Symptoms

What are hot flushes and night sweats?

Hot flushes and night sweats are among the most common and recognizable symptoms of menopause, often grouped together as vasomotor symptoms. You might feel an intense heat surge through your body, often leaving you red and flushed, followed by sweating—or even feeling soaked in sweat.
They can show up in different ways for different people: some experience them regularly, while others may only get the occasional episode. They tend to last a few minutes, but this can vary. You might get them during the day, at night, or both. Night sweats can happen even if you don’t get flushes during the day.
Sometimes, these episodes come with other sensations like dizziness, heart palpitations, or a sudden blush. They can be triggered by things like stress, embarrassment, a sudden temperature change, alcohol, caffeine, or hot drinks—or they may happen seemingly out of nowhere.

Hot flushes and sweats can also intensify other symptoms, including:

• Anxiety
• Fatigue
• Mood swings
• Brain fog
• Low mood or depression
• A dip in confidence and self-esteem

Interestingly, how you experience these symptoms may be shaped by your cultural environment. Research suggests that in societies where menopause and aging are viewed positively, vasomotor symptoms are often reported as less severe.

Hot flushes and work life

Managing hot flushes at work can bring unique challenges. Work-related stress can heighten symptoms, uniforms may make temperature regulation tough, and you might not have control over your work environment’s temperature. It’s also common to feel worried about how colleagues might react.
Research shows that women struggling with frequent or severe flushes and sweats are more likely to consider quitting their jobs. If you’re feeling this way, you’re far from alone.
Support at work matters. Try reaching out to your line manager or HR—many workplaces now have menopause support policies. Organizations like the Faculty of Occupational Medicine and the Chartered Institute for Personnel and Development offer great resources you can share.

What causes hot flushes and night sweats?

The exact cause of hot flashes is still being studied, but it is clear that hormonal fluctuations — especially changes in estrogen levels — play the key role. When estrogen decreases, the hypothalamus — the part of the brain responsible for temperature regulation — becomes more sensitive to temperature changes, triggering strong physiological reactions to even minor increases in heat. This phenomenon is called a “narrowing of the thermoneutral zone.” Other brain chemicals, such as serotonin and norepinephrine, also influence the thermoregulation center and are linked to the intensity of hot flashes.

How common are hot flushes and night sweats?

Around 75% of women experience hot flushes and night sweats during the perimenopause and menopause. About 30% report having them severely, and symptoms can last, on average, for around eight years.
Even among women aged 60–65, about 40% still experience them, and for roughly 20% of women, these symptoms can last 15 years or more.

When do they tend to occur in the menopause journey?

Vasomotor symptoms can start at any time during the perimenopause and often continue through menopause and into the postmenopausal years. They are most frequent in the year following your final period.
How can they be managed?
There’s no one-size-fits-all approach, but the good news is there are many effective options to explore.

Practical tips:

• Choose loose-fitting clothes that don’t restrict the body. Dress in layers so you can remove them if needed.
• Opt for natural fabrics (cotton, bamboo, linen) that “breathe” and help you stay cooler.
• Cotton bedding and nightwear can help reduce night sweats.
• Keep your bedroom cool—open a window or use a fan if needed.
• Have a change of clothes or towel nearby in case you need it at night.
• Try a cooling spray designed for menopausal symptoms.
• Adjust your work environment—see if you can keep a fan at your desk or ask to regulate the room temperature.

Lifestyle tips:

• Avoid known triggers where possible—like caffeine, alcohol, spicy foods, and hot drinks.
• Quit smoking—smoking can worsen symptoms, and the NHS offers support if you’re trying to stop.
• Stay active—regular exercise and maintaining a healthy weight can ease symptoms, even though we know it’s not always easy. Our friends at Her Spirit offer supportive wellness programs, and our nutritionist partner can help with personalized diet tips.

Hormone Replacement Therapy (HRT)

HRT is the most effective treatment for hot flashes and night sweats. It restores estrogen levels and directly addresses the underlying cause of these symptoms — disrupted thermoregulation in the brain. For most women, HRT significantly reduces both the frequency and intensity of symptoms.

In addition, it helps preserve bone density, lowers the risk of heart disease, and can have positive effects on mood and sleep.

Although some women are concerned about a potential increase in breast cancer risk, for many the benefits of HRT outweigh the risks. The treatment plan, dosage, and form should always be determined by a doctor, taking into account your individual health history.

Alternative treatments:

• Phytotherapy (herbal remedies): products with a THR (Traditional Herbal Registration) mark meet quality and safety standards (though this does not guarantee effectiveness).
• Black Cohosh: may help reduce symptoms, but scientific evidence is mixed, and its long-term safety is unclear. Not recommended for women with high blood pressure, liver disease, or those taking tamoxifen.
• Sage: may help ease sweating, but high-quality studies are lacking. It may not be suitable for those with hypertension.
• Phytoestrogens (plant compounds with mild estrogen-like effects): found in soy, flax, sesame seeds, legumes, and certain vegetables (e.g., garlic, broccoli).
  • Red Clover: contains phytoestrogens, especially isoflavones. Research results are inconsistent — some women may experience relief, but the effect is usually mild and depends on gut microbiota (which determines whether the compound is converted into its active form).
  • Overall, phytoestrogens may provide mild symptom relief for some women, but the effect is often weak, and for those with hormone-sensitive cancers, they should not be used without medical supervision.

Relaxation techniques:

• Relaxation techniques: yoga, meditation, and breathing exercises — help reduce stress.
• Psychotherapy / Cognitive Behavioral Therapy (CBT) for menopause:** research has shown it significantly reduces the intensity and frequency of symptoms, and it is especially effective when HRT is not an option.

