Menopause is a familiar term, but premenopause might sound vaguely familiar. What period does it exactly refer to? How do you recognize it, and most importantly, how can you navigate through it as smoothly as possible? We explore these questions with Dr. Michel Mouly, a gynecologist, surgeon, and oncologist in Paris, and author of a book on the subject titled “Menopause: Everything Can Change” released in October 2022.

The gradual cessation of menstruation, hot flashes, mood swings – the symptoms of menopause are well-known. However, there’s an increasing mention of premenopause and even perimenopause. What do these terms mean? Are there specific symptoms to watch for? Should one adapt behaviors and lifestyles to approach these periods better and prepare for menopause? To shed light on these questions, we interviewed Dr. Mouly, a specialist in the field. He emphasizes that it’s not normal for women to suffer during this period and suggests various ways to alleviate or eliminate the unwanted effects of menopause, starting from premonopause, if not earlier. Here’s the interview.

Menopause, premenopause, perimenopause… What do these terms mean?

There is indeed some confusion around these terms. First, menopause occurs theoretically around the age of 51, but some women may experience it at 46, while others may not until 55. Premenopause refers to the period before menopause and can last between 2 and 7 years. So, a woman with menopause at 53, for example, may start experiencing signs 7 years earlier. Finally, perimenopause means around. It includes all the signs that appear in the year before and after menopause. 

When is a woman considered menopausal? 

To simplify, a woman is considered menopausal when she hasn’t had her periods for a consecutive year. However, this isn’t how it plays out in real life. For instance, a woman who begins experiencing early signs of premenopause at 44 may stop having periods by the age of 46 but without complete signs of menopause, maintaining a certain level of hormones. She might only reach menopause at 51, for example. It’s very much a case-by-case scenario.

Signs of Premenopause

All the signs found in menopause can occur during premenopause. The most common is hot flashes, often occurring in the late afternoon, but some women experience them 3-4 times a day. There are also symptoms like night sweats, when a woman not only feels hot but also sweats. It’s essential to pay attention, as this can also be a sign of undiagnosed nocturnal hypoglycemia, a symptom of type II diabetes.

On the skin, women may experience acne, increased sebum, and hair growth. The skin loses its elasticity, and some may suffer from vaginal dryness, urinary problems, or signs of premenstrual syndrome, such as swollen and painful breasts. Additionally, muscle and joint pain can occur, a symptom that should typically be present during perimenopause but can also emerge during premenopause and be a precursor to osteopenia or even osteoporosis.

In essence, any early symptoms persisting for more than 2-3 years is a warning sign. For example, hot flashes lasting more than 3 years indicate a potential future cardiovascular disease. Another common symptom is the “brain fog” experienced by around 30% of premenopausal women. They may feel depressed, anxious, experience mood swings, and suffer from sleep disturbances, especially if the woman has gone through a challenging time, such as bereavement, baby blues, harassment, or assault.

Why do some women experience more symptoms than others?

When entering premenopause, progesterone levels start to decrease, and estrogen may continue intermittently. In some cases, estrogen levels can fluctuate up and down. Women with fluctuating hormone levels tend to have more symptoms. On the other hand, those with a gradual decrease in hormones may not experience all the signs because they maintain a more consistent hormone level.

Differentiating premenopause from thyroid issues

While the signs are not exactly the same, menopause can lead to thyroid fragility. Dysthyroidism, a malfunction of the thyroid, is common during perimenopause. Therefore, it’s essential to conduct a thyroid-stimulating hormone (TSH) test to rule out thyroid issues.

Weight gain and the belly during this period

Weight gain and the appearance of a small belly during this period can be concerning for many women. Normally, women can burn as many calories as they want until the age of 45, but it becomes more challenging with age, and the body starts storing fat. Many women wonder why they gain weight when they haven’t changed their eating habits. Dr. Mouly explains that dietary changes are needed and, more importantly, physical activity should increase.

