Menopause is marked exactly after the date of your last period. At this point we enter postmenopause, a normal process that comes with the natural decline of our reproductive hormones. On average this happens at 51, but it is quite common for this to begin a few years before or after that age. What we will focus on in this article is the time before menopause: pre-menopause, or perimenopause, to use a more technical term. This change in our hormones brings on a gradual transformation in our lives.  Perimenopause means “near menopause”, and it is when hormonal fluctuations begin to cause symptoms. This transition can last for around 10 years until the point of menopause. Once the last menstrual period has been reached, a woman enters post-menopause. These hormonal fluctuations can be the most intense in a woman's life, sometimes even more than in premenstrual syndrome (PMS). Doctors have reliable tests for determining menopause, however, for perimenopause, the diagnosis of accompanying symptoms is not so simple. It is marked by constant fluctuations in the sex hormones progesterone, estrogen and testosterone. It only takes a well-conducted anamnesis — listening to the woman's complaints and life story — to determine if a woman is experiencing the symptoms of perimenopause, even in her late 30s. Due to hormone fluctuations throughout the day, there is no standardized diagnosis. Officially, it is accepted that a woman is in perimenopause when her various symptoms are considered together.  Symptoms of perimenopause The amount of estrogen generated by the ovaries begins to decrease throughout our 30s and 40s. For this reason, changes in the menstrual cycle are common in perimenopause. Generally, the cycles at first become shorter and the flow more intense and, when menopause approaches, the cycles become less frequent. But of course, this varies a lot from one woman to another. Remember: abnormal bleeding can also indicate a larger problem that needs to be evaluated by your doctor. What other symptoms can occur during perimenopause? When they think about menopause, women usually think of the classic symptoms such as hot flashes and night sweats, but long before these happen, up to 10 years before, symptoms such as memory loss, changes in sleep quality, depression, emotional instability and irritability are the most common. Each woman is unique and so is her perimenopause  Some women experience a wide range of symptoms that can be quite serious while others experience few or no symptoms. In my experience, we all have symptoms, we just don't know that they are caused by hormonal fluctuations and we suffer without the necessary care.  Other signs that you may be in perimenopause Mood change: if you live with constant PMS, it may be in perimenopause. Mood swings, impatience and depressed feelings are the first symptoms of perimenopause. Additionally, sleep disturbances caused by hot flashes may be the source of these symptoms.  Fatigue: hormonal fluctuation, especially with progesterone, causes irritability, depressed mood, discouragement and procrastination, which are common complaints in perimenopause. Night sweats and hot flashes affect the quality and duration of sleep and, as a result, fatigue sets in. Weight gain: many women experience unexplained weight gain during perimenopause which can be attributed to hormonal changes affecting appetite, metabolism and body composition. But we cannot forget that sleepless nights, excessive alcohol consumption, a sedentary lifestyle, "emotional eating", and eating habits that cause inflammation can all contribute to weight gain. It is necessary to see the whole picture as there are many factors that contribute to weight gain.  Increased visceral fat: the increased activity of our circulating androgens (testosterone and others) leads to a change in where we store fat – less in the hips and thighs and more in the belly area. This change is marked by the weight loss in the waist and hips, which leads us to have a body shape more like that of men.  Sleep disorder: this is a very common symptom in perimenopause. You can experience insomnia, difficulty falling asleep, waking up earlier than normal or having your sleep interrupted several times. Night sweats also make it difficult to get enough sleep. Memory loss: memory problems are common during perimenopause. Mild memory loss and mental confusion are extremely common. These occur as a result of our bodies producing less estrogen and progesterone. The impact is often only temporary for many women. Hair loss: most women suffer from hair loss and graying hair. Hair on the front, sides, and top of your head may start to thin. Brushing and bathing can cause hair to fall out in larger quantities. Hair loss during perimenopause is especially linked to a decrease in estrogen and progesterone production. Hair grows faster and stays on the head longer when these hormones are present. The increased activity of testosterone can also cause hair loss during this period and increased hair growth above the upper lip and on the chin. However, other causes must also be investigated: nutritional deficiencies, digestive problems, autoimmune diseases and low levels of other hormones such as thyroid hormones. Low libido: sexual arousal and desire can change during perimenopause, even though this is more common in post-menopause. However, estradiol levels are not yet so low as to affect your libido, and if you can experience sexual pleasure before the hormonal fluctuation phase, you probably will continue to do so during post-menopause and beyond. Genitourinary problems: these symptoms are noticed more frequently after menopause but can also occur before. As estrogen levels drop, the vaginal lining can become thinner, drier, and less elastic. During sexual intercourse, vaginal dryness can cause discomfort, and you may be more susceptible to urinary tract infections if your estrogen levels are low. Loss of tissue tone can also cause urinary incontinence. Hot flashes: these usually occur with the approach of menopause. Hot flashes feel like a wave of heat in the upper torso and face that can last from a few seconds to several minutes. Some women experience hot flashes once or twice a month, while others experience them daily and even several times a day. During sleep they are called night sweats and can wake you up, leaving you tired, sluggish and grumpy the next day. What can you do?Perimenopause is often diagnosed by symptoms alone. There is no blood test and no quantifiable diagnosis to determine if a woman is perimenopausal due to wide fluctuations in hormone levels the condition causes. Adopting lifestyle changes and reevaluating your diet can alleviate most of your discomforts. Building your personalized care kit to get you through perimenopause will also help improve your symptoms and increase your overall well-being. Until next time and welcome to perimenopause (if that’s you)!  • Se você tem dúvidas, precisa de aconselhamento nutricional ou quer discutir alguma condição específica, por favor, entre em contato, eu vou ficar feliz em ajudar.