Some words arrive too late. Perimenopause is one of them. Millions of women navigate this phase with migraines that resist aspirin, fragmented nights, a memory that slips, joints that creak at dawn, a background fatigue they attribute to stress or age, without ever making the connection. The connection, however, exists. It is called oestrogen.
Perimenopause: a hormonal transition phase preceding the menopause, lasting between 2 and 10 years, characterised by oestrogen fluctuations, rising FSH levels and irregular menstrual cycles. Menopause: the permanent cessation of periods for 12 consecutive months, median age between 49 and 52 years depending on population.
The perimenopause begins, on average, between the ages of 40 and 45, sometimes as early as 35 for some women, and can last between two and ten years before the onset of menopause. The menopause is defined medically as the absence of periods for twelve consecutive months, with a median age of onset ranging between 49 and 52 years across different populations and geographical contexts. Between these two dates lies a territory rarely mapped: that of the great transition. A territory that deserves, at last, a name: the perimenopause.
Perimenopause and Hormones: What Changes in Your Body
At the heart of this transition, three hormones play the leading roles. Oestrogen, the most well-known, begins to decline in a non-linear fashion. These are not gradual, smooth decreases: they are sometimes violent fluctuations, peaks followed by troughs, which disorganise the systems that depend upon them. Progesterone, often overlooked by the general public, also declines, and sometimes first, disrupting cycles before periods even become truly irregular. FSH, the follicle-stimulating hormone, rises in turn, signalling to the pituitary gland to stimulate ovaries that respond less and less.
This hormonal dance affects dozens of receptors found throughout the body: the brain, the heart, the bones, the skin, the mucous membranes, the intestines. Oestrogen is not solely a reproductive hormone. It is a global regulatory hormone, present in every tissue, every organ. Its progressive, irregular, sometimes abrupt withdrawal is felt well beyond the uterus.
Neuroscientist Dr Lisa Mosconi, director of the Alzheimer Prevention Programme at Weill Cornell Medicine in New York and author of The Menopause Brain, has devoted a significant part of her career to exploring the impact of oestrogenic decline on the female brain. Her brain imaging research has revealed that the hippocampus, prefrontal cortex and amygdala, regions crucial for memory, concentration and emotional regulation, are directly and measurably affected by the hormonal transition. This is not accelerated ageing. It is a profound, documentable neurological adaptation that calls for specific support.
These discoveries are part of a broader body of knowledge on female cerebral plasticity in the face of major hormonal transitions. In 2017, a landmark study published in Nature Neuroscience by Elseline Hoekzema’s team at the University of Amsterdam documented brain changes during pregnancy: a reduction in grey matter of approximately 2 to 5 per cent, interpreted not as a loss, rather as a specialisation and optimisation of neural connections in service of maternal capacities. This process, sometimes referred to as matrescence, is often accompanied by short-term memory disruption, the famous ‘baby brain’: a sign of reorganisation, not of lasting diminishment.
The perimenopause transition follows an analogous logic, in the opposite direction. Where pregnancy involves a hormonal peak followed by restructuring, the perimenopause involves hormonal decline followed by adaptation. Lisa Mosconi’s work, published in PNAS in 2021, documents through metabolic imaging the changes in cerebral glucose metabolism during the menopausal transition: a transitory modification that stabilises and reorganises once the menopause is established. The female brain restructures itself at every major hormonal transition: puberty, pregnancy, the post-partum period, the perimenopause. This capacity for adaptation is not a vulnerability. It is a remarkable biological architecture.
Women have oestrogen receptors throughout the entire brain. Oestrogenic decline literally modifies cerebral metabolism. This is not an impression. It is MRI data.
Know yourself to choose for yourself: a blood test for FSH, LH, oestradiol and progesterone makes it possible to confirm entry into the perimenopause and to open an informed dialogue with your GP, your gynaecologist or your integrative health practitioner on the full range of options available: hormonal support, phytotherapy, acupuncture, adaptogens, nutrition, lifestyle. There is no universal approach. Every woman’s body navigates its own way, at its own rhythm. What matters is having the informed choice of how to support it.
One clinical observation deserves to be highlighted: the onset of the perimenopause is often precipitated or intensified by a significant life event. Bereavement, divorce, an episode of professional burnout, a profound emotional shock. This is not coincidence. The stress axis, known as the HPA axis, and the reproductive hormonal axis, known as the HPO axis, are closely interconnected. Chronic stress or intense trauma disrupts hypothalamic regulation, which governs both the stress response and the secretion of reproductive hormones. The body does not compartmentalise. What it experiences outside reverberates on what unfolds within.
