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Daring Menopause
Perimenopause: the menopausal transition finally explained
Odile Bagot demystifies perimenopause: the two alternating hormonal states, heavy periods, contraception, and why not everything is hormonal.
Summary
🔊 This program is an information program by a trained professional. This is generic advice and is not a personalized diagnosis. In all cases, we recommend that you be followed by a gynecologist and/or a midwife for individualized follow-up.
What you will learn in this episode
In this episode, Odile Bagot clears up a misunderstood and often misused term: perimenopause, which she prefers to call the menopausal transition. You will understand why this period is sometimes more difficult to experience than menopause itself, and how to get the right support.
- The difference between perimenopause, premenopause, and the menopausal transition
- The two opposing hormonal states that alternate during this period
- Why periods become heavier, and the solutions available
- Pregnancy and contraception: what you need to know at this age
- Why you shouldn't blame everything on hormones
💡 Key figures
The menopausal transition generally lasts from 4 to 8 years before the final menstrual period.
Source: MSD Manual, Professional Version, Gynecology and Obstetrics section - Menopause. Link
___
Uterine fibroids affect up to 70% of women over 45.
Source: deuxiemeavis.fr, citing data from Santé publique France and a study published in ScienceDirect. Link
Clearing up the terms: perimenopause, premenopause, menopausal transition
These terms are often confused. Today, many professionals prefer to speak of the menopausal transition : a period that lasts on average 5 years (between 3 and 8 years depending on the individual), and which begins on average around 45-46 years oldThis transition includes the famous final year without periods, which can only be identified as such in hindsight.
The two alternating hormonal states
This is the key to understanding this period: it is not linear, but rather alternates between two opposing hormonal states. At the beginning of the transition, progesterone levels drop too early after ovulation, creating a state ofrelative hyperestrogenism : shorter cycles, heavier periods, breast tenderness, water retention, and intensified PMS. Later in the transition, 2-3 month phases without periods may occur, characterized by a state ofhypoestrogenism, similar to menopause: hot flashes, irritability, and sometimes depressive episodes. Then, periods may return. It is precisely this alternation that makes the period difficult to manage: there is no single treatment for the entire transition; everything must be adapted on a case-by-case basis. Prescribing menopause hormone therapy during a phase without periods is risky: if the woman's own hormones kick back in, it can lead to an overdose.
Why periods become heavier
Three phenomena combine: a lack of progesterone, which prevents the endometrium from preparing properly; more frequent periods (every 3 weeks instead of 4); and the development of uterine fibroids, which affect a large number of women over 40. If periods become too heavy, it should not be downplayed: you should consult a doctor.
A solution for heavy periods
The progesterone IUD is presented as an "elegant and well-tolerated" solution: it respects the natural cycle (the woman continues to ovulate, and her own hormonal balance is not altered), but it thins the endometrium enough to significantly reduce, or even stop, bleeding.
Pregnancy and contraception: what you need to know
Pregnancy is still possible during the transition, even if the chances are slim and no fertility treatment is effective at this stage (the oocytes are no longer viable enough for fertilization).
If a pregnancy is not desired, contraception remains necessary.
The choice must be tailored: a copper IUD is not recommended (as it can worsen bleeding), and since vascular risks (heart attack, stroke) increase with age, the pill should be reconsidered on a case-by-case basis with your healthcare provider.
Beware of oversimplification
Odile is categorical: systematically attributing every discomfort between the ages of 40 and 50 to hormones is not accurate, especially when a woman still has regular periods (meaning no hormonal imbalance). She encourages always looking for a precise explanation first (bleeding → treat the cause; depressive phase → look at life context) rather than a single, simplistic explanation.
Listening above all: transference and counter-transference
Odile mentions a psychoanalytic principle essential to her practice: counter-transference, which occurs when a healthcare provider struggling with personal issues projects negativity onto their patient instead of helping them. She emphasizes the importance for every healthcare professional to do personal work to remain attentive, even when a patient arrives with information gathered from social media: the goal is not to contradict her, but to sort through it together.
