Understanding the Menopausal Transition: Symptoms, Hormonal Changes (Also in Men) and the Difference Between the Menopausal Transition and Menopause

Many people eventually notice changes that are initially difficult to classify. Sleep becomes more restless, mood fluctuates more than before, or the menstrual cycle changes. Sometimes these are only small signals from the body that at first barely stand out — yet many wonder whether they might already be related to the menopausal transition. Particularly in this phase of life, many questions arise. What exactly happens in the body? How are the terms “menopausal transition”, “perimenopause”, or “menopause” distinguished from one another — and why are they so often confused? Those who understand how this natural transition unfolds biologically can often classify physical changes more easily.

This article focuses on basic classifications and on correcting the assumption that hormonal changes in midlife don’t affect men.

Difference Between the Menopausal Transition and Menopause

In everyday language, the terms menopausal transition and menopause are often used synonymously. From a medical perspective, this is not correct. The menopausal transition — also called the climacteric — describes the entire period of hormonal changes that begins with the gradual decline in ovarian function. During this phase, the production of the female sex hormones estrogen and progesterone decreases, while at the same time the regulatory hormones FSH and LH increase. These hormonal changes may lead, among other things, to cycle irregularities, sleep disturbances, or hot flashes (Burger et al., 2002; Santoro & Randolph, 2011).

Perimenopause begins when the first hormonal changes and menstrual cycle irregularities occur. It ends 12 months after the last menstrual period; from that point on, the term menopause is used. Menopause refers to the last natural menstrual bleeding. Medically, this point in time can only be determined retrospectively — when no further menstrual bleeding has occurred for twelve consecutive months (Harlow et al., 2012).

The Menopausal Transition: What Happens in the Body?

Hormonal changes usually begin several years before menopause. The main cause is a gradual change in ovarian function.

During this phase, the following typically occur:

·       declining estrogen and progesterone levels

·       rising concentrations of the regulatory hormones FSH and LH

·       stronger hormonal fluctuations within the menstrual cycle.

Estrogen influences numerous processes in the body. Among other things, it acts in the brain, the cardiovascular system, bone metabolism, and temperature regulation. For this reason, hormonal changes can have noticeable effects far beyond the menstrual cycle (Santoro & Randolph, 2011).

What Are Typical Symptoms of the Menopausal Transition?

Not every woman experiences the menopausal transition in the same way. Some notice hardly any changes, while others experience significantly stronger symptoms.

Commonly described symptoms include:

·       hot flashes and night sweats

·       sleep disturbances

·       mood swings

·       exhaustion

·       concentration problems (“brain fog”)

·       joint or muscle pain

·       changes in skin and mucous membranes.

Hot flashes in particular are among the best studied symptoms. They are mainly associated with changes in temperature regulation in the hypothalamus, which are influenced by declining estrogen levels (Freedman, 2014).

“Brain Fog” During the Menopausal Transition: Annoying, but Temporary and Manageable

Many women report concentration problems, forgetfulness, or a feeling of mental slowing during the menopausal transition. These symptoms represent a temporary impairment of attention, memory, or mental resilience. Research findings show that changes in certain cognitive functions can also be observed during the menopausal transition phase (Greendale et al., 2009). Adequate sleep, reducing stress factors, and mental and memory exercises can help here. This may sound laborious or even like a cliché — and yet, constant dripping wears away the stone …

Skin and Hair Changes: Everything Depends on Estrogen

Many women report changes in their skin and hair. These changes are also related to declining estrogen levels.

Estrogen plays an important role in collagen formation, skin thickness, and moisture regulation. As hormone levels decline, the skin may therefore become drier and lose elasticity. Studies show that collagen levels in the skin can decrease significantly after menopause (Brincat et al., 2005).

Hair structure may also change. Some women notice thinning hair or increased hair loss, while at the same time increased hair growth may occur on other parts of the body. The cause lies in changes in the hormonal balance between estrogens and androgens.

These changes are part of the natural hormonal adaptation process and can vary greatly from person to person.

Why Can the Intensity of Symptoms Vary So Much?

Various factors can influence how strongly symptoms are perceived.

These include:

·       genetic differences

·       physical activity

·       exposure to stress

·       sleep quality

·       overall health status.

Cultural and social factors also play a role. Studies show that certain symptoms are reported with different frequency in different population groups. For example, in a large U.S. study, African American women reported hot flashes and night sweats more frequently, while Caucasian women more often reported psychosomatic complaints (Avis et al., 2001).

Hormone Treatments With Side Effects: How Conventional Medicine Masks Symptoms

In conventional medicine, various treatment approaches are used, most of which aim to suppress individual symptoms pharmacologically — although many of these measures are associated with potential, sometimes serious side effects (NICE guideline NG23, 2024).

Examples:

·       Certain antidepressants can reduce hot flashes and are sometimes used when HRT is not suitable. One may legitimately question why people without the corresponding indications should take antidepressants (which are certainly not comparable to peppermint sweets).

·       Gabapentin, a medication originally developed for epilepsy, is also used to treat hot flashes.

·       Clonidine is a blood pressure medication that can also show some effect against vasomotor symptoms (hot flashes).

·       Low-dose vaginal estrogen preparations to treat urogenital symptoms such as vaginal dryness or pain during sexual intercourse.