Dietary recommendations and lifestyle changes

After a certain age, women experience muscle loss, so to maintain muscles and prevent lean mass from turning into fat mass, they must consume enough protein. While fruits and vegetables are rich in antioxidants, vitamins, and other nutrients, they won’t prevent weight gain after 40. Proteins (both animal and plant-based) must be included in the diet twice a day starting in their forties.

Apart from a good diet, women must engage in strength training. Dr. Mouly recommends working on the lower body because that’s where calories are burned. Choosing activities that increase heart rate, such as brisk walking, cycling, elliptical training, or climbing stairs, is crucial.

As for foods, lean meats, poultry, eggs, quinoa, lentils, spelt, and kale are good sources of protein. Fatty fish, rich in omega-3 and vitamins, are anti-inflammatory and beneficial. Green vegetables and legumes like broccoli, spinach, and watercress are also healthy. Nuts and seeds like walnuts, hazelnuts, and almonds are excellent choices. Dr. Mouly also emphasizes the benefits of pollen as an excellent source of plant-based protein containing various vitamins, trace elements, antioxidants, and omega-3.

Foods to avoid

Avoiding white flour and opting for whole grains is recommended. Saturated and polysaturated fats found in processed and canned foods should be avoided. Excessive salt and sugar intake should also be minimized. Dr. Mouly cautions against excessive consumption of soups, as they may lead to water retention. He advises eating vegetables al dente or steamed instead.

Moreover, tobacco should be avoided as it can advance the onset of menopause by about three years, reducing estrogen levels in the body. Alcohol should be consumed in moderation.

Treatment for difficult perimenopause

When women experience anxiety, sleep disturbances, mood swings, or even depression, many are prescribed antidepressants. However, according to Dr. Mouly, this isn’t the solution. If a woman is in such a state, it’s due to fluctuating hormones, so the focus should be on rebalancing them. It begins with a comprehensive interview, considering the patient’s history and current state. Depending on the case, a personalized treatment plan is developed, resembling the process of tailoring a wedding dress – with fittings and adjustments.

Treatment options include naturopathy, with products based on borage, evening primrose, and sage. If this doesn’t work, contraceptive pills may be recommended, not to prevent pregnancy but to help balance hormones and prevent hormonal variations. If perimenopause is exceptionally challenging, and the woman is suffering, a minimal dose of hormonal menopause treatment can be considered, involving cutaneous estrogen and natural progesterone.

Historical perspective on hormonal menopause treatment

Historically, hormonal menopause treatment (HMT) has faced resistance, primarily due to the 2002 American study “Women’s Health Initiative Study.” The study suggested that HMT could lead to breast cancer. Dr. Mouly clarifies that HMT doesn’t cause breast cancer; it reveals it earlier. Furthermore, it doesn’t increase the risk of breast cancer; it reduces mortality. HMT reduces breast cancer mortality by 50%, significantly improving outcomes compared to women who don’t take it.

The study raised concerns about cardiovascular diseases linked to HMT, but Dr. Mouly argues that parameters for prescription matter. French and European hormones, unlike American ones, are natural. European hormones are applied cutaneously, while American ones are administered orally. In the U.S., hormones are derived from horse urine, whereas French hormones are sourced from yams, a plant known since the Aztecs. The combination of natural molecules and a non-liver pathway results in no increased cardiovascular risk if the prescribed doses are followed. On the contrary, it offers cardiovascular protection.

It took until July 2022, 20 years later, for the Americans to admit their mistake. They now recommend treating women more in line with French practices as early as possible.

Is hormonal menopause treatment a lifelong commitment?

There is no time limit for hormonal menopause treatment. Menopause affects 100% of women and lasts a lifetime. Dr. Mouly notes that 80% of women will struggle during this period and will need treatment to avoid the mentioned pathologies. He emphasizes the importance of prevention, urging women to discuss and act before symptoms appear.


Final advice

To prepare for menopause effectively, it starts with premenopause. Dietary changes, strength training, and proper guidance are crucial. Women need to be briefed and informed about the various options available to them. Prevention is key. Dr. Mouly suggests that women, who are already consulting with their doctors about other health concerns,  should also discuss menopause. Action should be taken before symptoms arise.

Picture (c) : Vogue 

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