Medications if HRT is not suitable

When hormone therapy is not an option, certain drugs originally developed for other conditions can help relieve hot flashes:

• Antidepressants (SSRIs/SNRIs, e.g., venlafaxine or paroxetine): can reduce symptoms while also improving mood.
• Gabapentin or pregabalin (used for nerve pain or epilepsy): may ease sleep disturbances but can cause dry mouth.
• Clonidine: a blood pressure medication that can sometimes also reduce hot flashes.
• Oxybutynin: typically used for bladder disorders, but studies show it may reduce hot flashes and night sweats. Possible side effects include dry mouth, constipation, drowsiness, or confusion — particularly in older women. While not a first-line treatment, it can be a useful alternative.

None of these medications are officially licensed for the treatment of menopausal symptoms, but in some cases, they can help around 25–50% of women. They are often prescribed when hormone therapy is not an option, such as after a history of breast cancer. However, these medications may have unpleasant side effects, so their use should always be discussed with a doctor — often in consultation with both a gynecologist and a psychiatrist.

A new drug has also been developed specifically for hot flashes:

Veoza (fezolinetant): an NK3 receptor antagonist that acts directly on the brain’s thermoregulation center. It is intended for postmenopausal women who cannot or do not wish to take HRT. Studies show it can significantly reduce the frequency and intensity of hot flashes within just a few weeks of use. The most common side effects are abdominal pain, changes in liver enzymes (requiring regular monitoring), and nausea. It is not yet widely available in all countries but is considered a promising alternative.

Understanding Bone and Joint Changes During Menopause

As you move through the different stages of menopause, you may notice new aches, stiffness, or changes in how your body feels—especially in your bones and joints. These shifts are common and largely linked to the natural drop in estrogen levels. Two of the most important and often-overlooked changes to be aware of are osteoporosis and menopause-related joint pain.

What Is Osteoporosis?

Osteoporosis is a condition where bones become thinner, weaker, and more fragile over time, making them more likely to break. It often develops slowly and quietly—many people don’t realize they have it until they experience a fracture, often in the spine, hip, or wrist.

Estrogen helps keep bones strong by supporting bone renewal. But during menopause, when estrogen levels drop, bone loss can speed up. In fact, women can lose as much as 20% of their bone mass within the first few years after menopause. Women with early menopause or Premature Ovarian Insufficiency (POI) may be at even higher risk.

The good news? There are effective ways to protect your bones. Bone density scans (DEXA scans) can help detect early signs of osteoporosis, and treatments like Hormone Replacement Therapy (HRT) can help slow down or even reverse bone loss.

What About Joint Pain?

If you’ve been noticing more creaky joints or unexpected stiffness in your hands, knees, or back, you’re not alone. Around 4 in 10 women aged 45–65 report joint or muscle aches during menopause. For some, it’s one of the earliest signs—even before hot flashes or sleep changes kick in.
This discomfort is often tied to lower estrogen levels, which affect the health of your cartilage (the smooth tissue that cushions joints) and can increase inflammation. Joint pain during menopause may feel like general stiffness or soreness, but for others, it might flare up in a more specific way—especially if there’s an underlying issue like osteoarthritis or rheumatoid arthritis.

Osteoarthritis is a wear-and-tear condition where cartilage breaks down over time. Rheumatoid arthritis, on the other hand, is an autoimmune condition where the body mistakenly attacks the joints. If your joints feel hot, swollen, or unusually painful, it’s important to check in with a doctor for the right diagnosis.
Sometimes, during menopause, women experience unexpected shoulder stiffness (adhesive capsulitis), which causes pain and restricts movement. It is thought that the decline in estrogen may contribute to changes in connective tissue and inflammation, making this condition more common in women aged 40–60. Treatment usually involves physiotherapy, pain relief, or orthopedic care, but in some cases, HRT can be very effective, helping to speed up recovery and reduce symptoms.

Supporting Your Bones and Joints Through Menopause

Whether you’re already feeling the effects or just want to be proactive, here are some helpful ways to care for your bones and joints during menopause:

1. Consider HRT (Hormone Replacement Therapy)
   HRT can be a powerful tool to ease joint pain and protect your bones by replacing some of the estrogen your body is no longer making. Some women have found that their joint pain improved dramatically—or even disappeared—after starting HRT. It’s also one of the most effective treatments for preventing osteoporosis. Talk to your doctor to see if it’s a good fit for you.
2. Movement — the most important tool for strengthening bones and joints
   Regular physical activity is one of the most important things you can do during menopause. Muscle mass and bone density directly influence how long and how well you live, and they are key to overall quality of life.
   • Weight-bearing exercises such as walking, dancing, running, jumping, or climbing stairs stimulate the formation of new bone tissue.
   • Strength training (e.g., weightlifting) not only builds muscle but also strengthens bones. Greater muscle mass also supports a faster metabolism and better weight control.
   • If joint pain leads you to move less, the condition may actually worsen — in contrast, gentle, regular movement helps reduce inflammation and pain.
   • Flexibility and mobility exercises (such as stretching, yoga, or Pilates) improve joint function and coordination, lowering the risk of falls — one of the main causes of osteoporotic fractures.
     The key is to move consistently, adjusting intensity to your abilities and avoiding long breaks from activity.
3. Eat for Bone Health
   • Calcium-rich foods (milk, leafy greens, fortified plant-based milks) help strengthen bones.
   • Vitamin D is essential for calcium absorption and bone strength, and it also plays a role in hundreds of processes in the body, including immune function, muscle performance, and even brain health. Most women during menopause have insufficient vitamin D levels. Consider supplementation, especially in winter or if you get little sun exposure. If possible, it’s worth checking your vitamin D levels with a blood test.
   • A Mediterranean diet, rich in healthy fats and whole, natural foods, can help reduce joint inflammation.
   • Omega-3 supplements also reduce inflammation in the body, and evidence suggests they may help ease joint pain.
4. Maintain a Healthy Weigh
   • Carrying extra weight puts more stress on your joints, especially your knees and hips. Gradual, sustainable weight loss can help reduce pain and improve mobility.
5. Get Support for Stress and Sleep
   • Pain often feels worse when you’re stressed or not sleeping well. Practices like mindfulness, CBT (Cognitive Behavioral Therapy), or simply getting back into a better sleep routine can help you manage pain more effectively
6. Try Medications or Topical Relief
   • Over-the-counter pain relievers or anti-inflammatory gels can offer short-term relief.
   • Speak with your pharmacist or doctor before starting new medications to make sure they’re safe for you.

