Perimenopause

Perimenopause can last seven to ten years or longer and bring shifting menstrual cycles, sleep and mood changes, and changes in brain metabolism as estrogen and progesterone fluctuate. 1 2

• Symptoms may begin in the thirties or forties: Cycles can initially become closer together; anxiety and difficulty sleeping may also appear. Brain fog and executive-function changes are described as possible cognitive symptoms. 3 4
• Brain metabolism: One account describes research finding an average cerebral-metabolism decline of about 20% from premenopause to postmenopause; women with more hot flashes, night sweats, and sleep difficulty were described as having greater cerebral hypometabolism. 5
• Factors linked to earlier menopause and associated risks: Smoking was described as speeding menopause. Another discussion identified toxin avoidance and untreated endometriosis-related inflammation as relevant factors, and linked earlier menopause with higher risks of dementia, osteoporosis, heart disease, and stroke. 6 7
• Hormone therapy timing and need: Hormone therapy was described as potentially beneficial when started near menopause—often around ages 51–52 and within roughly five to ten years. The discussion also cautions against treating it as automatically necessary, describing symptom relief and individualized decisions as important considerations. 8 9
• Estrogen with progesterone: For someone with a uterus, estrogen without a progestin can raise endometrial-cancer risk; adding progesterone or another progestin helps oppose that effect. 10