Expert advice and real-life experiences to get you through menopause

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World Menopause Day is October 18. Photo / Getty Images
The run-up to menopause can begin in your 30s, leaving young women confused by unexplained symptoms. Here are the tell-tale signs.

Perimenopause is the stage in your life when you experience symptoms of menopause but your periods have not yet
stopped. It usually starts several years before a woman reaches her menopause, which officially begins when you haven’t had a period for 12 months.

It is during perimenopause, when oestrogen and progesterone levels begin to fluctuate, that it’s common to experience difficult symptoms like mood changes, irregular periods and hot flushes.
The average age for menopause in the UK is 51, but because perimenopause can start as early as our 30s, some younger women don’t realise the uncomfortable and disruptive symptoms they are experiencing are due to being perimenopausal.
“Symptoms like poor memory, anxiety and low mood often occur before you see any changes in your periods, so you may not recognise these as being related to perimenopause,” says Kathy Abernethy, a menopause specialist with the British Menopause Society.
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They call it “the Davina effect”. Campaigns led by hormone replacement therapy (HRT) enthusiasts such as British broadcaster Davina McCall have led to a boom in demand. The number of women being prescribed HRT in England has risen by almost 30% over just the last year, from 1.8 million in 2021 to 2022, to 2.3 million from 2021 to 2023 – and has doubled since 2015.
So, if you are considering joining the hormone rush, here are some questions you might want to consider.
How should I broach the subject with my doctor?
Dr Juliet Balfour is a GP who runs an NHS menopause service in Somerset. She suggests you save time by being direct, saying something like, “I might be experiencing menopausal symptoms. Can we discuss the option of HRT?”
She says: “It can be useful to fill in a menopause symptom checker before your appointment. They are available on the internet. Or write down a list of things that are bothering you.” She adds: “You can have a menopause consultation over the phone and it is helpful to have a recent blood pressure reading plus your weight and height.”
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Sleep stress is one of the top menopausal symptoms, so getting it under control can make this life stage considerably less miserable.
Sleep is the salve that kickstarts our every day. Without the right quota, we stumble through, ragged and depleted. But menopause can be a demon that shreds our sleeping hours, with surveys revealing that more than half of midlife women struggle with insomnia.
Decreased levels of oestrogen, progesterone and testosterone induce night sweats, hot flushes, restless leg syndrome and anxiety, robbing us of essential respite and rejuvenating sleep. Science shows the health implications can be significant too, leaving us more vulnerable to heart disease, cancer, obesity, diabetes and stress.
But with a little expert advice, there’s no need to take the broken hours of darkness lying down.
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Nick Harding on how to be helpful rather than hurtful.
As Dr Samantha Wild, BUPA Health Clinics’ women’s health clinical lead, says: “For many years we’ve just been told that menopause is all about hot flushes and maybe night sweats, whereas oestrogen affects every single body function so women can experience the multitude of physical symptoms and a lot of psychological symptoms as well.”
My wife, Stephanie, is 45 and going through perimenopause, the transition stage leading to menopause. We already have a hormonal history. During unsuccessful IVF treatment she was put through a reversible chemical menopause, which served as a prelude to the biggie. I am fortunate. She has been a good teacher for me. The business she founded, Laughology, was also one of the first to offer menopause awareness workshops to organisations. With an expert navigator at the helm, I understood what the hell was going on when, in the middle of a shop, she suddenly started taking off her clothes and panting. I know (now) not to frown or laugh, but to patiently take her handbag and hold the layers as they peel off.
I also know that when I’m asked to sleep in the spare room, it’s no reflection on our relationship, she just wants a good night’s sleep. And that on the very rare occasions when she is angry with me for a minor infraction that would normally fly under the radar, the best thing I can do is roll with the punches. Do not react.
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Scientists are studying how to keep the ovaries working longer — and, potentially, prevent age-related diseases in the process.
In March, First Lady Jill Biden announced a new White House women’s health initiative that highlighted a seemingly obscure research question: what if you could delay menopause and all the health risks associated with it?
The question comes from a field of research that has started to draw attention over the last few years, as scientists who study longevity and women’s health have come to realise that the female reproductive system is far more than just a baby-maker. The ovaries, in particular, appear to be connected to virtually every aspect of a woman’s health.
They also abruptly stop performing their primary role in midlife. Once that happens, a woman enters menopause, which accelerates her aging and the decline of other organ systems, like the heart and the brain. While women, on average, live longer than men, they spend more time living with diseases or disabilities.
