There are days of hot flashes, regular nights and others when one feels capable of taking on the world. Photo: Konstantin Dawn / Pexels
A storm with an expiration date
In this stage, the body seems determined to oppose you, and when you think you’ve got the trick, it changes strategy. Fortunately, it does not last forever
By Salomé García Gómez
26 SEPTEMBER 2026 / 08:00
Menopause has a playful way of appearing. One day, suddenly, your entire body decides to descend into chaos without warning. One day it decides to gift you infernal hot flashes, preferably at midnight, those that wake you up in a pool of sweat. The next day, however, you sleep like a baby. Or you do so without hot flashes, but waking up four times and with difficulty getting back to sleep. One day you are sad; the next, euphoric, apathetic, or with the urge to take on the world.
Not to mention those last menstrual periods, which one month are scant and the next arrive in a torrent.
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You are you, but in different multiverses. “Many patients tell me the feeling of ‘I don’t recognize myself’ “, explains the gynecologist Diana López Freire, associate specialist in the Department of Gynecology and Obstetrics at Vigo’s Ribera Povisa Hospital and member of the Spanish Association for the Study of Menopause (AEEM).
If those situations feel familiar to you, congrats, you have reached the crazy years of perimenopause. The good news is that they do not last for life.
Hormones Out of Control
There are horror stories about menopause, rarely accurate. “It’s not hell, but the remaining half of our life,” notes the gynecologist. But we won’t deny that its onset is usually quite abrupt. “I always tell my patients that you are not going crazy. What happens has a name, a cause and a solution,” she explains.
That name is perimenopause.
We tend to imagine that the drop in estrogen, as Luis Fonsi would say, happens ‘despacito’. And no, the truth is that it is a start-stop, forward-going and surges more typical of crazy cars than of a measured retreat. The ovary does not like to retire quietly. It works like a clock for years until a moment comes when it begins to work poorly before stopping. And that working poorly of the ovary is the transition to menopause,
No Two Days Are the Same
That variability in how the ovary works generates pronounced fluctuations in estrogen levels that are, in turn, responsible for that roller-coaster of symptoms. “Our body has estrogen receptors from head to toe. Any alteration in estrogen levels not only affects menstruation. It also impacts all our systems,” explains the expert.
That ‘random work stoppage’ of the ovary also makes it difficult for doctors when diagnosing. “When a patient tells me to order a hormonal panel to know if she has entered menopause, I have to explain that the results will not be definitive. Which one do I order, the morning one? the night one? the one from tomorrow? the one in three days? The values will be different depending on the time of day I order it and the date. It is a time of great fluctuation,” details López Freire.
Today I feel terrible, tomorrow I can take on the world
Perimenopause is characterized by an adventure of symptoms that worsen each day. As new as they are unpredictable, they lead many women to fear that the rest of their days will be a nightmare of hot flashes, sleepless nights, and heaps of sadness. The good news is that, as with storms, it is common for them to subside after the downpour.
“That emotional variability, irritability, sadness, hot flashes… these are not symptoms of hormonal deficiency but of the own fluctuation. That’s why there are symptoms we will see in the transition to menopause that are not as common in postmenopause. They occur with more intensity during these years because the hormones are up and down. With menopause everything settles down,” explains the expert.
The writer Adela Páez, author of the book Postmenopause, and one of the guests at the latest edition of ASISA WeLife Menopause in Madrid, confessed that staying without a period was “a huge liberation. I had a terrible perimenopause, with very heavy bleeding.”
Yes, the Terrible Hot Flashes Do Disappear
The difficulty in maintaining continuous sleep, joint pains and hot flashes are the symptoms that intensify the most during these years. “Not all women have hot flashes, but around 80% experience them. Vaginal dryness is also common, even while still having the period, because the skin is especially sensitive to hormonal changes,” notes the gynecologist.
Many of those symptoms that appear with variable intensity, such as hot flashes or waking up at midnight, tend to remit once we enter menopause. “It would be something like puberty changes: there are a few years of instability to move into a long period of balance,” adds the doctor. In the case of hot flashes, studies suggest they last about 7 years before decreasing in frequency or disappearing.
That they are not lifelong does not mean you should turn away from them. “When these symptoms affect a woman’s quality of life, you should discuss it with the gynecologist and assess the advisability of starting hormone therapy, even before menopause definitively begins,” she concludes. There is no one-size-fits-all recipe, but there is a reality: medicine already has therapeutic tools to ease these hormonal fluctuations.
