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cofactor · 1
The Recommended Dietary Allowance of 0.8 g/kg a day is a floor against deficiency and may be low for women in midlife and beyond: the PROT-AGE consensus advises 1.0–1.2 g/kg a day for healthy people over 65, and at least 1.2 g/kg for those who exercise regularly. After menopause it matters even more to get enough protein, together with strength training.
regulates · 7
→Bone
Perimenopause is the turning point for bone loss: as estrogen withdraws, the cells that remove bone outpace the cells that build it, and bone is lost fastest in the years around menopause. So attention to bone need not wait until 65.
Perimenopause and the first years after menopause are when women lose bone fastest, most of all in the spine. Menopausal hormone therapy slows bone loss, but whether to use it and when to start depend on age, time since menopause and other risks, and are for the woman to decide with her doctor. So bone risk is best assessed around the time of menopause.
Insomnia in perimenopause is not just psychological: allopregnanolone, a breakdown product of progesterone, strengthens the brain's calming GABA signal, so high progesterone in the luteal phase was helping you sleep. In this period progesterone swings sharply, and trouble falling asleep, staying asleep and waking too early all become common.
Muscle is not lost at a steady rate: the loss speeds up year by year after midlife and becomes more marked after 70, and strength falls faster than muscle size. In women, the curve may steepen further once estrogen falls at menopause.
A sharp drop in estrogen is one of the main triggers of menstrual and perimenopausal migraine. In early perimenopause, when hormones swing widely, attacks may become more frequent and more severe; after menopause, when hormones settle, many people improve. Anyone with migraine who is considering menopausal hormone therapy should discuss the form and the way of taking it with a doctor.
In the luteal phase the range of temperatures the body finds comfortable narrows, so the same room feels warmer. A group of neurons in the hypothalamus (KNDy neurons) helps control both reproductive hormones and body temperature, and they are also involved in perimenopausal hot flashes, so the two experiences may share part of the same pathway.
Estrogen helps the kidneys clear uric acid, which is why women before menopause generally have lower blood urate than men; after menopause the gap closes quickly, and the same person's risk takes a turn in those few years.
contrast · 2
Hormonal aging in men is not the same event as menopause: menopause brings a steep fall in estrogen over a few years, with a clear endpoint, while in men it is a gentle slope. By the criteria of the European Male Ageing Study (EMAS), true late-onset hypogonadism affects only about 2% of men aged 40–79, and many symptoms blamed on low testosterone improve noticeably with serious lifestyle changes.
These two periods are often talked about as one: perimenopause is a transition of roughly 4–10 years before menopause, with estrogen swinging up and down and hot flashes coming and going; postmenopause is a new baseline with estrogen steady at a low level, lasting about the last third of life. A period of swings and a period of stability call for different responses.