An integrative health approach
Odile advocates for integrative health : the best of conventional medicine (including medication when necessary), the best of complementary medicine (acupuncture, homeopathy, herbal medicine, nutritional therapy, dietary supplements, hypnosis), and taking the patient herself and her environment into account. Regarding mood disorders, she cites saffron, for example, as a natural antidepressant, while reminding us of the necessary caution with St. John's wort due to its drug interactions.
On the scientific evidence for dietary supplements
Odile explains that the lack of large, double-blind randomized studies does not mean a lack of value:Evidence-Based Medicine also includes the practitioner's experience and the patient's own experience. She shares personal follow-up data on patients taking dietary supplements (questionnaires at day 0, day 30, and day 60): 80% of the women followed felt better, with 80% of symptoms improved, while acknowledging that a placebo effect is likely involved.
We don't treat statistics; we treat patients.
🔎 Useful definitions
Perimenopause : a period lasting 4 to 8 years on average that precedes menopause, characterized by an alternation between relative hyperestrogenism and temporary hypoestrogenism.
___
Progestin IUD : an intrauterine device that thins the endometrium to reduce bleeding, without interfering with a woman's natural hormonal cycle.
___
Countertransference : a psychoanalytic concept referring to the emotional reaction (sometimes negative) of a caregiver toward their patient, distinct from the self-reflection necessary to avoid harming the therapeutic relationship.
🎯 Practical actions
- Consult my gynecologist rather than waiting if my periods become too heavy or frequent
- Discuss a suitable solution with my healthcare provider if my periods are heavy (such as a progestin IUD)
- Do not stop my contraception without talking to my doctor, even if I haven't had a period for a few months
- Avoid the copper IUD if my periods are already heavy during this time
- Do not automatically attribute my discomfort to hormones: talk about it to identify the real cause
- Consider psychological support if this period is difficult (reimbursable options are available)
- Tell my doctor about any dietary supplements I am taking, due to the risk of interactions
- Take care of my lifestyle now (diet, physical activity, stress management, and sleep)
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Summary
🔊 This program is an information program by a trained professional. This is generic advice and is not a personalized diagnosis. In all cases, we recommend that you be followed by a gynecologist and/or a midwife for individualized follow-up.
_____
⭐ The Daring Menopause series is made possible by the support of Puissante, a French brand dedicated to women's well-being and pleasure. Theepisode 8 is dedicated to them, featuring their famous Coco as well as their full range of products for intimate health.
What you will learn in this episode
In this episode, Odile Bagot clears up a misunderstood and often misused term: perimenopause, which she prefers to call the menopausal transition. You will understand why this period is sometimes more difficult to experience than menopause itself, and how to get the right support.
- The difference between perimenopause, premenopause, and the menopausal transition
- The two opposing hormonal states that alternate during this period
- Why periods become heavier, and the solutions available
- Pregnancy and contraception: what you need to know at this age
- Why you shouldn't blame everything on hormones
💡 Key figures
The menopausal transition generally lasts from 4 to 8 years before the final menstrual period.
Source: MSD Manual, Professional Version, Gynecology and Obstetrics section - Menopause. Link
___
Uterine fibroids affect up to 70% of women over 45.
Source: deuxiemeavis.fr, citing data from Santé publique France and a study published in ScienceDirect. Link
Clearing up the terms: perimenopause, premenopause, menopausal transition
These terms are often confused. Today, many professionals prefer to speak of the menopausal transition : a period that lasts on average 5 years (between 3 and 8 years depending on the individual), and which begins on average around 45-46 years oldThis transition includes the famous final year without periods, which can only be identified as such in hindsight.
