There is a moment in every woman's life when her body begins to change silently but profoundly. Sleep is no longer the same. The mood decreases for no apparent reason. The mood fluctuates. Memory seems to fail. And, little by little, the feeling arises that something is different, without being able to name exactly what. For millions of Brazilian women, these signs mark the beginning of a phase still surrounded by misinformation: the hormonal transition that precedes menopause. Menopause itself is a biological milestone: the definitive end of menstrual cycles, confirmed after 12 consecutive months without menstruation. But before it arrives, there is the climacteric — a transition period that can last from five to ten years and that begins, on average, around the age of 40 to 45. It is at this stage, also called perimenopause, that hormones begin to fluctuate irregularly, causing symptoms that affect the entire body. Dr. Rozeny Anute Disclosure The hormonal journey: what happens inside The protagonists of this change are two hormones: progesterone and estrogen. Progesterone is the first hormone to start falling — and it is largely responsible for sleep regulation, the calming effect on the nervous system and emotional balance. When its levels decrease, insomnia, anxiety and irritability set in, often even before any change in the menstrual cycle. Therefore, progesterone is often one of the first hormones to be replaced during clinical monitoring. Estrogen, produced mainly by the ovaries, affects disposition, body temperature, bone metabolism, cardiovascular health and cognitive function. It is what keeps women active and vital. When its production begins to drop, the effect spreads across multiple systems in the body — which is why symptoms seem so varied and, at times, disconnected. The simultaneous drop in progesterone and estrogen also causes changes in the menstrual cycle — which can become irregular, more intense or more spaced out. These signs are usually the first to attract attention, but many women attribute them simply to natural aging, without seeking investigation. Dr. Rozeny Anute, a gynecologist and plastic surgeon dedicated to the comprehensive care of women, is in charge of the Lady Care Clinic, with units in São José dos Campos, Caraguatatuba and São Paulo. She explains: "One of the biggest pitfalls at this stage is that the symptoms appear little by little, and the woman adapts to the discomfort. She thinks it's stress, that it's normal tiredness, and postpones care. When she finally seeks help, she's already been living with the problem for years." Symptoms that go unnoticed Hot flashes — the well-known hot flashes — are the symptom most associated with menopause, but they are far from being the only one. The list of climacteric manifestations is wide and often surprising for women themselves. Insomnia and nighttime awakenings are extremely common and are directly related to the drop in progesterone. The so-called “mental fog” — difficulty concentrating, memory lapses, sensation of cognitive slowness — is one of the complaints that most scare women at this stage, leading many to believe that they are developing a neurological problem when, in fact, the cause is hormonal. Mood changes also deserve attention: disproportionate irritability, anxiety attacks, feelings of sadness for no clear reason. These symptoms affect not only the woman, but her family and professional relationships. Weight gain — especially in the abdominal region —, reduced muscle mass, drier skin and hair loss complete a picture that, when not investigated, profoundly compromises quality of life. Sexual health in later life One of the most avoided topics in consultations — and which has the greatest impact on well-being — is sexual health during and after menopause. The drop in estrogen causes intimate dryness, loss of tissue elasticity and reduced libido. Many women abandon their sexual life due to discomfort or pain, without knowing that there are effective and accessible treatments. Lady Care Clinic / Disclosure Personalized hormone replacement — which can be done orally, transdermally (gel or patch) or through hormonal implants (pellets) — is one of the most consolidated approaches in medicine today. When recommended and accompanied by a specialist, it restores comfort, lubrication and desire. Local treatments, such as fractional CO2 laser and intimate hyaluronic acid, complement the approach with significant results and high satisfaction. "Sexuality is part of health. When a woman stops feeling pleasure and accepts it as inevitable, she is giving up an important dimension of her own life. And it doesn't have to be like that", highlights Dr. Rozeny. Prevention: bones and heart require extra attention The drop in estrogen doesn't just affect immediate well-being. It has long-term consequences that require preventive monitoring. Osteoporosis — progressive loss of bone density that increases the risk of fractures — is significantly more common in women after menopause. Bone densitometry becomes a fundamental exam from the age of 50, or earlier, when there are risk factors such as family history, low body weight or smoking. Cardiovascular risk also increases at this stage. Estrogen exerts a protective effect on blood vessels, and its reduction is associated with an increase in LDL cholesterol, blood pressure and the risk of cardiac events. Taking care of your diet, maintaining regular physical activity and undergoing periodic cardiovascular monitoring are essential measures for this stage of life. For bone health, the current approach goes far beyond calcium and vitamin D. Building good bone mass also requires magnesium, vitamin K and collagen, in addition to adequate protein intake. Without this combination, isolated supplementation has limited effect. Regular practice of moderate impact exercises and weight training complements care, directly stimulating bone formation. As for the heart, weight control, stress management and sleep quality are as important as periodic exams. Lady Care approach: the woman beyond exams At Clínica Lady Care, climacteric and menopause monitoring is carried out on an individual basis. This means looking at the woman as a whole — not just the laboratory results, but the way she feels, how she sleeps, how she works, how she interacts. Treatment may include bioidentical hormone replacement, targeted supplementation, nutritional guidance, intimate health care — including aesthetic and regenerative procedures — and referral to other specialties when necessary. The focus is to restore vitality, disposition and quality of life. "Menopause is not a sentence. It is a phase that, when well monitored, can be lived fully. No woman needs to accept discomfort", summarizes Dr. Rozeny Anute. To schedule an appointment at Clínica Lady Care, contact us via WhatsApp (12) 98310-0106 or access the profile @clinica.ladycare on Instagram. Responsible doctor: Dr. Rozeny Anute CRM 111.127 / SP