Everything you need to know about pre-menopause.

Pre-menopause refers to the transition period before menopause. It signifies the initial bodily changes that accompany hormonal shifts, primarily the decrease in levels of oestrogen and progesterone in the body. The reduction in the amount of these hormones in the body begins in the twenties and continues until it reaches a minimal threshold at menopause. This decrease is explained by the defined number of follicles in the ovaries. These follicles produce sex hormones throughout life until the stock is exhausted, that is, the menopause.

During the first half of the menstrual cycle, follicles predominantly produce oestrogens, while the corpus luteum, in the second half of the cycle, produces progesterone. However, the decrease in the amount of progesterone occurs more rapidly than that of oestrogen, leading to a period of hyperoestrogenism : the pre-menopause. The pre-menopause phase typically lasts between 2 and 5 years, but can also extend up to 8 years. The age of menopause, and therefore pre-menopause, varies among women, however, it is observed that pre-menopause most often occurs between 45 and 50 years. We refer to "early menopause" before the age of 45 and "premature menopause" before the age of 40.

The hyperoestrogenism experienced by women during pre-menopause is responsible for several symptoms. Pre-menopause manifests differently in every woman and not all experience the same discomforts. However, it is estimated thatat least 80% of women experience one or more of the symptoms listed below.

Irregular menstrual cycles.

One of the initial indicators of pre-menopause is the alteration of the menstrual cycle. The cycle becomes irregular and periods often become shorter. Depending on the individual, an increase or decrease in blood flow can also be observed. These changes are the result of declining hormone levels which disrupt the balance of the cycle.

Furthermore, an intensification of premenstrual syndrome can occur, or its onset in women who did not previously suffer from it. Premenstrual syndrome combines headaches, swelling and tenderness of the breasts, bloating and anxiety. The exact biological mechanisms behind these discomforts are still poorly understood, however, scientists consider that the drop in progesterone levels may cause changes in certain neurotransmitters of the central nervous system such as γ-aminobutyric acid (GABA).

Hot flushes.

Another characteristic sign of pre-menopause, hot flushes affect approximately 85% of pre-menopausal women. The exact cause has not yet been determined. It is hypothesised that the decrease in oestrogen levels has a impact on the serotonin receptor in the hypothalamus. An additional amount of serotonin would then be released, which would trigger the activation of the serotonin receptor 5-HT2A, modulating the dilation of blood vessels. This activation would then accentuate the blood flow and cause hot flushes.

Mood disorders and a decrease in libido.

Emotional and hormonal disturbances often go hand in hand, and pre-menopause is no exception. Several studies suggest that oestrogens affect the serotoninergic and noradrenergic systems of the brain. In animal models, the administration of oestrogens can induce changes in serotonin neurotransmission in the amygdala, hippocampus, and hypothalamus, areas of the brain that are involved in the regulation of mood. The anxiety generated also has consequences on the sexual life of pre-menopausal women and can affect their libido.

Beyond these biological components, pre-menopause is also a stressful period as it can potentially bring about significant changes in women's lives, particularly in the structure of their family (divorce, remarriage, children leaving home, new responsibilities to assist parents and in-laws...). While these environmental factors are not solely responsible for the mood disturbances observed in pre-menopause, they can certainly contribute to them.

Insomnia.

As they transition into menopause, pre-menopausal women may increasingly struggle to find sleep. These bouts of insomnia can also be explained by the hormonal fluctuations they undergo, with studies showing a link between hormones and sleep quality. Sleep is generally more disturbed during menstruation, a period of the menstrual cycle when hormone levels are at their lowest. Pre-menopausal women are also more prone to night sweats, a phenomenon correlated with the hot flushes they experience.

Dryness of the skin and a loss of skin elasticity.

The decline in oestrogen and progesterone levels in women's bodies is not without consequences on their skin. Indeed, oestrogens normally act by stimulating fibroblasts, dermal cells that contribute to the synthesis of hyaluronic acid, collagen, and elastin. Found in the extracellular matrix, all three contribute to the well-being of the skin. Hyaluronic acid is a macromolecule that works by retaining water in the skin, while collagen and elastin provide tone and flexibility to the skin.

