Menopause and perimenopause — assessment and plan in Sofia

What perimenopause and menopause are

Perimenopause is the transition during which the ovaries gradually reduce oestrogen and progesterone production. It usually starts after age 40 and lasts about 4 years on average; cycles become irregular and symptoms come in waves.

Menopause is the point at which ovulation stops — confirmed after 12 months without a period, at an average age of around 51. It is a life stage, not a disease, but the fall in oestrogen accelerates bone loss and changes cardiovascular risk, which is why a timely assessment has real preventive value.

Symptoms you should not have to tolerate

Hot flashes and night sweats, poor sleep, irritability and anxiety, brain fog, dryness, reduced libido and abdominal fat gain are among the most common complaints. For some women they are mild; for others they affect work, sleep and quality of life for years.

Some symptoms have other possible causes — fatigue and weight changes often trace back to the thyroid or insulin resistance. That is why the first step is measurement, not guesswork.

What we test

A hormone profile matched to your stage: FSH, LH, oestradiol, progesterone and AMH when needed; thyroid (TSH, fT3, fT4 and antibodies); insulin and HOMA-IR; a lipid panel with ApoB; vitamin D and bone turnover markers; body composition with InBody and resting metabolic rate measurement.

Results are read together with your symptoms and family history — in perimenopause single hormone values fluctuate and neither confirm nor exclude the diagnosis on their own.

Hormone therapy — when and how

According to the 2022 position statement of The North American Menopause Society, hormone therapy is the most effective treatment for hot flashes and genitourinary symptoms, and for most healthy women under 60 or within 10 years of menopause the benefits outweigh the risks.

The decision is individual: we assess family history, blood pressure, lipids, mammographic status and personal preferences. When hormone therapy is not suitable, non-hormonal options exist and we discuss them openly.

Who leads the programme

The programme is led by Dr Svetla Dancheva, an endocrinologist with over 13 years of clinical experience in hormonal and metabolic conditions. She follows your results over time and adjusts the plan when needed. Dr Dancheva does not see children.