When to Seek Help?

It’s always okay to bring up your symptoms—even if they feel minor. If joint pain is getting in the way of your daily life, or if you notice swelling, redness, or heat in a joint, don’t hesitate to check in with a healthcare provider. Early support can make a big difference.

Vaginal Changes and Shifts in Sex Drive During Menopause

Many women notice changes in their bodies and relationships with sex during the menopause transition. Two of the most common and often connected experiences are vaginal dryness and a drop in sex drive. These changes can show up gradually or more suddenly, and they may feel confusing or frustrating—but they’re entirely normal, and there are ways to manage them.

What’s going on with vaginal dryness?

Vaginal dryness affects a significant number of women during perimenopause and menopause. Some notice it only during sex, while others feel dryness, itching, or irritation daily. You might also experience a ‘prickly’ feeling, discomfort, or pain, especially during penetration.

As estrogen levels drop, the vaginal tissue becomes thinner, less elastic, and more sensitive. This can lead to what’s known as urogenital atrophy—a general thinning and drying of the vaginal and vulval areas. These changes not only affect comfort but can also increase your risk of infections like thrush or bacterial vaginosis, as the balance of natural bacteria shifts.

Is this related to libido?

Yes, and it’s often part of a wider picture. Many women notice a loss of desire for sex during menopause—sometimes as a result of physical discomfort, but also due to other factors like fatigue, stress, body image shifts, or changes in relationships. On a hormonal level, falling estrogen and testosterone levels can both impact libido and energy levels.
Painful sex caused by dryness or thinning of the vaginal walls can understandably make you less interested in sex. Or, you may still feel desire, but find that arousal feels slower or less intense. All of this is very common.

In fact, studies show that around one-third of women experience vaginal dryness, and up to 40–50% notice a reduced sex drive during the menopause transition. These issues can happen at any stage—whether you’re just entering perimenopause or years into postmenopause.

What can help?

The good news is that there’s a lot you can do to feel more comfortable and connected with your body again.

Vaginal moisturisers and lubricants

Daily vaginal moisturisers (available over the counter) can help soothe dryness and restore comfort. For sex, lubricants—especially water- or silicone-based ones—can reduce friction and make things feel more pleasurable. Oil-based options last longer but aren’t compatible with condoms. Avoid scented or “tingling” varieties, which can worsen irritation.

Vaginal estrogens

If moisturizers alone are not enough, a doctor may prescribe local estrogen treatments — creams, suppositories, or vaginal rings. These act directly on the vaginal and urinary tissues, improving elasticity and moisture, while reducing itching, burning, and pain during intercourse. Local estrogen can also help lower the risk of recurrent urinary tract infections and improve bladder function. Because their effect on overall hormone balance is minimal, they are considered safe even for women who cannot use systemic HRT — including many who have undergone breast cancer treatment.

Hormone Replacement Therapy (HRT)

Systemic HRT (such as patches, sprays , gels, or tablets) may improve both vaginal symptoms and sex drive for some women. However, not everyone finds relief this way, and some women using HRT still benefit from adding vaginal estrogens.

Explore what feels good again

Sex might need to look or feel a little different now—and that’s okay. Using a vibrator, making time for relaxation, or even rediscovering solo pleasure can all help boost confidence and arousal. Pressure is the enemy of desire, so be kind to yourself and move at your own pace.

Talk about it

If sex is causing discomfort or strain in your relationship, open conversations with your partner or a therapist can help. Many couples find new ways to connect emotionally and physically once they understand what’s changing.
Consider professional support

Loss of libido or painful sex doesn’t mean there’s something wrong with you—it just means your body and hormones are evolving. A GP, menopause specialist, or psychosexual therapist can work with you to create a plan that fits your needs and goals.

What are sleep problems related to menopause?

Many women tell us they’re struggling to get a good night’s sleep during menopause. Poor sleep can be really draining and can affect your mood, behavior, and even your long-term health.

Research shows that not getting enough sleep can make your brain more focused on negative thoughts and memories, rather than positive ones. It can also impact your ability to think clearly and make decisions—worsening things like menopausal brain fog. You might even find yourself taking more risks, reacting slower, or being more accident-prone when sleep-deprived.

If sleep is a challenge for you, this guide might help you understand what’s going on—and encourage you to ask for support if you need it.

What causes sleep problems?

Sleep disruptions during menopause can happen for a variety of reasons. To understand why, it helps to know how sleep normally works.