Symptoms of the Perimenopause: Far Beyond Hot Flushes
Hot flushes have had the merit of entering common parlance. They have also had the misfortune of representing, on their own, the entire perimenopause in the collective imagination, relegating everything else to invisibility. That everything else, however, is immense.
Migrainous headaches intensify for many women during the perimenopause, in direct connection with oestrogenic fluctuations that affect prostaglandin regulation and vascular sensitivity. Joint pain, often surprising because so unexpected, is explained by the loss of oestrogen’s anti-inflammatory properties. Muscles lose elasticity. Tendons lose suppleness. The overall effect creates a sense of a body that is less reliable, more unpredictable, which women do not spontaneously associate with a hormonal origin.
Oestrogen also plays a role in regulating insulin sensitivity. Its progressive decline can cause functional hypoglycaemia: sharp drops in blood sugar after meals, accompanied by intense cravings, trembling or sudden fatigue. Over time, if left unidentified, these disruptions can foster insulin resistance and increase the risk of type 2 diabetes. Here again, the hormonal link is rarely made during medical consultations.
Among the most striking and least known manifestations are vasovagal episodes and drops in blood pressure. The dysregulation of the autonomic nervous system, linked to oestrogen fluctuations, can trigger sudden episodes of dizziness, palpitations, blurred vision and loss of consciousness. Some women, combining profound fatigue from sleep deprivation, dehydration and intense heat during a hot flush, end up in A&E, sometimes on several occasions, before a link is finally established with the hormonal transition. These episodes are frightening and deserve to be recognised for what they are.
When the Body Changes Shape: Fat Redistribution
Many women notice, during the perimenopause, a change in their figure without any notable change in their dietary habits or physical activity. Abdominal weight gain and the redistribution of fat towards the abdomen and thighs are neither a lack of discipline nor an inevitable consequence of ageing: they are the direct result of a hormonal change that the body experiences from within.
Oestrogen directs the distribution of body fat according to a so-called gynoid pattern: hips, thighs, buttocks. When oestrogen declines, this regulation disappears and the body shifts towards an android pattern, redistributing its reserves towards the abdomen. This visceral adipose tissue, located around the internal organs, is not merely a question of appearance: it is associated with an increased risk of metabolic syndrome, type 2 diabetes and cardiovascular disease, making it a health indicator to be monitored attentively. Understanding this hormonal mechanism makes it possible to stop judging oneself and to begin supporting oneself with precision.
The Second Puberty: Body Hair, Perspiration and Body Odour
The perimenopause shares with adolescence a common hormonal logic: in both cases, the body undergoes a reconfiguration of the balance between oestrogens and androgens. At puberty, androgens rise. During the perimenopause, it is the oestrogens that decline: their relative proportion diminishes, while that of androgens asserts itself more strongly. The consequences are similar, in mirror image.
An increase in hair growth on the chin, between the eyebrows, the upper lip, sometimes the abdomen or chest, is one of the least discussed manifestations of this transition. The hair often becomes thicker and darker, and its location surprises women who were unprepared for it. This phenomenon can coexist, in an apparently paradoxical way, with thinning of the scalp hair: two opposite effects, one and the same cause. The body is responding to what its androgen receptors perceive as a new hormonal balance of power. Worth noting: some women beginning a course of micronised natural progesterone supplementation observe an intensification of this hair growth, as natural progesterone can have androgenic effects in certain profiles. A point to monitor and discuss with one’s doctor.
Perspiration follows the same logic. The hypothalamic dysregulation caused by oestrogen fluctuations intensifies the activity of the apocrine glands. At the same time, the skin microbiome transforms during the transition: the way in which the bacteria on the skin break down perspiration changes, and with it, body odour. These changes echo those of adolescence, and for good reason: they obey the same hormonal architecture, that of a body recalibrating in depth.
Sleep quality deteriorates, sometimes because of night sweats and nocturnal flushes, yet the deepest cause is often elsewhere: progesterone, a naturally sedative hormone, is one of the first to decline. Less progesterone means less deep sleep, more nocturnal awakenings, an impoverished sleep architecture. This sleep debt in turn generates a cascade of consequences: increased irritability, difficulty concentrating, brain fog, heightened emotional sensitivity. What women describe as ‘no longer being themselves’ is often, above all, severe sleep deprivation layered over an ongoing neurological reorganisation.