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It’s more than just a male sex hormone and can be the foundation for a healthy lifestyle, writes Hattie Garlick.
“Historically, testosterone has not been considered to be particularly important for women in midlife,” says Dr Kim Ruddy, GP and menopause specialist. “The main focus has been around trying to manage hot sweats and other miserable symptoms of the menopause.” Yet, she says: “Many women are frustrated by the lack of libido that this brings. It can have a big impact on self-esteem and relationships”.
In fact: “about 25% of menopausal women will suffer from hypoactive sexual desire disorder (HSDD),” explains Dr Louise Newson, GP, menopause expert and the founder of Newson Health. “Basically, they’ll get a really low libido. Testosterone has been shown to help significantly with that.”
A 2020 review of trials concluded decisively that, compared to either a placebo or oestrogen and progesterone HRT, testosterone therapy “increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness and self-image”.
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Could the onset of perimenopause exacerbate ADHD symptoms?
All her life, Rosie* felt there was something wrong with her. “I couldn’t really ‘get it together’ like most other people did, and I just felt different.”
For as long as she could remember, she’d had a head full of “constant, indecipherable chatter”. “Someone else said all the metaphorical tabs on the computer are open at once but you can’t remember why or which you’re meant to deal with first. It manifests in a feeling of real overwhelm when things pile up and that’s when I shut down and kind of crash.”
By the time she reached her 50s, she felt exhausted by living in a constant state of chaos. When one of her children was tested for ADHD, everything suddenly made sense. “I was reading up about their issues that I thought, s***, that sounds like me!” She was diagnosed with ADHD at 52.
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Experts argue that the menopause should be reframed as a neurological condition, not a gynaecological one – Hattie Garlick explains why, and what to do about it.
I am turning 40 and honestly – really – I feel fine about my ageing body. My husband and I will grow more wrinkled and stooped in tandem. That seems fair enough.
A growing field of research, however, suggests that as we enter into this new midlife phase, my brain will begin to age, change and decline in ways that his will not. And this inequality is the straw that broke the camel’s back or, if you will, the symptom that snapped my perimenopausal patience.
If my husband and I sat down to take a verbal memory test today, it’s quite likely I would trounce him. If we sat the same test in around a decade’s time, however, the tables might turn.
On average, adult women perform better than men at such skills, explains Jill Goldstein, a professor of psychiatry and medicine at Harvard Medical School, and the founder of the Innovation Centre on Sex Differences in Medicine at Massachusetts General Hospital.
That advantage, however, narrows during the menopause. Professor Goldstein’s own work has probed some of the reasons for this.
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Your body changes during the menopause transition. So should your fitness routine.
When Alison Gittelman turned 49, she found she couldn’t run as fast or as long as she had before. She was an experienced marathoner and triathlete, but suddenly, as she entered menopause, her heart rate was unusually elevated while running. Her joints hurt. She gained weight. She started experiencing debilitating menstrual cramps.
“I hadn’t anticipated this at all,” said Gittelman, now 51. “I thought I would breeze through menopause.”
Soon, Gittelman realised she had to adjust her exercise routine. She started to run less and rededicated herself to strength training and mobility exercises.
Whether you work out regularly or you’re just building a fitness habit, exercise can feel harder as you reach menopause, which typically occurs in your 40s or 50s. But that doesn’t mean you should hang up your sneakers. “Exercise can be a tool to build up your resilience to the shifts that are going to happen,” said Dr Alyssa Olenick, an exercise physiologist who studies metabolism and menopause.
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Sexual concerns – from a lower libido to difficulty achieving orgasm or pain during sex – are common among women experiencing perimenopause and menopause.
After surgery thrust her into menopause at age 40, Stephanie Scott of Hamilton, Ontario said she had “zero sex drive”. Hormone treatments helped with hot flashes and insomnia, but they didn’t increase her desire for sex.
So she signed up for a research study testing a unique type of therapy for menopausal women with low desire because of menopause. The result: a noticeable improvement in her sex life.
“The focus was on reshaping your thoughts about your own body, your own needs and desires and desirability,” said Scott, now 49, who entered early menopause after having a hysterectomy and one ovary removed. She said the therapy helped her “understand the emotional and psychological changes going on during menopause”.
The results of the research, being presented on Tuesday in Chicago at the annual meeting of the Menopause Society, suggest cognitive behavioural therapy – a specific form of talk therapy – can significantly improve sexual dysfunction problems related to perimenopause and menopause. Earlier research has shown CBT to be effective for hot flashes and other symptoms of menopause.
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