How sleep works

Sleep occurs in cycles, consisting of three main non-REM stages and one REM stage.

Non-REM sleep:

N1 stage – transitional, light drowsiness

N2 stage – light sleep, when breathing and heart rate slow down

N3 stage – deep slow-wave sleep, essential for recovery and immune function

REM sleep:
Occurs later in the cycle, associated with dreaming and emotional processing. During this stage, it is easier to wake up — especially if disturbed by hot flashes or anxiety.

How menopause affects sleep

Menopause can disrupt sleep in several ways. Physical symptoms such as hot flashes, night sweats, or joint pain can cause repeated awakenings throughout the night.

Many women notice that their sleep quality worsens during menopause: difficulty falling asleep, frequent night awakenings, and morning fatigue. This is influenced not only by physical symptoms (hot flashes, night sweats) but also by deeper neurological and hormonal changes.

Progesterone and Estrogen

• Progesterone has a calming effect — it enhances the action of GABA (a soothing neurotransmitter) in the brain, naturally promoting sleep and relaxation. During perimenopause, progesterone levels decline earlier than estrogen, which is why insomnia is often one of the first symptoms.
• Estrogen supports:
  melatonin production (the hormone that regulates the sleep–wake cycle)
  • serotonin, dopamine, and norepinephrine activity (mood- and sleep-regulating chemicals). When these decrease, anxiety may rise and it becomes harder to relax before sleep.
  • body temperature regulation, meaning low estrogen can trigger night sweats and awakenings.

Circadian rhythm and aging

With age, natural melatonin secretion declines, the internal clock weakens, and women become more sensitive to disruptions in rhythm. Even small shifts (late screen time, late meals, exposure to light at night) can significantly affect sleep quality.

You may also need to use the bathroom more frequently at night than before. Emotional changes — increased anxiety or low mood — can make it harder to fall asleep or stay asleep.

Sleep apnea, a condition where breathing briefly stops during sleep, also becomes more common after menopause due to hormonal changes. It is characterized by snoring, gasping, and poor sleep quality. While often linked to excess weight, it can occur even in women without it. If you suspect sleep apnea, consult your doctor.

Many women turn to melatonin, the hormone that regulates the sleep–wake cycle. Its levels decline with age. Melatonin can help with falling asleep at the right time but does not act like a sleeping pill and does not prevent frequent night awakenings.

It is important to note that sleep is affected not only by hormones but also by the natural process of aging — in both women and men.

Other factors that impact sleep

• Alcohol: Can help you fall asleep but leads to lighter, poorer-quality sleep
• Caffeine: A stimulant—having too much or drinking it too late in the day can keep you awake
• Chronic pain or certain medications: Can interfere with sleep patterns
• Obesity: Increases the risk of conditions like sleep apnoea
• Smoking: Nicotine is a stimulant that can make it harder to sleep

How common is this?

According to the British Menopause Society, around 60% of women report experiencing sleep issues during menopause.

When do sleep problems happen during menopause?

Sleep disturbances can happen at any point in the menopause transition—and they may continue even after menopause due to aging.

What can help?

There are many ways to improve sleep during menopause. If it’s really affecting your life, speak to a healthcare professional for support.

Coping with stress and sleep-related worry

Worrying about not sleeping can actually make things worse. It helps to know that the most restorative sleep usually happens in the first part of the night. So even if you wake up later, your body may have already gotten what it needs.

Try not to limit your day just because you didn’t sleep well—doing small, manageable tasks can help maintain your routine and make you feel more tired (and ready to sleep) later.

Improving your sleep environment

• Keep your bedroom cool, dark, and comfortable—breathable sheets and light nightwear can make a difference
• Avoid screens before bed, and try to use your bedroom only for sleeping
• If you can’t sleep, get up and do something calming before returning to bed—this helps train your brain to associate bed with sleep
• Going to bed too early can backfire, leaving you awake for long stretches—try timing it when you actually feel sleepy

Everyday habits

• Avoid heavy, rich, or spicy meals before bed
• Cut back on caffeine after lunchtime
• Try not to drink too much alcohol—it can disrupt sleep quality
• If you smoke, consider quitting, since nicotine can make falling asleep harder

Can HRT help?

HRT does not act as a sleeping pill, but it can indirectly improve sleep by:

• reducing hot flashes and night sweats,
• stabilizing mood and improving overall well-being,
• enhancing the nervous system’s sensitivity to melatonin and serotonin.

It is especially beneficial for women in perimenopause, when insomnia is often driven by progesterone deficiency. In such cases, micronized progesterone (particularly taken in the evening) can be an effective and safe way to improve sleep.

While some people are concerned about the small risks (like a slight increase in breast cancer risk), these risks are often smaller than lifestyle factors like body weight or alcohol intake.

Cognitive Behavioral Therapy for Insomnia (CBT-I) — an evidence-based treatment for chronic insomnia.

It is considered the first-line treatment and includes:

• changing sleep habits,
• addressing anxious thoughts about sleep,
• restoring circadian rhythm.

In the long term, CBT-I is much more effective than sleeping pills, which carry many side effects and negative impacts on health over time.

It can be used on its own or in combination with HRT.

What causes brain fog, memory disturbances and lack of concentration?

If you’ve found yourself struggling to remember things, losing track of your thoughts mid-sentence, or feeling less sharp than usual, you’re not imagining it. These experiences—often referred to as brain fog—are a common part of the menopausal transition, and you’re certainly not alone.