Mood Swings and Crying Episodes: A Hormonal Signal, Not an Emotional Disorder
Among the most destabilising symptoms of the perimenopause are mood swings and crying episodes that arise without identifiable cause. Intense irritability upon waking, sudden sadness in the middle of the afternoon, uncontrollable weeping over a minor detail: these experiences, often lived with shame and incomprehension, have a precise neurochemical explanation. Progesterone binds to GABA receptors, the brain’s principal inhibitory system, the natural regulator of calm and emotional balance. Its decline deprives the brain of an essential stabiliser. Simultaneously, oestrogen fluctuations disrupt serotonin and dopamine, the neurotransmitters of mood and pleasure. The result is a neurochemical storm whose origin women do not understand, and which they attribute to themselves far too readily. To these manifestations are sometimes added intense, sudden panic attacks without identifiable trigger: palpitations, a feeling of tightness, diffuse fear. These too have a precise hormonal origin and deserve to be named for what they are, not mistaken for a chronic anxiety disorder.
This clinical picture is regularly confused with a depressive episode, and antidepressants are prescribed without a prior hormonal assessment. This treatment does not resolve the hormonal origin of the symptoms: certain antidepressants additionally worsen the sleep and libido disturbances already weakened by the transition. Some women spend several years on inappropriate medication, believing themselves resistant to treatment, when the fundamental cause has never been identified or named. This is a medical reality that remains insufficiently recognised, and one of the reasons why information on the perimenopause remains a public health issue.
If you are experiencing unusual emotional instability, crying episodes or anxiety, ask your doctor for a full hormonal assessment: FSH, LH, oestradiol and progesterone. If these symptoms coincide with changes in your cycle, the perimenopause is a hypothesis to evaluate seriously before any psychotropic prescription.
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Perimenopause: Acupuncture, Herbs and Complementary Medicine
The body knows what it is doing. The perimenopause transition is not a malfunction to repair: it is a biological process inscribed in the female body for millennia. This does not mean it must be navigated without support. On the contrary, it is an invitation to surround oneself with the tools best suited to one’s own physiology, one’s values and the intensity of one’s symptoms. Many complementary approaches have been the subject of robust clinical studies.
Acupuncture
Rooted in traditional Chinese medicine for more than two thousand five hundred years, acupuncture rests on the principle of rebalancing the Qi, the vital energy circulating through pathways called meridians. The insertion of fine needles at precise points on the body aims to release blockages and restore the harmony between Yin and Yang. In the reading of traditional Chinese medicine, the perimenopause is often associated with a deficiency of Kidney Yin, the energetic organ that governs deep vitality and reproductive essence.
Clinically, a meta-analysis published in the journal Menopause in 2019, covering eighteen controlled clinical trials, demonstrated a significant reduction in the frequency and intensity of hot flushes in women treated with acupuncture. Benefits were also documented for sleep quality, anxiety and joint pain. The British Menopause Society recognises acupuncture as a valid complementary option for women preferring a non-hormonal approach or wishing to integrate it within a broader programme of support.
Phytotherapy: the Plants of the Transition
Several plants have been the subject of robust clinical studies and are recognised by institutions such as the European Medicines Agency (EMA) for their action on menopausal symptoms. They do not replace medical support when that is necessary, yet they offer real, documented support for many women.
Black cohosh (Actaea racemosa), also known as Cimicifuga, is the most extensively studied plant in this field. The EMA recognises its well-established traditional use for the relief of hot flushes and sleep disturbances associated with the menopause. Its mechanism of action, partially serotonergic, is not purely phytoestrogenic. It is, however, contraindicated in cases of hormone-sensitive cancer history, and prior medical consultation remains essential.
Common sage (Salvia officinalis), used since antiquity to reduce excessive perspiration, was studied in a controlled clinical trial published in Advances in Therapy (Bommer et al., 2011) demonstrating a significant reduction in hot flushes within eight weeks. Valerian (Valeriana officinalis) supports sleep quality and reduces anxiety, with several controlled trials published in the journal Menopause. Ashwagandha (Withania somnifera), an adaptogen from Indian Ayurvedic medicine, reduces cortisol, fatigue and anxiety: three common burdens of the perimenopause, confirmed by multiple rigorous clinical trials published notably in the Indian Journal of Psychological Medicine.
