Menopause - what you need to know

Why it’s important to know what is happening to you

One of the most effective ways to manage menopause is to understand what it does to you. However, as many high-profile campaigns have publicised in recent years, there is a lack of information available.

Dr Crystal Wyllie, Asda Online Doctor, says: “Many women feel ill-informed about the menopause. It’s so important for awareness around this topic to continue growing, so feelings of shame, isolation, and poor understanding are reduced. A lack of public education is a likely cause for the common myths and misinformation around menopause.”

Wylie is backed up by a 2023 University College London study, which found that 9 in 10 women did not receive any menopause education at school. It also found that 1 in 2 women felt they were not informed about the menopause, and 6 in 10 did not begin to learn anything until after their menopause symptoms had begun.

This situation should improve in the future. Since 2024, all medical students in England will receive some menopause training. Also, menopause was added to the schools’ curriculum in England in September 2020. However, with the average age that women start the menopause being around 51, it will take a few decades to filter through.

Understanding the changes you're going through can help you feel more in control, and mentally and physically healthier. Dr Neesha Patel, Chartered Health Psychologist, Founder of Evoking Health, UK, explains: “When you feel informed and validated, you’re far more able to navigate this stage with confidence and clarity.”

Here we will explain what is happening to you and what you can do to ease the symptoms.

What is happening to my body?

Menopause is when you have not had a menstrual period for 12 months. Whilst that explanation is simple, what actually happens to you may not be so straightforward.

Whilst the average age is 51, Wylie says menopause typically affects women between 45 and 55, but it can happen earlier, or later. Menopause brings a range of physical and mental changes. It’s not a condition or illness that, if you are lucky, you can avoid, and it’s not something that you can change your chances of developing - it’s a stage of life every woman goes through.

Menopause means your body’s production - and therefore your own levels - of oestrogen, progesterone, and testosterone decline.

This decline creates a hormone imbalance, which Dr Bruce Dorr, boarded in Obstetrics and Gynecology and Female Pelvic Medicine, senior medical advisor Biote, USA, says is the root cause of more than 30 menopause symptoms, including hot flushes, sleep disturbances, brain fog, and anxiety. However, as Dr Geny Ann Augustine, Solace Health, USA, says: “Every woman will be affected differently.”

Around 9 out of every 10 women will have some symptoms of menopause - such as hot flushes and brain fog. For around 1 in 4 women, those symptoms will be so severe as to affect their day-to-day life and may cause them to quit work. However, around 1 in 10 women have no noticeable or very mild symptoms.

Menopause symptoms

Hot flushes and night sweats

Hot flushes and night sweats - also known as vasomotor symptoms and called hot flashes in the US - are the most common menopause symptoms. A hot flush usually begins with a sudden burst of heat in your face, neck, or chest - often followed by sweating, redness, and a racing heart - these can last anywhere from 30 seconds to an hour. Night sweats are simply hot flushes which happen when you are in bed.

The exact reason why hot flushes happen is not known, but it’s thought they may stem from changes in the brain’s temperature regulation caused by falling oestrogen levels. Triggers may include caffeine, alcohol, stress, and temperature changes.

Whilst the most common, hot flushes, are just one of around 30 menopause symptoms.

Dr Wylie says: “Menopause is not just hot flashes and night sweats.” She says symptoms can appear at any stage and may last for several years and vary from person to person. “Some improve with time, while others, such as vaginal dryness or joint pain, can continue after menopause.” She adds.

As well as hot flushes and night sweats, common symptoms include:

• Aching muscles and joints.

• Brain fog - forgetting things, feeling confused.

• Difficulty sleeping - sometimes due to night sweats.

• Headaches and migraines.

• Mood swings.

• Reduced sex drive.

• Skin changes including dry and itchy skin.

• Urinary tract infections (UTIs).

• Vaginal dryness, itching, or discomfort during sex.

Other symptoms include a dry mouth, tinnitus, brittle nails, and a change in your sense of smell.

What medicines you might take and what they do

HRT

Various treatments can ease symptoms and support your wellbeing - the most prescribed is hormone replacement therapy (HRT). HRT replaces the lost oestrogen - and sometimes progestogen - and can help ease your hot flushes. The increase in oestrogen can also help to reduce your chance of developing osteoporosis and broken bones. Other benefits include helping you sleep better and easing vaginal dryness.