·       Hormone Replacement Therapy (HRT), which is often used in more severe cases. In this therapy, estrogens — sometimes combined with progestogens — are administered to compensate for hormonal deficiencies.

Possible risks of these symptom-oriented therapies include:

·       increased risk of venous thromboembolism (e.g., deep vein thrombosis or pulmonary embolism)

·       increased risk of stroke

·       possible increased risk of coronary heart disease

·       possible increased risk of dementia when therapy begins at an older age

·   increased risk of breast cancer with prolonged combined estrogen–progestogen therapy.

(National Institute for Health and Care Excellence, 2024; The North American Menopause Society, 2022).

Because non-hormonal alternatives are increasingly sought and demanded, a broad field of naturopathic research has developed around this topic. Which plant-based active substances and complementary medical approaches may be particularly helpful will be discussed in detail in the next article.

Bonus Material: Do Men Also Go Through a Hormonal Transition?

In fact, hormonal balance also changes in men over the course of life. With increasing age, the level of the male sex hormone testosterone gradually declines. This age-related decrease initially belongs to the normal hormonal changes of ageing and usually occurs gradually over many years.

The medical term late-onset hypogonadism (LOH) is used only when two conditions are met simultaneously: typical symptoms must be present and reduced testosterone levels must be detectable in the blood. Not every age-related decline in testosterone meets these criteria.

Nevertheless, men may experience symptoms such as:

·       declining energy

·       reduced muscle strength

·       changes in mood

·       changes in libido.

While female menopause represents a clearly defined point in time, hormonal changes in men occur more slowly, more individually, and without a clearly defined transition. For this reason, many experts prefer to refer more generally to “age-related hormonal changes in men” (Wu et al., 2010).

Hormonal Transition and Menopause: The Body Reorganises Itself

Hormonal processes also change in men over the course of life, although much more slowly than in women.

While menopause refers only to the time of the last menstrual period, the climacteric encompasses the entire hormonal transition before and after it.

It is a natural process that no one needs to fear. Those who understand these differences can often better classify physical changes in midlife — and find ways to deal with them.

FAQ – Frequently Asked Questions About the Menopausal Transition and Menopause

1. When does the menopausal transition typically begin?

For most women, the menopausal transition begins between the ages of 45 and 55. However, the exact timing can vary considerably. Genetic factors, lifestyle, smoking, and certain medical procedures may influence its onset (Harlow et al., 2012; Gold et al., 2001). 

2. Can the menopausal transition start at age 40?

Yes, if hormonal changes begin before the age of 40, this is medically referred to as premature ovarian insufficiency. It is relatively rare but may have genetic, autoimmune, or medical causes (Nelson, 2009).

3. How long does the menopausal transition usually last?

The hormonal transition can last several years. Many women experience the first changes already during the so-called perimenopause, which often begins four to eight years before menopause. Overall, the phase of hormonal adjustment can therefore last up to ten years (Santoro & Randolph, 2011).

4. Why do some women gain weight during the menopausal transition?

During the menopausal transition, metabolism and fat distribution in the body often change. Declining estrogen levels are associated with increased fat storage in the abdominal area as well as with changes in energy expenditure (Lovejoy et al., 2008).

The newly published fifth volume of our “Codex Humanus” is now available in our online shop. The other four volumes of the series are also available there, as well as all volumes of the “Medizinskandale” series. You can find further information on the menopausal transition, menopause, and many other topics on our blog.

Sources:

·       Burger, H. G.; Dudley, E. C.; Robertson, D. M.; Dennerstein, L. (2002): “Hormonal changes in the menopause transition,” Recent Progress in Hormone Research.

·       Santoro, N.; Randolph, J. F. (2011): “Reproductive hormones and the menopause transition,” Obstetrics and Gynecology Clinics of North America.

·       Harlow, S. D.; Gass, M.; Hall, J. E.; et al. (2012): “Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging,” Menopause.

·       Freedman, R. R. (2014): “Menopausal hot flashes: mechanisms, endocrinology, treatment,” Journal of Steroid Biochemistry and Molecular Biology.

·       Greendale, G. A.; Huang, M. H.; Wight, R. G.; et al. (2009): „Effects of the menopause transition and hormone use on cognitive performance in midlife women“, Neurology.

·       Brincat, M.; Baron, Y. M.; Galea, R. (2005): „Estrogens and the skin“, Climacteric.

·       Avis, N. E. et al. (2001): „Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups“, Social Science & Medicine.

·       National Institute for Health and Care Excellence (2015, updated 2024): „Menopause: identification and management (NICE guideline NG23)“.

·       The North American Menopause Society Advisory Panel (2022): „The 2022 hormone therapy position statement of The North American Menopause Society“, Menopause.

·       Wu, F. C. W.; Tajar, A.; Beynon, J. M.; et al. (2010): „Identification of late-onset hypogonadism in middle-aged and elderly men“, New England Journal of Medicine.

·       Gold, E. B.; Bromberger, J.; Crawford, S.; et al. (2001): „Factors associated with age at natural menopause in a multiethnic sample of midlife women“, American Journal of Epidemiology.

·       Nelson, L. M. (2009): „Primary ovarian insufficiency“, New England Journal of Medicine.

·       Lovejoy, J. C.; Champagne, C. M.; de Jonge, L.; Xie, H.; Smith, S. R. (2008): „Increased visceral fat and decreased energy expenditure during the menopausal transition“, International Journal of Obesity.