The two alternating hormonal states
This is the key to understanding this period: it is not linear, but rather alternates between two opposing hormonal states. At the beginning of the transition, progesterone levels drop too early after ovulation, creating a state ofrelative hyperestrogenism : shorter cycles, heavier periods, breast tenderness, water retention, and intensified PMS. Later in the transition, 2-3 month phases without periods may occur, characterized by a state ofhypoestrogenism, similar to menopause: hot flashes, irritability, and sometimes depressive episodes. Then, periods may return. It is precisely this alternation that makes the period difficult to manage: there is no single treatment for the entire transition; everything must be adapted on a case-by-case basis. Prescribing menopause hormone therapy during a phase without periods is risky: if the woman's own hormones kick back in, it can lead to an overdose.
Why periods become heavier
Three phenomena combine: a lack of progesterone, which prevents the endometrium from preparing properly; more frequent periods (every 3 weeks instead of 4); and the development of uterine fibroids, which affect a large number of women over 40. If periods become too heavy, it should not be downplayed: you should consult a doctor.
A solution for heavy periods
The progesterone IUD is presented as an "elegant and well-tolerated" solution: it respects the natural cycle (the woman continues to ovulate, and her own hormonal balance is not altered), but it thins the endometrium enough to significantly reduce, or even stop, bleeding.
Pregnancy and contraception: what you need to know
Pregnancy is still possible during the transition, even if the chances are slim and no fertility treatment is effective at this stage (the oocytes are no longer viable enough for fertilization).
If a pregnancy is not desired, contraception remains necessary.
The choice must be tailored: a copper IUD is not recommended (as it can worsen bleeding), and since vascular risks (heart attack, stroke) increase with age, the pill should be reconsidered on a case-by-case basis with your healthcare provider.
Beware of oversimplification
Odile is categorical: systematically attributing every discomfort between the ages of 40 and 50 to hormones is not accurate, especially when a woman still has regular periods (meaning no hormonal imbalance). She encourages always looking for a precise explanation first (bleeding → treat the cause; depressive phase → look at life context) rather than a single, simplistic explanation.
Listening above all: transference and counter-transference
Odile mentions a psychoanalytic principle essential to her practice: counter-transference, which occurs when a healthcare provider struggling with personal issues projects negativity onto their patient instead of helping them. She emphasizes the importance for every healthcare professional to do personal work to remain attentive, even when a patient arrives with information gathered from social media: the goal is not to contradict her, but to sort through it together.
An integrative health approach
Odile advocates for integrative health : the best of conventional medicine (including medication when necessary), the best of complementary medicine (acupuncture, homeopathy, herbal medicine, nutritional therapy, dietary supplements, hypnosis), and taking the patient herself and her environment into account. Regarding mood disorders, she cites saffron, for example, as a natural antidepressant, while reminding us of the necessary caution with St. John's wort due to its drug interactions.
On the scientific evidence for dietary supplements
Odile explains that the lack of large, double-blind randomized studies does not mean a lack of value:Evidence-Based Medicine also includes the practitioner's experience and the patient's own experience. She shares personal follow-up data on patients taking dietary supplements (questionnaires at day 0, day 30, and day 60): 80% of the women followed felt better, with 80% of symptoms improved, while acknowledging that a placebo effect is likely involved.
We don't treat statistics; we treat patients.
🎯 Concrete actions
- Consult my gynecologist rather than waiting if my periods become too heavy or frequent
- Discuss a suitable solution with my healthcare provider if my periods are heavy (such as a progestin IUD)
- Do not stop my contraception without talking to my doctor, even if I haven't had a period for a few months
- Avoid the copper IUD if my periods are already heavy during this time
- Do not automatically attribute my discomfort to hormones: talk about it to identify the real cause
- Consider psychological support if this period is difficult (reimbursable options are available)
- Tell my doctor about any dietary supplements I am taking, due to the risk of interactions
- Take care of my lifestyle now (diet, physical activity, stress management, and sleep)
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