Cognitive changes like forgetfulness, difficulty focusing, and trouble recalling words can become part of daily life during this time. While these moments can be unsettling, they’re usually temporary and related to the hormonal shifts happening in your body.

Brain fog can be especially frustrating if you’re managing a busy household, working in a demanding job, or simply trying to stay on top of everyday tasks. Many women describe a dip in confidence or self-esteem when their mind doesn’t feel as sharp as it used to.

In many cases, brain fog occurs alongside other menopausal symptoms—such as mood changes, anxiety, low mood, or disrupted sleep—which can all further affect your mental clarity and emotional wellbeing.

But what is brain fog, exactly? It’s not a clinical diagnosis, but rather a term used to describe the sensation of slowed or fuzzy thinking—like your brain is wrapped in cotton wool. It can make even simple decisions feel overwhelming.

The good news? You don’t have to just live with it. With the right support and some simple lifestyle adjustments, many women see real improvements in how they feel and function.

Understanding Brain Fog During Menopause

Feeling mentally foggy, forgetful, or unable to concentrate? You’re not imagining it—and you’re definitely not alone. Brain fog is one of the most frequently reported symptoms during menopause, and research confirms just how widespread it is. In one survey, over 70% of women said they experienced difficulty thinking clearly during the menopause transition. Other studies have found that up to half of working women struggle with memory and focus issues that affect their daily performance.

Why Does Brain Fog Happen?

Shifts in hormone levels—particularly a drop in estrogen—can significantly affect how your brain functions. Estrogen supports key regions of the brain involved in memory, focus, and mood regulation. When levels decline, you may start to feel mentally slower or more forgetful. Other hormones, like testosterone and cortisol, also play a role. In times of stress, rising cortisol can interfere with concentration and make symptoms worse, creating a frustrating cycle.

When Can Brain Fog Appear?

Brain fog can show up at any point during the menopause transition, but many women notice it first during perimenopause—the early stage when hormone levels begin to fluctuate. For some, it’s an early sign that something is changing.

What Does It Feel Like?

Women often describe brain fog as a sensation of “mental fuzziness” or having a clouded mind. It can involve:

• Trouble concentrating
• Short-term memory lapses
• Forgetting familiar words
• Feeling mentally sluggish

These symptoms are usually temporary but can be disruptive—especially when combined with other menopausal challenges like poor sleep, anxiety, or mood swings.

How Can You Manage It?

While brain fog often eases over time, there are many ways to support brain health and clarity in the meantime:

1. Prioritise Sleep

Poor sleep or frequent night wakings (often caused by hot flushes or night sweats) can make brain fog worse. Try to improve your sleep hygiene and address the root causes of sleep disruption.

2. Move Your Body

Regular physical activity has been shown to boost brain function. Even short daily walks can improve mental clarity. If you’re looking for motivation, communities like Her Spirit can help you find the right activity and stay on track.

3. Eat Well

Focus on a balanced, brain-friendly diet that includes plenty of vegetables, fruits, oily fish, and whole grains. Limit added sugars and alcohol, both of which can impair brain performance.

4. Reduce Stress

Stress can amplify brain fog. Finding healthy ways to decompress—whether through mindfulness, journaling, or talking to a therapist—can help lower cortisol levels and improve focus.

5. Consider Hormone Replacement Therapy (HRT)

HRT can be an effective option for many women, easing symptoms like fatigue, poor concentration, and memory issues. While concerns around breast cancer risk are common, for most women the benefits outweigh the small risks—especially when considering overall wellbeing, bone health, and cardiovascular support.

6. Explore Testosterone

Although not officially licensed for this use in women, testosterone can be prescribed by menopause specialists and may help some women with low energy and reduced mental sharpness. Speak to your provider to learn more.

7. Cognitive Behavioural Therapy (CBT)

CBT can help you reframe unhelpful thought patterns and break the cycle of stress and mental fatigue. Our CBT partners, Sue and Claire, offer support designed specifically for women navigating these changes.

When to Talk to a Doctor

If your symptoms feel overwhelming, worsen over time, or affect your ability to function, it’s important to consult your GP. Brain fog may occasionally point to other medical issues such as thyroid disorders, vitamin deficiencies (like B6 or B12), liver problems, or side effects from medication. Your doctor can rule these out and guide you toward the most effective support.

Day-to-Day Tips to Stay Sharp

• Use reminders: Notes, to-do lists, and phone alerts are your allies.
• Do brain exercises: Try puzzles, crosswords, reading, or learning something new.
• Create mental space: Schedule demanding tasks during times when you feel most alert.
• Make time to unwind: Daily relaxation—guilt-free—is key for restoring mental clarity.

If you’ve noticed your body changing even though your habits have stayed the same, it’s not your imagination.

Many women gain weight during perimenopause and menopause, see changes in fat distribution, experience bloating, or feel their digestion slow down — even without eating more than before.

These changes don’t mean you “lack discipline” or have poor willpower. They are closely linked to hormonal, metabolic, and even gut microbiome changes that occur during menopause.

Why does weight change during menopause?

Estrogen plays a role in many processes — from metabolism and fat storage to appetite regulation and body fat distribution.

When estrogen levels decline, the body naturally begins storing more fat, especially around the abdomen. At the same time, muscle mass decreases with age, which slows metabolism. This means the same amount of food can now lead to more weight gain than before.

Sleep problems, fatigue, and stress are also common during perimenopause. All of this can increase cravings for sweets or carbs and reduce motivation to stay active — creating a vicious cycle that can be hard to break.

Higher stress levels also affect cortisol, the stress hormone, which promotes fat storage, particularly around the waist. These changes are linked to an increased risk of cardiovascular disease and certain cancers.

