Regaining balance during perimenopause and menopause

Important natural stages in women's lives, perimenopause and menopause are accompanied by hormonal, physical and emotional changes that can sometimes be difficult to cope with. For gynaecologist Claire Liberatore-Dupas, appropriate medical support and targeted solutions can help to better manage symptoms and maintain long-term well-being. MonacoSanté keeps you informed.

Understanding to better live the transition

It is a subject that women are increasingly talking about openly. However, for years, perimenopause and menopause remained taboo subjects. “Even today, some patients still feel uncomfortable talking about it with their spouse or partner”, explains Dr Claire Liberatore-Dupas, a private gynaecologist in Monaco . From a medical point of view, the menopause corresponds to the complete cessation of menstruation for at least one year, marking the end of reproductive capacity. It occurs on average around the age of 51. Perimenopause, the, transitional period that precedes it, can cause a variety of symptoms. For some women, it begins 7 to 8 years before the average age of menopause. In her medical practice in Fontvieille, Dr Liberatore-Dupas sees women who are aware of changes in their bodies but do not always link them to these hormonal transitions. It is up to the healthcare professional to offer personalised care. “Sometimes, the first signs of perimenopause appear as early as age 43. I tactfully suggest to them that they are probably entering this period of their lives and that hormonal or non-hormonal treatments can provide appropriate and evolving care”.

Perimenopause: recognising what is happening in our bodies

This first stage is a real upheaval in women's lives and daily routines. Some even say they no longer recognise themselves and lose confidence in themselves. “If they don't dare talk about it, if they don't receive care and no one listens to them, it can become a very difficult period, with enormous variability from one woman to another”, says Dr Liberatore-Dupas. What are the first signs of perimenopause that women do not always associate with hormones? The most common symptom is shorter cycles, often accompanied by more severe premenstrual syndrome. "Cycles go from 28 days to 25 or 26 days. My patients tell me that after ovulation, for about ten days, they feel very unwell: fatigue, extreme irritability, hypersensitivity, sleep disturbances, breast pain, hot flushes and night sweats, for example". The gynaecologist also points out that, despite a sharp decline in fertility during perimenopause the risk of becoming pregnant remains. “It's rare, but among my patients, I see about one pregnancy per year in women aged 47 to 50”.

The impact on daily life

Other symptoms, particularly emotional or cognitive ones, may also appear. "As menopause approaches, we see many cases of short-term memory problems American women refer to this as mental fog". In this context, hormone treatment can already be started, combining natural progesterone taken orally and oestrogen in the form of a transdermal gel. “Even if they have two, three or four cycles a year, we can start this treatment because it's what they need”. For other women, periods become heavy and unpredictable. “For those with very short cycles and repeated bleeding, we can limit this with a progestogen pill or the insertion of a hormonal IUD to make them more comfortable”. Perimenopause and menopause can lead to weight gain, estimated on average at about ten kilos, with an inevitable impact on self-image and personal life. “We need to make women feel less guilty, because it’s a natural phenomenon. When they tell me they're doing the right thing and they've put on weight anyway, I say, « If they hadn't done anything, they probably would have put on more”. To limit its impact, the doctor recommends a balanced diet, rich in calcium, trace elements, omega-3 and vitamins, as well as regular physical activity. “Sedentary lifestyle and industrial food are two major enemies on the verge of menopause”. Finally, non-hormonal supplementation, via dietary supplements, can also be considered.

Menopause, a new hormonal status

How long does menopause last? “It starts when the period stops and lasts until the end of life. This is a definitive hormonal state. It's scary, but essential to know. It should also be remembered that in 2026, we have many ways to support women, both during the transition and during this new period of life. And generally, after a few years of menopause, most of them regain hormonal stability”. If 15-20% of women have few or no symptoms, menopause can be very stressful for many others: hot flashes, weight gain, irritability, mental fog, dry mucous membranes, loss of elasticity and skin hydration. “Every woman reacts differently. When you are well supported, it goes much better”, the specialist reassures The standard treatment is to compensate for hormonal deficiency by providing what the ovaries no longer produce: progesterone and oestrogen “Natural progesterone is given orally, while oestrogen is prescribed percutaneously, via a gel or patch. This allows you to supply hormones without resorting to synthetic hormones orally, which are more at risk from cardiovascular and venous aspects”.

Changing your perspective on this period of life

Do not invisibilize the symptoms and consult to find a balance: this is the message of Dr. Liberatore-Dupas. “During these pivotal times, we cannot stand by and do nothing. Many things can be put in place. You have to consult, and change interlocutors if listening is not satisfactory". For appropriate care regular follow-up is recommended: one to two gynaecologist consultations per year, or even more depending on the symptoms and treatments offered. Although perimenopause and menopause are not diseases, they can have significant health consequences, sometimes with debilitating symptoms. Because they impact women's entire social life, including their professional and intimate lives, their care is essential. According to the “Haute Autorité de Santé” (National Authority for Health) (HAS in France, only 6% of eligible women benefit from hormone treatment. “Without follow-up, for some women, these are ten years of life put in brackets: physical and moral exhaustion, sleepless nights, symptoms with sometimes serious consequences - diseases, depression, isolation. You have to consult”, stresses the gynaecologist.