Journal

Perimenopause, Premenopause and Menopause: Understanding the female hormonal transition in light of contemporary biological evidence.

Introduction — A biological transition more complex than a simple hormone deficiency

The menopausal transition is one of the most complex endocrine phases of a woman’s life. Long described as a single event corresponding to the cessation of menstruation, it is now recognised as a progressive biological process, unfolding over several years and involving a profound reorganisation of hormonal, metabolic, neuroendocrine and immune systems [1–3].

The distinction between premenopause, perimenopause and menopause is not merely semantic. It helps to clarify how the underlying pathophysiological mechanisms evolve, why symptoms vary so widely, and what the short- and long-term clinical implications may be [2].

I. Physiological definitions: premenopause, perimenopause, menopause

Premenopause

Premenopause corresponds to the reproductive period preceding entry into the menopausal transition. Menstrual cycles are still regular, ovulation is generally present, and ovarian production of oestrogen and progesterone remains broadly functional [4]. From a biological standpoint, subtle changes can nonetheless occur, including a gradual decline in follicular reserve, without immediate clinical expression [5].

Perimenopause

Perimenopause refers to the transition phase surrounding menopause. It begins several years before the final menstrual period and extends up to twelve months afterwards [1]. It is characterised by marked hormonal instability, with significant fluctuations in oestrogen and a progressive reduction in progesterone production linked to increasingly frequent anovulatory cycles [2,6].

This phase is now identified as the period during which most symptoms—often mistakenly attributed to menopause itself—actually occur [3].

Menopause

Menopause is defined clinically as the permanent cessation of menstruation, confirmed retrospectively after twelve consecutive months of amenorrhoea, in the absence of pathological causes [4]. It corresponds to the functional loss of ovarian follicular activity, with a sustained fall in oestrogen and progesterone production and a persistent rise in gonadotrophins (FSH, LH) [7].

II. Endocrine changes across the menopausal transition

The menopausal transition is not accompanied by a linear decline in sex hormones, but by a progressive disorganisation of endocrine signalling [1,6].

Longitudinal cohort data show:

• increased variability in oestradiol concentrations;
• an earlier and more consistent decline in progesterone;
• a compensatory rise in FSH, reflecting reduced ovarian responsiveness [6–8].

These fluctuations explain why a single hormone test often correlates poorly with symptom intensity, particularly in perimenopause [3,8].

III. Clinical manifestations: a systemic expression of the transition

Vasomotor and somatic symptoms

Vasomotor symptoms (hot flushes, night sweats) are the most emblematic manifestations, but they are neither universal nor exclusive to established menopause [9]. They may appear early in perimenopause and persist for several years after menopause [10].

Other commonly observed manifestations include:

• sleep disruption;
• chronic fatigue;
• joint pain;
• changes in body composition [9–11].

Neuropsychological symptoms

Oestrogen fluctuations influence neurotransmitter systems (serotonin, dopamine, noradrenaline), contributing to a heightened risk of anxiety, depressive and cognitive symptoms during perimenopause [12–14].

Studies show increased vulnerability to depressive episodes during this phase, independently of psychiatric history [13].

IV. Medium- and long-term physiological consequences

The menopausal transition is accompanied by durable biological shifts that extend beyond immediate symptom burden.

Reduced oestrogen exposure is associated with:

• altered lipid and glucose metabolism;
• increased cardiovascular risk;
• progressive loss of bone mineral density;
• changes in fat distribution [15–18].

These changes help explain why perimenopause is now considered a critical window for preventive intervention [16,19].

V. Clinical approaches and therapeutic strategies

Hormone therapies

Menopausal hormone therapies remain the most effective treatments for vasomotor and genitourinary symptoms [20]. Recent data confirm that the benefit–risk balance depends strongly on:

• age at initiation;
• timing relative to the onset of menopause;
• an individual cardiovascular and breast-risk profile [20–22].

Non-hormonal approaches

For women who do not wish to use, or cannot use, hormone therapy, non-hormonal strategies can be proposed:

• lifestyle measures;
• nutritional support;
• sleep and stress management [21,23].