All of this creates the “perfect storm” for weight gain — even if your diet and activity haven’t changed.

Insulin resistance: the hidden player

Estrogen helps cells remain sensitive to insulin — the hormone that regulates blood sugar. When estrogen declines, insulin sensitivity also decreases, and the body becomes less efficient at using glucose for energy. In response, the body produces more insulin, leading to insulin resistance.

This can cause:

• Increased abdominal fat and weight gain
• Blood sugar spikes and sudden energy “crashes”
• Intense carb cravings
• Greater risk of type 2 diabetes, heart disease, or even increased body hair

Research shows that women’s risk of developing insulin resistance rises significantly during perimenopause — even if their weight is normal.

What about digestive changes?

Menopause often brings new digestive issues: bloating, constipation, reflux, or sudden sensitivity to certain foods.

This may be linked to:

• Slower intestinal movement due to declining progesterone
• Hormone-driven changes in gut microbiota
• Elevated cortisol, which suppresses digestive function
• Age-related decline in digestive enzymes and bile production

Some women become more sensitive to gluten, dairy, alcohol, or processed foods during this stage.

When to see a doctor

Consult a doctor if you notice:

• Sudden or unexplained weight changes
• Persistent fatigue or bloating
• Blood in stool or new digestive symptoms

It may be helpful to check for insulin resistance, thyroid function, vitamin D deficiency, or other health conditions.

What you can do

1. Strength training and daily movement
   Strength training is one of the most effective ways to boost metabolism, improve insulin sensitivity, and prevent midlife weight gain. The more muscle you have, the more calories you burn at rest. It also supports bone density. Pair it with daily walking, yoga, or any enjoyable activity.
   Aim for strength, not just “thinness.”
2. Nutrition for hormone and blood sugar balance
   • 25–30 g of protein per meal (~80–120 g per day total)
   • At least 30 g of fiber daily (vegetables, seeds, legumes)
   • Limit processed carbs, sugar, and fast food
   • Include healthy fats (olive oil, avocado, fatty fish)
   • Reduce alcohol — even small amounts affect sleep, blood sugar, and belly fat

Tip: Track your food for a few days with a nutrition app to see how much protein and fiber you’re currently getting — it can help you adjust gradually.

3. Support digestion and gut health
   • Fermented foods: kefir, kimchi, sauerkraut
   • Prebiotics: onions, garlic, asparagus, berries, dark chocolate, and other polyphenol-rich foods that feed good gut bacteria
   • Eat mindfully and chew thoroughly (more important than you think!)
   • Stay hydrated and avoid eating 2–3 hours before bed
   • If hungry at night, choose a protein-rich snack or 2 kiwis (studies show they improve sleep quality)

4. Gentle blood sugar regulation
   4. Don’t skip meals — keep a steady rhythm
   5. Pair carbs with protein or fat to slow digestion and prevent energy crashes
   6. After meals, take a short walk or do 10 squats — both improve blood sugar control and insulin sensitivity

5. Stress reduction and better sleep
   Poor sleep and high cortisol make it harder to maintain or lose weight. Helpful strategies include:
   • A consistent bedtime routine
   • Nervous system calming (breathing exercises, CBT, yoga nidra)

6. Focus on progress, not perfection
   Perimenopause and menopause are not a “body breakdown” but a transformation. Track how you feel — not just the number on the scale. Use a symptom journal, monitor muscle strength, or note your energy levels as signs of progress.

Can HRT help with weight and metabolism?

Yes — indirectly.

Hormone Replacement Therapy (HRT) is not prescribed specifically for weight loss, but it can have positive effects such as:

• Improving sleep quality
• Reducing hot flashes and night sweats
• Relieving joint pain and fatigue
• Helping maintain muscle mass and energy levels
• Improving insulin sensitivity in some women

All of this can boost energy, mood, and motivation to maintain healthy habits.

Common fear: “Will HRT make me gain weight?”

This is one of the biggest myths. Research shows HRT is not associated with weight gain. Sometimes mild water retention occurs at the start, but it usually passes quickly. In fact, by improving sleep, mood, and energy, HRT can actually make it easier to maintain healthy habits and preserve lean body mass.

A 2021 review in The Journal of Clinical Endocrinology & Metabolism confirmed that HRT does not cause weight gain and may even help prevent the typical postmenopausal shift toward abdominal fat storage.

Final thoughts

Weight gain, bloating, or metabolic changes during menopause are not your fault — they are a natural and inevitable result of hormonal shifts.

The good news? You have many ways to support your body. With the right knowledge, balanced nutrition, daily movement, and a little more self-compassion, you can feel stronger, clearer, and more in control of your well-being.

Whether through lifestyle changes or the decision to try HRT, even small steps can make a big difference. Menopause is not the end — it’s the beginning of a powerful new chapter, especially when you know how to embrace it.

What are bladder infections?

Bladder infections—also known as urinary tract infections (UTIs)—are quite common during the menopause. They occur when bacteria infect the lining of the bladder.
 About two-thirds of women will experience a bladder infection at some point in their lives, and the chances go up with age. Research suggests that around one in three women deal with repeated UTIs or incontinence linked to the menopause.

What are the symptoms?

Symptoms can vary, but often include:

• A stinging or burning sensation when you urinate
• Needing to pee more often than usual
• Waking up at night to pee
• Passing only small amounts of urine
• Pain at the end of urinating
• Discomfort or aches in the lower tummy or back
• Blood in the urine
• Leaking urine (incontinence)
• Feeling feverish, tired, or generally unwell
• Pain in the lower back or sides (your ‘loins’) if the infection spreads to the kidneys

All in all, bladder infections can make you feel pretty miserable. A high temperature or more intense pain in your back could point to a kidney infection, which needs urgent medical attention.

