It's Time for Change: Raising Awareness of Menopause

By Dr Michelle Wright and Dr Mecky McNeil

Half the world’s population will experience menopause, yet it remains one of the least understood stages of life. Because menopausal symptoms and their consequences are driven by changes in hormone levels, menopause can also affect trans men and some non-binary people. While it directly affects billions of people worldwide over the course of their lives, its impact extends much further, influencing families, relationships, workplaces and communities.

Awareness has grown enormously in recent years, but there is still a long way to go. Too many people continue to struggle with symptoms without recognising they are related to menopause, and too many feel unable to talk openly about the impact it has on their daily lives, relationships and work.

Key takeaways
Menopause affects every woman, and many others around them.
It’s more than hot flushes and mood swings.
It affects both physical and mental health.
Symptoms are common, but effective treatments are available.
HRT remains the most effective treatment for most women.
Healthy lifestyle choices support symptom control and long-term health.
Awareness and open conversations help everyone.

Not just hot flushes and mood swings

When people think about menopause, hot flushes and mood swings often come to mind. But menopause is much more than that. It is a major hormonal transition that affects almost every organ system in the body, influencing both immediate well-being and long-term health.

As we age, our risk of developing long-term health conditions naturally increases. But after menopause, some of these risks increase further. Falling hormone levels are associated with a higher risk of osteoporosis, fractures and cardiovascular disease. In fact, cardiovascular disease, including angina, heart attack, heart failure and stroke, remains the leading cause of death and disability in cisgender women globally.

What happens in the body?

Most people experience menopause between the ages of 45 and 55, but the changes usually begin several years before periods stop. This stage is known as the perimenopause, when levels of oestrogen, progesterone and testosterone fluctuate before eventually declining.

These hormones do much more than regulate the menstrual cycle. They help maintain healthy bones, muscles, skin, blood vessels, the bladder and many other tissues throughout the body. As hormone levels change, a wide range of physical symptoms can develop.

For some people, the transition is relatively straightforward. For others, symptoms can be life changing. Around 80% of people experience menopause-related symptoms, and for around one in four these symptoms significantly affect their quality of life.

Hot flushes and night sweats are among the best-known symptoms, but they are only part of the picture. Many people also experience disturbed sleep, overwhelming fatigue, headaches, palpitations, joint and muscle aches, and changes in weight. Falling oestrogen levels can lead to dry skin, thinning hair, vaginal dryness and bladder symptoms such as urinary frequency or recurrent infections.

It’s not all in your head, but it does affect your mind

The physical symptoms of menopause are becoming better recognised, but its effects on the brain are often overlooked.

Oestrogen helps regulate serotonin and dopamine, two brain chemicals that influence mood, motivation and emotional well-being. It also supports memory and concentration. As hormone levels fluctuate and decline, many people experience anxiety, low mood, reduced resilience, forgetfulness and the familiar experience of “brain fog”.

Falling progesterone can contribute to irritability and mood swings, while declining testosterone may affect mental stamina, concentration, motivation and libido.

More than half of people in perimenopause report increasing symptoms of anxiety or low mood. Some experience intrusive thoughts and, for a small number, these may include suicidal thoughts.

These psychological changes can have a profound impact on everyday life. Many people find they have less energy and motivation, struggle to enjoy activities they once loved, or lose confidence in their abilities at work. Changes in body image and sexual desire can also affect confidence, relationships and overall well-being.

Understanding that these changes are driven by fluctuating hormones, not personal weakness or a failure to cope, is an important step towards getting the right support.

Menopause affects everyone

Although menopause is experienced individually, its effects reach much further. Partners, children, friends, colleagues and employers may all notice changes without understanding the cause.

Greater awareness helps everyone. When partners and families understand what someone is experiencing, they are better able to offer support. When workplaces recognise the impact menopause can have, they can make simple adjustments that help people remain healthy, productive and confident. Open conversations reduce stigma and ensure fewer people feel they must struggle in silence.

So, what can be done?

If menopause symptoms are affecting your life, there are several approaches that may help.

Start with good self-care

Prioritise sleep, regular physical activity and a balanced diet. These are the foundations of good physical and mental health at every stage of life.