Peruvian maca (Lepidium meyenii), consumed for millennia in the high Andes, has shown positive effects on energy, libido and bone density markers during the perimenopause in trials published in the journal Menopause (Meissner et al., 2006). Red clover (Trifolium pratense), rich in isoflavones, is studied for its effect on hot flushes and the maintenance of bone density. Hops (Humulus lupulus) contain 8-prenylnaringenin, one of the most potent plant phytoestrogens known to date. Chasteberry (Vitex agnus-castus), one of the most prescribed plants in phytotherapy for the perimenopause, acts on the hypothalamic-pituitary axis to support the progesterone-oestrogen balance and alleviate premenstrual symptoms during the transition.
Finally, soya and its isoflavones, including genistein and daidzein, are the subject of clinical studies for their phytoestrogenic action on hot flushes and bone density. One precaution is necessary: soya isoflavones can interfere with the absorption of thyroid hormones. Women with a thyroid condition should consult their doctor before taking any supplement.
Yoga, Mindfulness and Mind-Body Therapies
Therapeutic yoga has been the subject of several controlled clinical trials documenting a reduction in hot flushes, sleep disturbances and anxious and depressive symptoms (Carson et al., Menopause, 2009; Cramer et al., 2018). Mindfulness-based stress reduction, known by its acronym MBSR and developed by Jon Kabat-Zinn, shows documented benefits on the frequency of hot flushes and overall quality of life (Carmody et al., Menopause, 2011).
Cognitive Behavioural Therapy (CBT) in its version adapted for menopausal symptoms, the CBT-MEN programme developed by Myra Hunter, is one of the best-documented non-hormonal approaches for reducing the impact of hot flushes on everyday quality of life, recognised by the National Health Service.
Before beginning any phytotherapy, consult your doctor, a qualified herbalist or naturopath: certain plants carry important contraindications or drug interactions. An integrative approach, combining self-knowledge, lifestyle adjustments and complementary support, is often the most effective and the most respectful of each woman’s singularity.
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Konenki 更年期: When the Menopause Becomes Wisdom
In 1984, anthropologist Margaret Lock introduced the notion of ‘local biologies’ by comparing the experience of the menopause in Japan, North America and Europe. Her findings profoundly unsettled the Western medical world: Japanese women reported significantly fewer hot flushes than their American or European counterparts. The Japanese term for the menopause, 更年期 (konenki), translates as ‘renewal of vital energy’: a period of transition, of acquired wisdom, of earned authority. Without connotation of loss. Without stigmatisation of the changing body.
Western medicine, by contrast, long treated the menopause as a failure. A hormonal deficiency to be corrected. A decline to be delayed. This posture has shaped women’s very experience of it: several comparative studies have demonstrated that the cultural representation a woman holds of the menopause directly influences the intensity of her perceived and reported symptoms. Context is a physiological variable in its own right.
The word 更年期 does not carry shame. It carries authority. What we call decline, other cultures have always named initiation."
This is not to say that symptoms are imaginary. It is to say that the context in which they are experienced radically changes their character. A culture that honours the fifty-year-old woman differently from one that erases her creates bodies that navigate the transition differently. In Japan, a woman in konenki does not have to conceal what she is living through. She transitions. And this social permission, in itself, transforms the experience from within.
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Saisei 再生: A Ritual Born of Conviction
It is in listening to this reality that HedonX conceived the Saisei Ritual. In Japanese, 再生 is composed of 再, ‘anew’, and 生, ‘birth, life’. A renaissance. Not a step backwards: a movement forwards, into a body that has evolved and that deserves care that evolves with it.
The Saisei Ritual was born of a simple yet rarely asked observation: intimate care products have been formulated for a fertile pH, between 3.8 and 4.5. Yet the body of women in the perimenopause and menopause is no longer that body. Its pH has changed. Its flora has changed. Its mucous membranes need another form of gentleness. A product designed for one does not suit the other. HedonX therefore conceived the Saisei Ritual to support this new intimate physiology: probiotic to nourish the fragile intimate microbiome, deeply hydrating for mucous membranes that lack the moisture oestrogens once ensured, and soothing through Helichrysum, that flower known as the Immortelle, symbol of resilience and renewal.
The prebiotic harmony that preserves and honours intimacy at every transition. The resilient strength of Helichrysum meets the hydrating embrace of hyaluronic acid. A precious encounter that elevates the daily gesture to the level of a true Renaissance Ritual. Saisei Ritual 再生 · Autumn 2026 launch.
