Dreading menopause? Here’s what you need to know.

Many women reach menopause knowing surprisingly little about what is happening or why. With World Menopause Day this Sunday, 18 October, now is a good moment to change that, because women who understand the change are better placed to seek the right support at the right time.

What is menopause and when does it start?

Menopause is the point at which periods stop for good. It is confirmed once you have gone 12 months without a period. In the UK it usually happens between the ages of 45 and 55 (NHS, n.d.). The years leading up to it, when hormones fluctuate and periods change, are called perimenopause.

What causes menopause symptoms like hot flushes and brain fog?

As the ovaries wind down, levels of oestrogen and progesterone fall. During perimenopause they can also swing unpredictably. Oestrogen acts on tissues throughout the body, including the brain, bones, heart, skin, bladder and vagina, which helps explain why symptoms are so varied. Hot flushes, for example, are linked to changes in a group of neurons in the hypothalamus, the brain’s temperature control centre. These neurons become more active as oestrogen falls (Rance et al., 2013). In one large US study, hot flushes and night sweats lasted a median of 7.4 years (Avis et al., 2015).

How menopause affects your physical, mental and social wellbeing

Hormones are only part of the story. The biopsychosocial framework looks at how biology, psychology and social circumstances interact (Hunter & Rendall, 2007).

Biological: hormonal change, disrupted sleep, joint aches, and longer-term effects on bone and heart health.

Psychological: low mood, anxiety, brain fog and a dip in confidence, often made worse by poor sleep.

Social: work pressures, caring for children and ageing parents, relationships, and the cultural messages we absorb about ageing.

These factors feed one another. Night sweats disrupt sleep, and poor sleep affects mood and concentration, which can show up at work and at home. Beliefs matter too. A systematic review found that women with more negative attitudes towards menopause tended to report more symptoms (Ayers et al., 2010).

Is menopause always negative? A more positive view of the change

Many women approach menopause with real fear. Yet experiences vary widely, and plenty of women have few or manageable symptoms. Researchers have argued that presenting menopause mainly as a disease of deficiency can fuel anxiety. They have called for a more balanced, empowering approach (Hickey et al., 2024).

Why do women go through menopause? The grandmother hypothesis

There is a fascinating scientific debate about why menopause exists at all. Very few species live for decades after reproduction ends. Humans are one, and some toothed whales, such as killer whales, are among the others (Croft et al., 2015). The grandmother hypothesis suggests that older women helped their families thrive by supporting their grandchildren, which may have shaped our long lives beyond reproduction (Hawkes et al., 1998). The theory is still debated, but it suggests this stage of life may be valuable in its own right.

How to talk to your GP about menopause symptoms

Track your symptoms and periods for a few weeks before an appointment, and note how they affect your sleep, work and relationships. Ask your GP directly about your options. These include hormone replacement therapy (HRT), non-hormonal treatments, and cognitive behavioural therapy, which NICE recommends for some menopause symptoms (NICE, 2024). If you do not feel heard, it is reasonable to ask for a second opinion.

How to support someone going through menopause

Learn the basics so she does not have to explain everything. Ask how she is, then listen rather than rushing to fix things. Be patient with changes in mood or energy. Offer practical help, whether that is sharing the load at home or making reasonable adjustments at work.

Taking control of your health through menopause

Menopause is a natural transition, not an ending. With good information and the right support, women can move through this stage with confidence, especially when they pay attention to sleep, nutrition, movement and stress. Many find it brings new clarity and freedom.

References:

Avis, N. E., Crawford, S. L., Greendale, G., et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539. 

Ayers, B., Forshaw, M., & Hunter, M. S. (2010). The impact of attitudes towards the menopause on women’s symptom experience: A systematic review. Maturitas, 65(1), 28-36. 

Croft, D. P., Brent, L. J. N., Franks, D. W., & Cant, M. A. (2015). The evolution of prolonged life after reproduction. Trends in Ecology & Evolution, 30(7), 407-416. 

Hawkes, K., O’Connell, J. F., Blurton Jones, N. G., Alvarez, H., & Charnov, E. L. (1998). Grandmothering, menopause, and the evolution of human life histories. Proceedings of the National Academy of Sciences, 95(3), 1336-1339. 

Hickey, M., LaCroix, A. Z., Doust, J., et al. (2024). An empowerment model for managing menopause. The Lancet, 403(10430), 947-957. 

Hunter, M., & Rendall, M. (2007). Bio-psycho-socio-cultural perspectives on menopause. Best Practice & Research Clinical Obstetrics & Gynaecology, 21(2), 261-274. 

National Institute for Health and Care Excellence. (2024). Menopause: Identification and management (NG23). 

NHS. (n.d.). Menopause. Retrieved 15 October 2026, from 

Rance, N. E., Dacks, P. A., Mittelman-Smith, M. A., Romanovsky, A. A., & Krajewski-Hall, S. J. (2013). Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes. Frontiers in Neuroendocrinology, 34(3), 211-227.