The effects of progesterone on the skin are less well understood, but it is suggested that this steroid hormone upregulates the sebum synthesis by the sebaceous glands. However, sebum is an essential constituent of the hydrolipidic film found on the surface of the epidermis. This film acts as a protective shield for the skin, limiting water loss and the penetration of aggressive external agents (pollution, UV rays, allergens...).

Vaginal dryness.

The urogenital tissues are extremely sensitive to oestrogens and their fluctuations and can become fragile during the pre-menopausal period. Numerous studies confirm that 30 to 60% of women report moderate to severe symptoms of vaginal dryness or dyspareunia, that is, pain during sexual intercourse, in association with menopause. A vaginal atrophy, accompanied by a shortening of the vagina is often observed, which can cause irritations during sexual intercourse.

A urinary weakness.

The previously mentioned symptoms may be accompanied by stress incontinence and a loss of tone in the pelvic muscles. As stated earlier, fluctuations in oestrogen levels can lead to changes in the elasticity of urinary tissues, resulting in difficulties urinating.

A weight gain.

It is not uncommon for women to experience a more or less significant weight gain during pre-menopause. The reasons for this are manifold: the worsening of premenstrual syndrome, a decrease in energy expenditure, an increase in caloric intake, and an increase in fat mass due to age. It is also likely that hormones play a role in the storage and elimination of water and fats.

Furthermore, oestrogen impacts the levels of LDL-cholesterol and HDL-cholesterol. Indeed, it has been shown that this hormone has a cardioprotective role and it helps to maintain a healthy lipoprotein profile. From pre-menopause, HDL-cholesterol, also known as "good cholesterol", decreases, while LDL-cholesterol, referred to as "bad cholesterol", increases, which heightens the risks of weight gain and cardiovascular disease.

Pre-menopause affects approximately 1.5 million women each year. Although this phenomenon is a natural part of a woman's life, it is accompanied by several symptoms, some of which can be unpleasant. An evaluation based on 386 Australian menopausal women showed that 86% of them had consulted a doctor to discuss the symptoms of menopause and pre-menopause. While there is no specific treatment for pre-menopause, certain daily habits can help to better manage this transitional period.

Preparing for hot flushes.

Hot flushes are difficult to anticipate but it is possible to prepare for them. One of the best ways to be ready to face a hot flush is to always have a bottle of water with you. Drinking indeed helps to regulate body temperature and allows the body to cool down. You can also favour the wearing of several thin layers of clothing in winter instead of a single thick layer. Thus, if you experience a hot flush, you can easily remove a layer.

Maintaining a balanced diet.

Diet plays a crucial role in managing pre-menopause symptoms and maintaining overall good health. Adopting a diet rich in fruits, vegetables, whole grains, lean proteins, and unsaturated fatty acids can help to alleviate some pre-menopause discomforts such as hot flashes, weight fluctuations, and sleep issues. Moreover, foods high in calcium and vitamin D such as cheese, seafood, and certain fish (herring, trout, sardine...) are important for strengthening bone health, which becomes more fragile after menopause.

Throughout life, it is recommended to engage in physical activity. This advice is particularly resonant during the pre-menopause stage. The practice of physical activity has numerous benefits and allows for the improvement of cardiovascular health, reduction of stress, enhancement of self-confidence, improvement of sleep quality, reduction of hot flushes, and combating weight gain. Moreover, there are so many different sports that it is hard not to enjoy at least one : walking, cycling, yoga, swimming, badminton... Physical activity not only enables women to better manage the symptoms of pre-menopause but also to improve their physical and mental well-being.

Daily hydration of the skin.

Daily skin hydration is key to counteract the drying effects of decreasing hormone levels in the body. To restore the skin's hydrolipidic film and the skin barrier, we recommend relying on products rich in hydrating active ingredients such as glycerine or hyaluronic acid and in nourishing ingredients such as shea butter, sweet almond oil or even ceramides. At Typology, we offer a wide range of moisturising creams to cater to all skin types.

Use a lubricant and a vaginal moisturising cream.

To alleviate vaginal dryness and irritation, it may be beneficial to use a moisturising cream specifically formulated for this sensitive area. In addition to helping restore the natural hydration of the vaginal mucosa over the long term, the regular application of a moisturising cream provides comfort and reduces irritation and potential itching. It is also beneficial to use a lubricant to reduce friction and enhance comfort during sexual intercourse. If you still experience discomfort a week after incorporating these new products into your routine, do not hesitate to seek advice from your gynaecologist.

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