Dorr says: “HRT is just putting the same hormones inside your body that were meant to be there. It just makes sense - when you lose your hormones, you experience not-so-great symptoms. HRT ideally allows you to live and age better.”

Wyle says that many women tend to notice improvements in their symptoms within 2 to 6 weeks of starting HRT.

As well as easing the symptoms of perimenopause, HRT also reduces the risk of osteoporosis and may help with other health issues, including cardiovascular disease and stroke. Dr Jo Josson McConnell, GP Clinical lead/Director, Private GP Services UK, says there also appears to be some protection against dementia when HRT prescribing starts before age 60.

Types of HRT

• Patches - convenient for those who prefer twice-weekly or once-weekly application.

• Gels and Sprays (oestrogen-only) - used daily. Progesterone must also be taken to protect the womb.

• Oral HRT - combined oestrogen and progesterone tablets to be taken daily. Women without a womb may be prescribed oestrogen-only tablets.

• Mirena coil - lasts for five years and provides the progesterone element of HRT.

There are also oestrogen implants which are inserted under the skin every 3-6 months - these have limited availability and suitability.

Your healthcare professional should discuss what method is most appropriate for you. Josson McConnell says: “There is no one-size-fits-all approach to HRT. For instance, if you have certain allergies, you may not absorb hormones well from patches, and autoimmune conditions - such as hypothyroidism - may require higher doses

Non-hormonal options:

There are alternatives if HRT is not suitable for you - due to certain health conditions or being at high risk of them. Dr Jane Limmer, VCU Health, USA, and a Menopause Society Certified Practitioner says: “Make sure you discuss whether hormone therapy is right for you with your health care provider if you are in any doubt.”

Various non-hormonal medicines that can be taken as alternatives to HRT include:

Neurokinin-3 (NK3), a receptor antagonist known as Fezolinetant. This works on the part of the brain where it is believed hot flushes originate. In the UK it is available only on private prescription.

Dr Dorr says it can reduce the frequency and severity of night sweats, but it does not help with the multitude of other symptoms associated with menopause.

Antidepressants - such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Limmer explains that although antidepressants do not primarily manage menopause symptoms, they have been shown to help.

Herbal medicine and supplements

There are a variety of herbal supplements and products to treat menopause symptoms that you can buy over the counter. These are not tested or regulated in the same way as medicines such as HRT, so their effectiveness or safety is not guaranteed. Limmer says: “There is likely no harm in trying them, but we cannot be sure that they will actually improve your symptoms.”

Fitness and nutrition consultant, Charmaine Cameron-Webb, BACPR, owner of Your Ideal Body, Truro, UK recommends creatine and collagen for women with menopause as they support the changes happening in midlife.

"Creatine helps maintain strength, muscle, and cognition. Collagen supports joints, tendons and connective tissue, which become more vulnerable as oestrogen declines. They’re simple, well-researched and effective.” She says.

She also recommends adaptogenic herbs, which include:

• Ashwagandha - for calming the system and supporting sleep.

• Rhodiola - for energy and focus.

• Holy basil - for stress.

• Maca - to lift mood and support libido.

Cameron-Webb says: “These are a gentle, natural way to take the edge off some common menopausal symptoms. They don’t replace hormones, but they make the ups and downs feel far more manageable.”

Dr Dorr says he often advises his patients to take Flower Pollen Extract (Relizen). "This plant-based, non-hormonal supplement has been shown in small clinical studies to reduce the frequency and severity of hot flushes.”

If you’re unable to take HRT, Wylie says lifestyle modifications, including regular exercise, stopping smoking, and reducing stress levels can also help to manage menopausal symptoms.

Oestrogen - what it does

Oestrogen is vital for a healthy body - not having enough affects your mental and physical health.

Some of the key areas where oestrogen helps you include:

• Bone strength.

• Heart health.

• Mood and brain health.

• Skin and hair.

• Vaginal health.

Augustine says that bone loss speeds up when your oestrogen levels drop - particularly during the initial five years after menopause. As a result, calcium, vitamin D, and weight-bearing exercise are all vital to maintaining good health.