What causes them?

Your bladder empties through a small tube called the urethra. This area relies on estrogen to stay healthy, but during menopause, your body produces less estrogen. That can lead to:

• A thinner, more fragile urethra that’s easier for bacteria to infect
• A shorter urethra, making it easier for bacteria to travel to the bladder
• Weakened muscles around the bladder and urethra, which can prevent your bladder from fully emptying—leaving behind urine that may become infected
• An increased risk of infection after sex

How common are bladder infections?

Bladder infections are a regular concern for many women going through menopause.

How are they treated?

Fortunately, there are a number of ways to help prevent and manage bladder infections. Start with:

• Staying hydrated – drink plenty of fluids throughout the day
• Wiping front to back – to help stop bacteria from spreading

If you do get a UTI, there are a few treatment options to consider:

See your doctor. Your GP can test your urine or send it to a lab to confirm if it’s an infection. Some mild cases clear up with plenty of fluids, but others may need antibiotics.

Antibiotics. If your symptoms are more severe—especially if you have a fever—you’ll likely need antibiotics.

For recurring UTIs, your doctor might suggest a low-dose antibiotic as a preventative measure. Some women take a low dose after sex to reduce the risk.

Hormone Replacement Therapy (HRT). If your symptoms are due to urogenital atrophy—thinning and drying of tissues caused by low estrogen—HRT may help. This treatment can restore the strength and health of bladder and urethral tissues.

If you’re also dealing with other menopause symptoms, systemic HRT (such as patches, pills, gels, or sprays) might be the right fit. But if it’s just bladder or vaginal symptoms, you might only need local treatment with vaginal estrogen.
About 1 in 4 women using systemic HRT also benefit from adding a vaginal estrogen.

Vaginal estrogens. Vaginal estrogen is one of the most effective ways to prevent recurrent urinary tract infections (UTIs) after menopause. Studies show it can reduce the risk of recurrence by up to 50% — far more effective than long-term antibiotic use. It strengthens the tissues of the vagina and urethra, improves local immunity and microbial balance, and reduces bacteria entering the bladder. Regular use can also help prevent more serious complications, such as UTI-related sepsis or hospitalization, which become more common with age. These treatments are available by prescription as creams, suppositories, or small vaginal rings.

They also relieve other symptoms such as dryness, irritation, and painful intercourse.

Key points:

• Typically take about three months to work. If symptoms are long-standing, it may take longer. Patience and consistent use are essential.
• Not associated with an increased risk of breast cancer — the body absorbs only a very small amount of hormone, making it safe even for women with a history of breast cancer.
• Do not increase the risk of blood clots, stroke, or heart disease.
• Can be used long-term, though yearly check-ins with a doctor are recommended.
• Symptoms may gradually return if treatment is discontinued.
• Some women notice an increase in vaginal discharge during use.

The menopause transition brings about a range of changes in your body, many of which show up visibly in your hair, nails, and skin.

These shifts are closely linked to declining levels of estrogen, though age and other external factors play a role too. Understanding what’s happening can help you manage symptoms and feel more at ease in your skin—literally.

Hair Changes

Hair is made of keratin, a tough, fibrous protein that also forms nails and the outer layer of your skin. As estrogen levels decline during the menopause transition, many people notice that their hair begins to thin or fall out more easily. Estrogen helps keep hair in its growing phase longer, so when levels drop, more hairs may shift into the shedding phase.

Some also experience changes in hair texture—hair may become more dry, brittle, or frizzy due to decreased sebum (natural oil) production. Conversely, increased levels of androgens (male hormones) relative to estrogen can cause more facial hair to appear, especially on the chin and upper lip.

Tips for managing hair changes:

• Avoid harsh chemical treatments and limit heat styling tools
• Use gentle, moisturizing shampoos and conditioners. Shampoos containing caffeine, ketoconazole, or saw palmetto are also effective and scientifically proven to support hair growth. For best results, these products should be left on the scalp for at least 5 minutes to allow absorption.
• Eat a balanced diet rich in iron and protein (about 90–120 g of protein per day)
• Minoxidil 5% (solution or spray) for the scalp is an excellent, scientifically proven treatment that stimulates blood circulation in the scalp and promotes hair growth. However, it only works while being used, and since hair grows slowly, it takes 6–9 months of daily application to see the full effect.
• PRP hair treatments combined with Minoxidil are among the most effective methods for stimulating hair growth.
• Consider discussing HRT (Hormone Replacement Therapy) with your doctor, as it may help reduce hair thinning caused by hormonal shifts
• If hair loss is very pronounced or causing concern, consult a trichologist. This is a dermatologist specializing in hair health, who can accurately determine the cause of hair loss and recommend an individualized treatment plan.

Nail Changes

Nails—like hair—are made from keratin, and they too can reflect changes happening within the body. During menopause, many notice that their fingernails become dry, brittle, and more prone to splitting. This is often linked to falling estrogen levels, which reduce the skin’s and nails’ ability to retain moisture.

