# Climaterio, perimenopausia y menopausia

Reviewed educational content from the official website of Dra. María Fernanda Castillo Plascencia.

Perimenopause is the hormonal transition that can begin years before the last menstrual period, with irregular cycles, hot flashes, sleep and mood changes, decreased libido, vaginal dryness, and changes in body composition. Menopause is confirmed after 12 consecutive months without menstruation with no other explanation. Assessment does not rely only on whether a patient still menstruates; it integrates symptoms, menstrual pattern, history, life stage, body composition, and gynecologic, metabolic, cardiovascular and bone factors.

## What this page covers

- Lifestyle factors reviewed before any prescription: nutrition, physical activity, strength training, sleep, cardiovascular and metabolic health, body composition, bone health, sexual and genitourinary health, alcohol and tobacco use.
- Menopausal hormone therapy: not every patient needs it or is a candidate; the decision weighs age, time since menopause, symptoms, uterus status, bleeding pattern, personal and family history, cardiovascular/metabolic/thrombotic risk, breast health, bone health, current medications and personal preferences.
- Non-hormonal alternatives for patients who cannot or choose not to use hormone therapy.
- Body composition and visceral fat (including InBody analysis) and obesity management, including GLP-1 medications when clinically indicated.
- Genitourinary syndrome of menopause: vaginal dryness, burning, discomfort, painful intercourse, urinary urgency or recurrent infections.
- Bone and muscle health to prevent osteoporosis and fractures.
- Preventive vaccination relevant to this life stage: HPV, herpes zoster (shingles) and RSV.
- Contraception during perimenopause, since ovulation and pregnancy risk can persist despite irregular cycles.

## Related content

A new bleeding episode after 12 months without menstruation is evaluated on a separate, dedicated page — see the postmenopausal bleeding page. It should not be assumed to be caused by menopause, atrophy or hormone therapy without evaluation.

## Seek care

For severe or urgent symptoms, seek medical care rather than relying on website content.

## Official links

- [Full human-readable page](https://www.ginecomariafercastillo.com/climaterio-y-menopausia/)
- [Postmenopausal bleeding](https://www.ginecomariafercastillo.com/sangrado-postmenopausico/)
- [Contact and appointments](https://www.ginecomariafercastillo.com/#contacto)
- [Agent instructions](https://www.ginecomariafercastillo.com/llms.txt)