Genitourinary syndrome of menopause (GSM)

Genitourinary syndrome of menopause (GSM) is a caused by lower oestrogen levels, and affects the vulva, vagina, and lower urinary tract. Dr Rachel Gelman PT, DPT, CSC, Pelvic Floor Specialist, says that the tissue around your vaginal opening is heavily dependent on oestrogen to stay robust, healthy, and moisturised.

As a result of this, Gelman adds: “If you’re oestrogen levels have declined, some not so fun symptoms can happen.”

Those “not so fun” symptoms include:

• Pain with sex.

• Urgent and frequent need to pee.

• Pain when peeing.

• Recuring urinary tract infections (UTIs).

• Vaginal dryness.

Unlike many menopause symptoms, GSM can worsen over time and requires treatment.

HRT will help, but there are other non-hormonal treatments that can ease GSM, these include:

• Water-based lubricants - help reduce friction during sex caused by vaginal dryness.

• Vaginal moisturisers - help relieve dryness and discomfort. For regular use, not just before sex.

• Avoiding irritants - use emollient creams or coconut oil, rather than soap, for gentle cleansing.

Gelman says that both the pelvic floor and hormonal changes contribute to the symptoms of GSM, which is why an interdisciplinary approach to treatment is important. She recommends incorporating pelvic floor exercise into your health regime.

Pelvic exercises can strengthen muscles, improve bladder control and improve blood flow to ease pelvic discomfort.

Mental health - what to look out for and how to manage it

The hormonal changes during menopause affect mental health and how your brain manages emotions. Recognising what is happening and getting help and support is vital, so you do not become overwhelmed.

Health Psychologist Neesha Patel says women often come to her for help with issues such as low motivation or emotional eating. She says: “As we explore their experiences, it frequently becomes clear that wrapped within these challenges are hormonal changes linked to menopause.

“Recognising this connection transforms the conversation. It helps women see that what they’re experiencing isn’t a lack of willpower - it’s a blend of psychological, physiological, and hormonal changes that deserve understanding, not judgment.”

Whilst HRT can help improve both depression and anxiety, it should not be used exclusively to treat these conditions. Always speak to a healthcare professional to see what treatment is needed.

Ingrid Radford, clinical hypnotherapist and mental health first aid champion specialising in anxiety-related conditions, says that fluctuating hormones can increase anxiety, short temper, and sadness - all of which are normal in menopause.

She explains this can happen because the amygdala - the part of our brain which governs our threat and fear responses - can become more active. At the same time, the prefrontal cortex, responsible for clear thinking and emotional regulation, “can end up taking a back seat.”

This unbalanced combination can make small stresses feel bigger than they are, leading to anxiety, irritability, or low mood.

Radford warns the key signs to look out for include:

• Increased emotional sensitivity.

• Racing thoughts.

• Mental tiredness or brain fog.

Radlet says: “Managing this starts with understanding it’s a brain-based response, not a personal weakness. Regular gentle exercise, a good sleep routine, and staying socially connected all help calm the amygdala and strengthen your emotional resilience.”

Radlet advises that you watch out for any changes that last for more than two weeks and get help quickly if they do.

What else to be aware of with menopause

Menopause affects more than just hormones - it can also affect your wider health. Dr Dorr warns: “Night sweats and hot flushes aren’t just uncomfortable - they can also be a signal for increased risks of hypertension (high blood pressure), heart disease, or stroke."

The changes following menopause that may happen to your body - such as weight gain, lower oestrogen levels, or higher cholesterol - also increase your chances of developing heart disease.

Lack of awareness about this increased risk is one possible reason that heart attack survival rates are lower for women than for men. If more women who are living with menopause knew their chances of heart attack were increased, they would be more likely to spot the symptoms.

August says: “As oestrogen’s healing effects diminish after menopause, your risk of heart disease increases. It is critical to keep your blood pressure, cholesterol levels, and physical activity system in good shape.

How long will menopause last?

Menopause symptoms don’t last forever, but how long you have all, or some of them, varies for everyone.

Your symptoms should begin to ease two to three years after your last period. For most women, symptoms will cease after four to eight years, but hot flashes often last much longer. Some women will continue to have symptoms indefinitely.

Even if the key symptoms decrease, other issues may emerge. Dr Dorr says that as your body becomes increasingly hormone-deficient in the long term, other issues like joint pain, tiredness, and loss of libido may also emerge.

