Understanding Perimenopause: Insights from the Mind's Realm
In the journey of life, women often encounter a significant phase known as perimenopause, the transition leading up to menopause. This phase, which is not clearly defined, is often experienced by women in their 40s and 50s, though some may start as early as their 30s.
During perimenopause, women may experience a range of symptoms, including acne, mood swings, weight gain, sore breasts, extreme premenstrual cramping, heavier bleeding, and more. Some women may also become clumsy, experience a change in their sense of smell and taste, chronic fatigue, anxiety, night sweats, insomnia, joint pain, hair changes, skin dryness, ear itching and ringing, and heart palpitations.
The brain plays a crucial role in these symptoms. Women's brains are connected to their ovaries via the nervous system and the endocrine system, and fluctuations in sex hormones, primarily estrogen and progesterone, may contribute to perimenopause symptoms. A neuroscientist, Lisa Mosconi, has found evidence that women experiencing perimenopause symptoms show a decline in their white and gray brain matter volume, similar to that of a pregnant woman. Moreover, Mosconi's research suggests that estrogen's activity in the brain may be closely correlated to both cognitive and vasomotor symptoms of perimenopause, such as brain fog and hot flashes.
In the quest for effective treatments, two drugs have shown promising results. Fezolinetant, approved for use in the U.S. in 2023, works by acting on a brain receptor that regulates body temperature and contains no hormones. Another drug, Elinzanetant, has shown similar efficacy for hot flashes and seems to improve other symptoms like sleeplessness. It was approved in the U.K. and Canada in July 2025 and is currently under FDA review.
Hormone replacement therapy (HRT) is recommended by the North American Menopause Society as a frontline treatment for perimenopause. HRT is linked to decreased odds of depression and anxiety, while women who don't take hormones experience an elevated risk of osteoporosis. However, it's important to note that some women may not be suitable candidates for HRT due to personal or medical reasons.
Research into perimenopause is increasing, and it is becoming a more discussed topic in the media and among scientists. Yet, it's disheartening to note that Black women are more likely to have severe perimenopause symptoms than white women, but they are also 50 percent less likely to be prescribed HRT.
Moreover, a U.K.-based study of 100,000 women found that 4 out of 5 women reported times when their doctor did not listen to them. This underscores the need for increased awareness and understanding of perimenopause among healthcare providers.
One woman, Lauren Keefe, a 40-year-old, experienced a myriad of symptoms. Her symptoms were not diagnosed until she was 46, after seeing multiple doctors and specialists, and was finally diagnosed with perimenopause by a doctor she found through the Menopause Society.
Perimenopause is a complex and multifaceted phase, with at least a hundred different associated symptoms. Some women barely experience anything, while up to a third may endure years of escalating problems. It's essential to raise awareness, encourage research, and advocate for equitable healthcare for women during this crucial phase of life.
