Menopause – what to expect, and what actually helps

Menopause is a single point — twelve months after the last period. Everything people actually mean by the word happens in the years leading up to it, when hormone levels swing rather than simply falling. That phase commonly lasts four to eight years and often starts in the mid-forties.

Because periods are still happening, symptoms in that phase are frequently attributed to stress, work or age. Irregular cycles, worsening premenstrual symptoms and heavier or lighter bleeding are all typical of it.

• Hot flushes and night sweats.
• Disrupted sleep, often independent of the sweats.
• Mood changes, anxiety, irritability and tearfulness.
• Brain fog and word-finding difficulty, which is real and usually temporary.
• Joint aches — extremely common and rarely connected to menopause by the person experiencing it.
• Vaginal dryness, discomfort with sex, and more frequent urinary infections.
• Bladder urgency and leaking.
• Changes in skin, hair and body shape.

1. 1Layered clothing, a cooler bedroom, and identifying flush triggers — commonly alcohol, caffeine, spicy food and stress.
2. 2Regular exercise, which improves sleep, mood, joint pain and bone strength together.
3. 3Strength training specifically. Bone loss accelerates sharply around menopause, and loading bone is what slows it.
4. 4Enough calcium and vitamin D.
5. 5Stop smoking — it brings menopause earlier and worsens both flushes and bone loss.
6. 6Cognitive behavioural therapy has genuine evidence for flushes and for sleep, not only for mood.

Vaginal dryness responds to lubricants for sex and to regular moisturisers for daily comfort — and these are different products used differently.

Hormone therapy is the most effective treatment for flushes and night sweats, and it protects bone. Its reputation was shaped by a study whose findings were widely reported without their context — the participants were substantially older than the women who typically start treatment, and the risks were often presented as relative rather than absolute.

• For most healthy women starting within about ten years of menopause and under 60, benefits generally outweigh risks.
• It is not suitable for everyone — a history of breast cancer, some clotting conditions, and certain liver or cardiovascular disease change the calculation.
• Anyone with a uterus needs a progestogen alongside oestrogen, to protect the womb lining.
• Low-dose vaginal oestrogen for dryness and recurrent urinary infections acts locally, carries a very different risk profile from tablets, and is suitable for many women who cannot take systemic hormones. It is substantially under-prescribed.

Also worth checking rather than assuming: a thyroid problem, anaemia and depression all overlap heavily with menopausal symptoms and are treated differently.