Perimenopause library

Versioned, bilingual education compiled from named papers. Informational only.

Foundations

Perimenopause basics — A plain-language map of the menopause transition: what the word means, how researchers stage it, and what a symptom log can and cannot do.
What perimenopause is — and what STRAW actually staged — STRAW and STRAW+10 are the research map: early and late menopausal transition around the final menstrual period. Perimenopause is the patient-facing word for a longer stretch.
Hormones during the transition — and why one lab result is not a diagnosis — AMH tends to fall first, then inhibin B, then FSH rises. Estradiol can stay high or even spike before it drops. There is still no validated hormone cutpoint that diagnoses the transition for one person.
Perimenopause and menopause are not the same stage — STRAW treats menopause as a point in time — twelve months after the final period. Perimenopause is the longer stretch around that point. Averages are not a personal clock.

Hot flashes and night sweats last longer than older advice often said — In SWAN, frequent vasomotor symptoms lasted a median 7.4 years. Duration varies by when they start and by race and ethnicity. Four trajectory patterns showed up across more than a decade of follow-up.
Mood during the transition: status matters more than one hormone draw — SWAN found two-to-four times the odds of a major depressive episode in peri- or early postmenopause versus premenopause. Prior depression is the strongest predictor. New-onset risk is less consistent.
Cycle changes in the 40s: what tracking can show — STRAW+10 uses persistent cycle-length change, then longer gaps, as research stages. Tracking those dates is useful. A log still cannot stage you or explain every bleed.
Brain fog in the transition — what studies can and cannot say — People often report foggy thinking in midlife. The strongest cohort evidence in this library is about depressive episodes and mood, not a validated “brain fog” test. Describe the pattern. Do not self-diagnose cognitive decline.
Sleep in perimenopause — Night sweats can last years in SWAN. Sleep also moves with mood, stress, and other conditions. Track what breaks the night. Do not let an app name the disorder.

What NAMS currently says about hormone and nonhormone options — NAMS 2022 describes hormone therapy as the most effective treatment for bothersome vasomotor symptoms and genitourinary syndrome, with a timing window. NAMS 2023 lists nonhormone options with evidence grades. This is guideline language, not a prescription.

Where the medical and social accounts meet — SWAN’s race and duration gaps, depression as a status effect, and Lock’s local biologies are the same story told in two dialects. Offering treatment for bothersome symptoms is not the same as treating midlife as a deficiency disease.
Prepare a perimenopause visit without diagnosing yourself — A visit goes better with a pattern, a short list of questions, and a clear ask. Education and a log can fill those three. They cannot replace the appointment.

Midlife is not only an endocrine event — Qualitative and cross-cultural work shows that meaning, work, family, and local biologies shape how the transition is felt. Uncertainty is part of the experience, not a failure of staging.

What this library, and this app, cannot tell you — A hard list of the questions education and a symptom log are not allowed to answer. Use it as a checklist for what belongs with a clinician.
Bleeding patterns that need clinical attention — Some bleeding changes belong in a log. Some belong in a clinic this week. Education can name the flags. It cannot decide which side of the line you are on.