During menopause, a calcium-rich diet and adequate vitamin D help protect bone health. Regular exercise is equally important. We encourage people to ‘move more’, ‘move faster’ and ‘move stronger’. Maintaining muscle strength supports healthy bones, improves balance and benefits both physical and mental well-being.

Limiting alcohol and stopping smoking are also important. Alcohol disrupts sleep and can worsen night sweats, while smoking increases the risk of cardiovascular disease and cancer.

Finding time to relax, enjoy hobbies and spend time with people you care about can also help reduce stress and improve mood.

Healthy lifestyle changes not only improve menopause symptoms but also reduce the risk of many chronic diseases. Research suggests that adopting healthy habits can increase life expectancy by as much as 14 years.

Consider topping up your hormones

Hormone replacement therapy with the newer body-identical preparations remains the most effective treatment for perimenopausal and menopausal symptoms and is considered safe for the vast majority.

Recent studies show that when started within the first 10 years of menopause or before the age of 60, HRT not only improves symptoms such as hot flushes, night sweats and sleep disturbance, but also protects against long-term health risks, including osteoporosis and fractures, cardiovascular disease and diabetes.

International guidelines recommend that HRT can be used as long as benefits outweigh risks and no longer set a defined length of treatment.

The preferred route for taking oestrogen is via the skin (transdermal), as a gel, cream, patch or spray. This does not increase the risk of blood clot or stroke, making it a safer option for those in their 60’s who wish to continue HRT. Natural (micronised) progesterone, usually taken orally, not only protects the lining of the uterus, but also has calming effects on mood and can help with sleep.

Benefit may also be gained from transdermal testosterone therapy, usually administered as a cream or gel, particularly for symptoms of reduced libido. In addition, some people report improvements in cognitive symptoms, mood, energy, and overall well-being.

Concerns about breast cancer are common when considering HRT, but it is important to recognise that the type of HRT matters. Oestrogen-only HRT does not increase the risk of breast cancer, and growing evidence suggests that newer body-identical HRT preparations may also carry little or no increased risk, although research is ongoing. By contrast, older combined HRT preparations containing synthetic progestogens are associated with a very small increase in breast cancer risk – around three to four additional cases per 1,000 women over the age of 50. To put this into perspective, this increase is smaller than the risk associated with several lifestyle factors, including being overweight or drinking around two units of alcohol a day.

Of course, HRT is not suitable for everyone, particularly people with a current or previous diagnosis of breast cancer, so treatment should always be individualised following discussion with a healthcare professional.

Try the talking therapies

Evidence shows that psychological therapies such as cognitive behavioural therapy (CBT) and counselling can help many people manage the emotional and psychological challenges associated with menopause and perimenopause.

Think about non-hormonal medications

If HRT is not suitable, or someone chooses not to take it, there are several non-hormonal treatments that can help manage hot flushes.

One of the newest options is fezolinetant, which works on the brain’s temperature control centre. However, because it does not replace the hormones that decline during menopause, it does not provide the wider health benefits of HRT, such as protecting bone health or reducing the long-term risks of cardiovascular disease.

Other options to reduce hot flushes include gabapentin, pregabalin and some antidepressants, such as fluoxetine, paroxetine and venlafaxine. However, these medications can cause side effects, especially nausea. Some antidepressants should be avoided in those with a history of breast cancer taking tamoxifen because they can reduce its effectiveness.

It is also important to remember that low mood, poor sleep and reduced motivation are often early symptoms of menopause. These are sometimes mistaken for depression, leading to antidepressants being prescribed. However, there is little evidence that antidepressants improve psychological symptoms of menopause, and HRT is the more effective option when menopausal hormone deficiency is the cause.

Herbal and complementary therapies

Some herbal treatments, such as St John’s Wort, may improve mood, although again, they do not address the underlying hormone changes. Other complementary approaches, including aromatherapy and acupuncture, may help some people relax and improve their overall well-being.

Keep talking about menopause

Perhaps most importantly, keep the conversation going. Talking openly about menopause helps normalise a life stage that every woman will experience. Greater understanding benefits families, friendships and workplaces, making it easier for people to seek help and receive support.

Menopause is not a disease. It is a natural transition. With better awareness, earlier recognition and appropriate treatment where needed, people can continue to live healthy, fulfilling and productive lives.