That said, brittle nails aren’t only due to hormonal changes. Other common causes include:

• Cosmetic trauma: Repeated use of gel nails, acrylics, or harsh nail polish removers
• Frequent hand washing: Exposure to water and detergents strips moisture
• Age-related changes: Fingernails tend to thin over time, while toenails may thicken
• Health conditions: Iron deficiency, underactive thyroid, Raynaud’s syndrome, or fungal infections

Tips for maintaining healthy nails:

• Apply moisturiser regularly—on hands and directly onto nails
• Wear gloves when cleaning or in cold weather
• Keep nails short and filed to reduce breakage
• Avoid acetone-based polish removers
• Consider taking iron supplements if your levels are low (check with your doctor)
• Eat iron-rich foods like leafy greens, legumes, and fortified grains

Skin Changes

Skin is especially sensitive to the hormonal fluctuations of menopause. Up to 50% of women report noticeable changes during this time, often in the form of:

• Increased dryness and sensitivity
• Thinner skin prone to bruising
• Slower wound healing
• More visible wrinkles
• Acne breakouts and rosacea flares
• Increased facial hair (hirsutism)
• Flushing or fungal infections
• Keratoderma climacteric (thickening of palms/soles)
  

These changes largely result from reduced estrogen, which plays a key role in maintaining skin hydration and collagen. Collagen gives skin its structure and elasticity, and up to 30% of it can be lost in the first five years after menopause. As collagen diminishes, skin becomes more fragile and less able to bounce back.

Androgen levels, rising in relative dominance as estrogen drops, can increase oil production and cause acne or extra facial hair. External factors—like UV exposure, smoking, and stress—can amplify these effects.

Tips for healthier skin during menopause:

• Moisturise twice daily with products suited for dry or sensitive skin
• Retinol-based products are among the most effective and scientifically proven treatments for reducing wrinkles. However, retinol can irritate the skin for some women, so start with a lower concentration, use it a few times per week, and avoid combining it with other potentially irritating products (e.g., exfoliants) on those days.
• Use gentle, soap-free cleansers, preferably gel or milk-type. Avoid foaming cleansers, as they tend to dry out the skin further.
• Apply broad-spectrum SPF daily. Sun exposure is one of the main factors that damages collagen and skin, so choose a high SPF (30–50) and use it every day, even in winter.
• Stay hydrated and prioritize good sleep.
• Avoid smoking and manage stress.
• Consult a dermatologist if needed for conditions such as acne, rosacea, or infections, which often flare up during peri-/menopause.
• Consider HRT, which can help restore collagen levels and reduce skin thinning (though it is not prescribed solely for skin concerns).

In summary, while not all changes are caused solely by menopause, the hormonal shifts that happen during this life stage play a major role in how your hair, nails, and skin look and feel. With the right support—through self-care, diet, and where appropriate, medical treatment—these changes can often be managed effectively.

Many women notice that their migraines change — or even worsen — during perimenopause and menopause.

This is most often related to fluctuating or declining estrogen levels, which can trigger more frequent or more intense headaches. If you’ve found yourself reaching for painkillers more often lately, it’s not your imagination. Hormonal changes have a major impact on brain function.

What is migraine?

Migraine is a neurological condition characterized by recurring, usually one-sided headaches, often accompanied by nausea, sensitivity to light, sound, or smells. Some women also experience an aura — temporary visual or sensory disturbances that appear before the pain begins.

If your headaches last 4–72 hours, occur in cycles, and interfere with daily life, they may be migraines.

Why do migraines worsen in perimenopause?

Estrogen influences many brain functions, including pain perception and serotonin activity. During perimenopause, when estrogen levels can fluctuate daily or weekly, migraines may become more frequent or more severe — especially if you’ve previously been sensitive to hormonal shifts.

For many women, migraines ease after menopause when estrogen stabilizes, but unfortunately not for everyone.

What can help?

1. Hormone Replacement Therapy (HRT)
   In some cases, HRT can reduce not only hot flashes but also migraine frequency. Transdermal estrogen (sprays, gels, patches) is particularly helpful, as it avoids the hormonal fluctuations that often trigger headaches.

For women with migraine with aura, combined oral contraceptives are not recommended. However, appropriately prescribed HRT with transdermal estrogen is considered safe and can be an important part of peri-/menopause treatment.

Usually, the lowest effective dose of estrogen is recommended, along with continuous progesterone protection (e.g., hormonal IUD or micronized progesterone).

2. Non-hormonal medications
   If HRT is not suitable or desired, some antidepressants (e.g., SSRIs such as escitalopram, or SNRIs such as venlafaxine) can reduce the frequency or severity of migraines. For some women, they also help relieve menopausal symptoms such as hot flashes and mood swings.
3. Lifestyle and prevention

• • Regular physical activity — especially aerobic exercise and strength training — helps regulate the nervous system, improves sleep, and reduces stress-related triggers.
  • Stable daily routines: consistent sleep, balanced meals, and adequate hydration are key in migraine prevention.
  • Diet: reducing alcohol and heavily processed foods can lower migraine risk. Avoid personal triggers (commonly chocolate, sugar, or coffee).
  • Stress management: mindfulness practices, breathing exercises, or Cognitive Behavioral Therapy (CBT) can significantly decrease migraine frequency.

When to seek help

If your migraines have become more frequent, more severe, or have changed in nature (e.g., you develop a new aura), consult your doctor. Early management can greatly improve quality of life. There are always options — you don’t need to suffer in silence.

Final thoughts

If your migraines have worsened or appeared for the first time during perimenopause, you are not alone. This is a common but often overlooked symptom of hormonal change. While it may feel like nothing works, there are solutions. From diet, sleep, and nervous system regulation to the right HRT, the key is finding what works for you.

The more you understand your body, the more peace, control, and relief you can reclaim. You deserve a life free from constant pain.