Their effectiveness is variable, but they contribute to a comprehensive approach to the menopausal transition.

VI. Scientific perspectives and current challenges

Perimenopause remains under-recognised and under-studied compared with established menopause [2,24].
Current research is moving towards:

• better characterisation of at-risk profiles;
• investigation of interactions between hormones, inflammation and metabolism;
• identification of early preventive strategies [19,24].

These findings reinforce the need for an integrative reading of the female hormonal transition.

VII. Nutritional strategies during the peri-menopausal transition

Diet plays a central role in supporting premenopause, perimenopause and menopause. While it does not replace appropriate medical or hormonal care, a balanced dietary pattern can reduce the intensity of certain symptoms, support metabolic, cardiovascular and bone function, and positively influence long-term health determinants [25–28].

General nutritional objectives

Scientific recommendations converge around dietary principles that aim to ensure:

• sufficient protein intake to preserve muscle mass and basal metabolic rate [26];
• adequate calcium and vitamin D intake to support bone health [27];
• a high fibre intake to support glycaemic regulation and gut health [25];
• regular intake of unsaturated fats, particularly omega-3s, to modulate inflammation [28];
• high micronutrient density (B vitamins, C, E, magnesium, zinc) [25].

Foods to prioritise

Evidence supports the value of:

• fresh vegetables and fruit, as sources of antioxidants and fibre;
• whole grains (oats, quinoa, brown rice);
• high-quality proteins: oily fish, eggs, legumes, poultry;
• dairy products or calcium-fortified alternatives;
• omega-3-rich foods (oily fish, flaxseed, walnuts);
• foods containing natural phytoestrogens (soy, flaxseed) [25–28].

Foods to limit

It is recommended to reduce:

• refined sugars and ultra-processed foods;
• saturated and trans fats;
• excess alcohol and caffeine;
• excess salt [25–27].

Adjustments across phases

In premenopause, the objective is prevention and support of overall metabolic health. In perimenopause, a Mediterranean-style diet is associated with fewer symptoms and a better cardiometabolic profile [28]. In menopause, emphasis shifts towards bone, muscle and cardiovascular health.

VIII. Targeted nutraceuticals in the hormonal transition

Cellular Nutrition® and biological support

Within an integrative approach, certain formulations can complement diet and lifestyle by targeting specific biological mechanisms.

N°5 OIL — Supporting lipid terrain and cellular signalling

The quality of cellular membranes conditions the transmission of hormonal and metabolic signals.
N°5 OIL combines an evening primrose oil standardised in gamma-linolenic acid (GLA) with vitamin E.

GLA is a precursor to prostaglandins involved in modulating low-grade inflammation and tissue reactivity. In perimenopausal and menopausal women, it helps improve tissue tolerance to hormonal fluctuations, without directly altering hormone levels.

Vitamin E protects polyunsaturated fatty acids from oxidation and supports maintenance of membrane integrity in a context of increased oxidative stress.

N°9 HARMONY — Neuro-endocrine, botanical and microbial regulation

N°9 HARMONY combines:

• chaste tree, for its action on the hypothalamic–pituitary axis;
• lady’s mantle, fenugreek and angelica, to support female comfort;
• a green tea extract rich in polyphenols;
• Lactobacillus crispatus, involved in microbiota balance and oestrogen metabolism.

This synergy is designed to support the body’s capacity to regain autonomous, coherent regulation of biological signals, without artificial stimulation.

IX. Targeted daily intake guidance during the hormonal transition

Nutritional needs evolve across premenopause, perimenopause and menopause, not only because of chronological age, but due to documented hormonal, metabolic and inflammatory changes. The recommendations below draw on international consensus statements and available clinical data.

Calcium

Reduced oestrogen exposure accelerates bone resorption, particularly from late perimenopause and during the first postmenopausal years.

Recommended intake:

• 1,000 mg/day in premenopause
• 1,200 mg/day in perimenopause and menopause

Preferred food sources:
dairy products (yoghurt, cheese, milk), calcium-rich mineral waters, sardines with bones, green vegetables (kale, broccoli), almonds.

