigue and discomfort from joints and muscles. Many also experience improved mental alertness and cognitive function. In addition, hormone therapy prevents bone loss and reduces the risk of osteoporosis and fractures.

When started early in the course (under 60 years of age or within approximately 10 years after menopause), HRT is also associated with a beneficial effect on cardiovascular disease.

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

In women with increased individual risk – for example, previous breast cancer or a strong family predisposition – hormone therapy may be less suitable and requires an individual assessment.

For the vast majority of women without significant risk factors, the treatment is safe with correct use and follow-up.

When should you seek help?

If the symptoms of menopause or hormonal imbalance are affecting your daily quality of life, you should consider seeking professional help. A doctor or gynecologist can help diagnose and recommend the best treatment plan for you. Early intervention can also help prevent long-term health problems.

Frequently Asked Questions

What is the difference between perimenopause and menopause?

Menopause officially marks the point in time when you have gone 12 consecutive months without a menstrual period. Perimenopause is the transitional phase leading up to menopause—often lasting several years—when hormone levels begin to fluctuate, causing various physical and emotional symptoms.

What are the most common symptoms?

The most frequent symptoms during this transition include hot flashes, night sweats, sleep disturbances, mood swings, and vaginal dryness.

Can Hormone Replacement Therapy (HRT) help with symptoms?

Yes, Hormone Replacement Therapy (HRT) is highly effective at relieving symptoms such as hot flashes and vaginal dryness. It also helps protect against bone loss (osteoporosis). However, it is important to discuss your personal health history with a gynecologist to weigh the benefits and risks of treatment.

When should I see a doctor about menopause?

 If your symptoms are affecting your daily quality of life, causing distress, or persisting for a long time, you should book a consultation with a gynecologist to explore your management and treatment options.