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The Woman Who Transitions
The fifty-year-old woman who forgets a name is not losing her mind. She is transitioning. The one who wakes at three in the morning, heart racing, is not anxious by temperament. She is fluctuating. The one who weeps for no apparent reason is not fragile. She is transforming. These are three simple sentences that have the power to change a life when they arrive at the right moment.
The great transition deserves to be named with precision, supported with scientific rigour and lived with grace. It is not an ending. It is an initiation. And like all initiations, it holds something that could not have been anticipated from the other side: a sharper presence to oneself, a knowledge of the body finally freed from the illusions of invulnerability.
The cultures that have understood this have produced women who move into the second half of their lives with a quiet authority. What they have that others have not yet found is the right word for what is happening to them. And the community to navigate it together. That is one of the reasons for the existence of HedonX Le Carnet: to give the words. To build the community.
Women are extraordinary. They evolve with time. They deserve care, information and a culture that loves them in return.
A woman does not age. She reveals herself."
References & Experts
Dr Lisa Mosconi. The Menopause Brain. Clarkson Potter Publishers, 2024.
Mosconi L. et al. Menopause impacts human brain structure, connectivity, energy metabolism and amyloid-beta deposition. PNAS, 2021.
Hoekzema E. et al. Pregnancy leads to long-lasting changes in human brain structure. Nature Neuroscience, 2017.
Dr Mary Claire Haver. The New Menopause. Rodale Books, 2024.
Dr Rachel Rubin. Georgetown University Hospital, Washington D.C. Specialist in sexual medicine and genitourinary syndrome of the menopause.
Margaret Lock. Encounters with Aging: Mythologies of Menopause in Japan and North America. University of California Press, 1993.
Menopause and the workplace: how many women are affected and what can be done? British Journal of Psychiatry, 2023.
Acupuncture for menopausal vasomotor symptoms: systematic review and meta-analysis. Menopause, 2019.
European Medicines Agency (EMA). Assessment report on Actaea racemosa L., rhizoma. EMA/HMPC, 2018.
Bommer S. et al. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Advances in Therapy, 2011.
Meissner H.O. et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon). International Journal of Biomedical Science, 2006.
Carson J.W. et al. Yoga for menopausal symptoms. Menopause, 2009.
Carmody J.F. et al. Mindfulness-based stress reduction for vasomotor symptoms in menopause. Menopause, 2011.
Hunter M.S. et al. Cognitive-behavioural therapy for menopausal symptoms. Climacteric / British Menopause Society, 2011.
Elodie Baron. Integrative psychotherapist and sex therapist, Intima Formations.
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References & Experts
Dr Lisa Mosconi. The Menopause Brain. Clarkson Potter Publishers, 2024.
Mosconi L. et al. Menopause impacts human brain structure, connectivity, energy metabolism and amyloid-beta deposition. PNAS, 2021.
Hoekzema E. et al. Pregnancy leads to long-lasting changes in human brain structure. Nature Neuroscience, 2017.
Dr Mary Claire Haver. The New Menopause. Rodale Books, 2024.
Dr Rachel Rubin. Georgetown University Hospital, Washington D.C. Specialist in sexual medicine and genitourinary syndrome of the menopause.
Margaret Lock. Encounters with Aging: Mythologies of Menopause in Japan and North America. University of California Press, 1993.
Menopause and the workplace: how many women are affected and what can be done? British Journal of Psychiatry, 2023.
Acupuncture for menopausal vasomotor symptoms: systematic review and meta-analysis. Menopause, 2019.
European Medicines Agency (EMA). Assessment report on Actaea racemosa L., rhizoma. EMA/HMPC, 2018.
Bommer S. et al. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Advances in Therapy, 2011.
Meissner H.O. et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon). International Journal of Biomedical Science, 2006.
Carson J.W. et al. Yoga for menopausal symptoms. Menopause, 2009.
Carmody J.F. et al. Mindfulness-based stress reduction for vasomotor symptoms in menopause. Menopause, 2011.
Hunter M.S. et al. Cognitive-behavioural therapy for menopausal symptoms. Climacteric / British Menopause Society, 2011.
Elodie Baron. Integrative psychotherapist and sex therapist, Intima Formations.
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"This article demanded time and much reflection. It was born from conversations with extraordinary women who surround and inspire me: those who navigate this great transition, sometimes without knowing its name, often with a strength they underestimate. I dedicate it to them."