Premenopause, i.e. the period before the menopause, is characterised by a decline in the hormonal function of the ovaries and a rapid decrease in the number of ovarian follicles. Already from the age of 42, a decrease in the secretion of the hormones of the somatotropic axis, growth hormone and insulin-like growth factor is observed.

There is also an inhibition of Graaf follicle maturation, ovulation, a decrease in corpus luteum function and capacity, leading to a decrease in progesterone production, a decrease in ovarian oestrogen and ovarian inhibin, and an increase in pituitary gonadotropins.

There are two main groups of pre- and perimenopausal disorders:

Menstrual cycle disorders

• normal concentrations of follicle-secreting hormone (FSH) and luteinising hormone (LH) - the menstrual cycle is shortened,
• high concentrations of FSH and LH (comparable to postmenopausal concentrations), the menstrual cycle lengthens,
• increase in FSH- shortened menstrual cycle,
• increase in LH concentration - menstrual cycle lengthens.

Accidental symptoms:

• thermoregulatory disorders,
• headaches,
• insomnia,
• hot flashes and drenching sweats.

Other symptoms of the menopausal transition period:

• disorders of the genitourinary system,
• disorders of the libido,
• disorders of the mental sphere,
• connective tissue disorders (skin lesions, sweat gland disorders),
• metabolic disorders,
• obesity,
• cardiovascular diseases,
• cancer.

The role of the gynaecologist is to diagnose non-gynaecological diseases and refer women to appropriate specialists.

The gynaecologist himself deals with:

• treatment of abnormal bleeding from the female reproductive tract - these are a major problem for women during the menopause, the bleeding being irregular and heavy, preceding the disappearance of menstruation.
• consultation on contraception - fertility in menopausal women is low, but this problem should not be underestimated as pregnancy during this period is dangerous and causes many medical, social and ethical problems.
• hormone therapy consultations, which is the main tool for menopausal care.

The activities of the gynaecologist are very complex. They include the performance of many screening tests and preventive measures, the promotion of a healthy lifestyle, cooperation with other specialists, and the provision of hormone therapy, which can reduce the discomforts of the menopausal period and improve women's quality of life.