Hello, I’m Dr. Mari Laasma, a physician and surgeon, and the founder of the Dr. Mari Laasma Laser Therapy & Aesthetic Clinic.
When a woman reaches her 40s, the body and mind may start sending “new messages” suddenly and loudly: hot flashes, waking at night, anxiety, trouble concentrating, “brain fog,” weight gain despite being active, mood swings, and changes in libido. Many ask: “Is this perimenopause? Is this normal?” The answer is — yes, it can be a completely normal part of life’s natural transition, and help is available. World Health Organization

In Estonia, this topic has long been kept quietly “under the table.” Meanwhile, globally there’s growing recognition that perimenopause and menopause affect health, work, relationships, and quality of life — and that supportive information and evidence-based treatment make a big difference. This page was created to offer a safe, clear, science-based starting point for anyone seeking answers.

What is perimenopause?

Perimenopause is the transition before menopause when ovarian hormone levels begin to fluctuate. Menstrual cycles may become irregular and typical symptoms can appear. Menopause is confirmed when there has been no menstrual period for 12 consecutive months. The average age at menopause is around 51. After menopause comes postmenopause. World Health Organization

Checklist:
“Could this be perimenopause?”

• Cycle changes (shorter/longer cycles, skipped months)
• Hot flashes and/or night sweats
• Sleep problems, early-morning awakenings
• Mood and anxiety fluctuations
• Concentration and memory difficulties (“brain fog”)
• Vaginal dryness or pain with intercourse
• Decreased libido
• Muscle and joint aches, headaches
• Weight gain or a change in fat distribution (e.g., more around the abdomen)

You don’t have to have all symptoms at once, and their intensity varies from person to person.

Why does this happen?

Beyond fertility, estrogen and progesterone also affect the bones, cardiovascular system, brain, skin, and mucous membranes. When hormone levels fluctuate during the transition and then decline more permanently, the changes described above can occur.

What do international guidelines say about treatment options?

• Hormone therapy (HT/HRT) is the most effective treatment for relieving hot flashes and genitourinary symptoms (vaginal dryness, bladder and urinary issues) and helps prevent bone loss and reduce fracture risk. The decision is individualized, taking into account age, time since the last period, health risks, and preferences.
• The “timing hypothesis”starting earlier (typically before age 60 or within about 10 years of menopause) is associated with a more favorable risk–benefit profile; at the same time, guidelines emphasize that the primary goal of therapy is symptom relief, not the primary prevention of chronic disease.
• Non-hormonal options (lifestyle measures and, if needed, medications) are alternatives for those who cannot or do not wish to use HT. Structure, sleep, stress management, regular exercise (including strength training), balanced nutrition, and quitting smoking significantly support well-being and long-term health.
• It’s also important to understand limitationsU.S. preventive guidelines do not recommend using HT for the primary prevention of chronic diseases (e.g., heart disease, diabetes) for “general benefit”; the role of HT is primarily symptom relief and bone-loss prevention based on individual risk.

Being honest about risks

HT risks depend on the type of preparation, dose, route of administration, duration of use, and more. It’s important always to discuss risks such as breast cancer, thrombosis, stroke, and gallbladder disease. However, for most healthy, symptomatic women under 60, the benefits outweigh the risks when therapy is appropriately selected and monitored.

Lifestyle that truly helps

• Sleep and stress: aim for a regular sleep rhythm; improve sleep hygiene and explore stress-management techniques.
• Exercise: at least 150 minutes of moderate aerobic activity per week + strength training twice weekly (for bones and muscles essentia).
• Nutrition: a protein-rich diet with vegetables and fruits, whole grains, and quality fats; increase vitamin D and calcium if needed.
• Habits: stop smoking; keep alcohol moderate or consider avoiding it.

This is the foundation that supports both daily well-being and long-term health — regardless of your treatment choices.

When to see a doctor?

• If symptoms interfere with sleep, work, or relationships
• If you experience bleeding after menopause
• If you develop new severe headaches, chest pain, shortness of breath, or signs of thrombosis —

please seek medical care immediately.

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Invitation to a consultation

If you feel this topic speaks to you, book an appointment at my clinic and let’s discuss it together.
If you wish, gynecologist Dr. Lasarus Mitrofanoff can see you in our clinic - more info about him is available here.

I’ve seen the immense relief women feel when they finally have clarity and support. Perimenopause and menopause do not have to be a “silent suffering” — let’s make this a conscious and supported journey.

Warmly,
Dr. Mari Laasma
Physician and Surgeon, Dr. Mari Laasma Laser Therapy & Aesthetic Clinic