Clinical data:
Insufficient intake is associated with accelerated bone loss and increased fracture risk after menopause [27].

Vitamin D

Vitamin D plays a central role in calcium absorption, muscle function, immunity and inflammation modulation. Deficiency is common in women over 45, particularly in temperate regions.

Recommended intake:
800 to 1,000 IU/day (20–25 µg), with higher requirements often needed in cases of documented deficiency.

Sources:
controlled sun exposure, oily fish (salmon, mackerel, sardines), eggs, fortified products.

Clinical data:
An optimal plasma concentration is associated with better bone density and a reduced risk of falls in menopausal women [27].

Omega-3 (EPA + DHA)

Omega-3 fatty acids contribute to inflammation modulation, cardiovascular health, brain function and mood regulation—domains that can be particularly sensitive during the menopausal transition.

Recommended intake:
at least 250 to 500 mg/day of EPA + DHA,
with benefits observed up to 1 g/day in certain inflammatory contexts.

Food sources:
oily fish (sardines, mackerel, salmon), seafood;
plant sources (flax, walnuts) provide ALA with limited conversion.

Clinical data:
Omega-3-rich diets are associated with a more favourable cardiovascular profile and modulation of low-grade inflammation in menopausal women [28].

Protein

Progressive loss of muscle mass (sarcopenia) often begins in perimenopause and accelerates after menopause, linked to reduced oestrogen and decreased muscle protein synthesis.

Recommended intake:

• 1.0 to 1.2 g/kg/day in premenopause
• 1.2 to 1.5 g/kg/day in perimenopause and menopause

Sources:
fish, eggs, poultry, legumes, dairy products, tofu, tempeh.

Clinical data:
Adequate protein intake is associated with maintenance of muscle mass, strength and basal metabolism after menopause [26].

X. Sample menus adapted to different hormonal phases

The following menus are structured examples designed to illustrate a coherent distribution of macro- and micronutrients, without rigidity or any universal prescription.

Sample menu — Premenopause

(Objective: prevention, nutrient density, metabolic stability)

Breakfast
Plain yoghurt or calcium-fortified plant alternative
Whole oats
Red berries
Ground flaxseed

Lunch
Quinoa salad, chickpeas, green vegetables
Chicken breast or tofu
Extra-virgin olive oil
Fresh fruit

Dinner
Oily fish (sardines or mackerel)
Roasted vegetables
Brown rice
Cheese or a fortified alternative

Sample menu — Perimenopause

(Objective: inflammatory modulation, neuro-endocrine support)

Breakfast
Scrambled eggs
Whole sourdough bread
Avocado
Fresh fruit

Lunch
Lentils or red beans
Cooked fibre-rich vegetables
Rapeseed or olive oil
Yoghurt

Dinner
Salmon or trout
Steamed green vegetables
Sweet potato
A few walnuts

Sample menu — Menopause

(Objective: bone, muscle and cardiovascular health)

Breakfast
Fromage blanc or a fortified alternative
Fresh fruit
Almonds
Chia seeds

Lunch
White fish or eggs
Mixed vegetables
Whole grains
Olive oil

Dinner
Homemade vegetable soup
Tofu or legumes
Cheese or yoghurt
Baked fruit if needed for digestion

About (micro)nutrient intake

Appropriate nutritional intake is a fundamental—yet often underestimated—lever in supporting premenopause, perimenopause and menopause. Adequate calcium, vitamin D, omega-3 and protein intake helps support bone structure, muscle mass, metabolic function and inflammatory stability.

Combined with a structured diet, the Cellular Nutrition® approach aims to strengthen the biological terrain underlying the hormonal transition, with a focus on coherence, prevention and respect for female physiology.

Conclusion

Premenopause, perimenopause and menopause form a biological continuum marked by a progressive reorganisation of endocrine, metabolic and neuroendocrine systems. Reducing this transition to a simple hormone deficiency leads to an incomplete understanding of the mechanisms involved.

A structured diet, combined with a targeted Cellular Nutrition® approach, makes it possible to act on the biological and cellular terrain that shapes symptom expression and long-term health.

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