Due to the uncertainty of when symptoms will ease or stop, it is important to set realistic expectations about the future - to help ease anxiety about what lies ahead.

Lifestyle tips - managing menopause day-to-day

Small changes can have a big impact. From diet and exercise to sleep and support, we asked our experts for their top tips to help you better manage menopause and feel healthier mentally and physically.

Diet and nutrition

“A healthy gut supports oestrogen metabolism, stabilises inflammation, improves energy, and reduces symptoms like bloating. More vegetables, a variety of colours, fibre-rich foods, berries, adequate hydration, walking after meals, and reducing ultra-processed foods can make a significant difference.” Cameron-Webb

"Following a healthy diet and lifestyle is the basis of symptom management. Diets that are rich in whole foods, plant-based proteins, and healthy fats may help control hormonal fluctuations and support overall well-being. Vitamins play a role, too. Vitamin D, calcium, and omega-3 fatty acids are frequently recommended to support bone health, mood stability, and cognitive function." Dorr

"A balanced diet filled with whole grains, fruits, and calcium sources stands to maintain your energy and bone strength. This can then help you tread through stiffness and uphold mood through regular movement - mainly resistance training and yoga." Augustine

Support

“Support from your health community, patient advocates, and healthcare team, can help you handle this transition with better clarity, safety, and control.” Augustine

“Getting care from medical professionals can help decrease symptoms - but it is very helpful to talk about what you are going through with friends. Their support will provide you with comfort, laughter and a little bit of hope that you will survive this time in your life.” Lanner

“Prioritise connection - Whether through workplace networks, online communities, or women’s health groups. Connection reduces isolation and supports mental wellbeing.” Patel

“Therapy, mindfulness, regular activity, and community connection all have a significant effect on your emotional health.” Radlett

“Working with a health care provider who is knowledgeable about menopause and hormone health can help you find answers - often without the need for pharmaceutical interventions.” Dorr

Lifestyle

“Move with self-compassion - regular movement helps manage stress and supports cognitive function. Choose what feels good - for example, walking, yoga, swimming, rather than pushing through exhaustion.” Patel

“Your sex life is not over - the hormonal changes your body goes through mean you might experience sex differently, but there’s a lot you can do to make sure your sex life works for you. HRT, for example, works by restoring the oestrogen and progesterone levels that fall during menopause, helping to improve sex drive if this is low and relieving symptoms such as hot flushes, mood swings, and vaginal dryness that may contribute.” Wylie

“When blood sugar swings around, so does mood, appetite, sleep, and hot flush frequency. Building meals around protein, fibre and colour, walking after meals, avoiding sugary snacks between meals, keeping alcohol away from bedtime, and not training fasted makes a huge difference to how you feel.” Cameron-Webb

Mental wellbeing

“Acknowledge the changes that are happening and feel reassured that brain fog is not dementia. Adjust your routines both at work and at home to give yourself grace during these years. Make lists and build extra time in your schedule to make work and life more manageable.” Lanner

“Sleep often becomes much more fragile at this stage. A cool bedroom, breathable bedding, cooling pillows, low lighting in the evening, blue-light glasses if screens are being used, avoiding late-night intense training, and keeping a consistent bedtime routine all help. Stability during the day leads to stability at night, and sleep often improves once you anchor your mornings with light and movement.” Cameron-Webb

“Practice emotional awareness - track your thoughts and energy patterns. Recognising links between stress, mood, and behaviour builds resilience and self-understanding.” Patel

Treatment

“Not everyone responds the same to drugs, hormones, or therapies. It’s essential to utilise as many therapeutic modalities as possible to ease symptoms and enhance quality of life. Many studies show the importance of sleep, relaxation, mindfulness, and relationships on our health and response to disease.” Dorr

And finally….

"Remember there is a light at the end of the menopausal tunnel. Life post-menopause is not going to be all good or all bad - but many aspects of menopause do get better. It may take years, but they will stop." Lanner

Where to get menopause support

The menopause Charity

Menopause Support

The British Menopause Society

The Menopause Exchange

The Office on Women’s Health, USA.

Let’s Talk Menopause

Red Hot Mamas Menopause Support Group