Menopause

Also called Perimenopause, The change

Not an illness. A hormonal transition that affects far more than periods, and that workplaces have only just started to notice.

What it is

Every woman who lives long enough goes through the menopause, and it has been strikingly badly served by medicine and by employers.

Menopause is technically one day: twelve months after the last period. The perimenopause, the years of fluctuating hormones leading up to it, is what most people actually mean, and it can last four to ten years.

Oestrogen receptors are all over the body, including the brain, bones, bladder and blood vessels. That is why the symptoms range so widely, and why brain fog and anxiety are as much a part of it as hot flushes.

Early menopause, before 45, and premature ovarian insufficiency, before 40, are different situations needing hormone replacement for bone and heart protection, not just symptom relief.

Signs you might notice

Periods changing: heavier, lighter, closer together, further apart.

Hot flushes and night sweats. Sleep disrupted, often the most disabling symptom.

Mood changes, anxiety, irritability, and low mood that is frequently treated as depression alone.

Brain fog: word-finding, concentration, memory. This is real, physiological, and terrifies people who think it is early dementia.

Joint aches. Vaginal dryness and urinary symptoms, which do not improve on their own and are rarely raised.

Palpitations, headaches, changes in libido.

How it can affect day-to-day life

The workplace cost is measurable. Surveys consistently find that a substantial share of women have considered leaving work because of menopause symptoms, and women in their late forties and fifties are the fastest-growing group of workers.

The medical failure has been the systematic misattribution: women prescribed antidepressants for symptoms that were hormonal, and told brain fog was stress.

Bone loss accelerates sharply after menopause, which is why osteoporosis risk assessment belongs in this conversation.

Supporting someone well

Keep a symptom diary before the appointment. Specific patterns get taken more seriously than a general description.

Understand the HRT position properly. NICE guidance is clear that for most women under 60 the benefits outweigh the risks, and the 2002 study that frightened a generation has been substantially reinterpreted.

Ask about vaginal oestrogen specifically. It is separate from systemic HRT, carries a very different risk profile, and treats symptoms that otherwise persist for the rest of life.

Protect sleep, strength and bone: resistance exercise, protein, vitamin D.

At work, make adjustments ordinary: temperature control, uniform flexibility, breaks, and not scheduling everything critical for the morning after a bad night.

For a woman with a learning disability, menopause is very often missed entirely, and behaviour change gets attributed to the disability. Ask the question.

Where to get help

A GP should be the first stop. If you are offered antidepressants for low mood in perimenopause without a conversation about HRT, NICE guidance says that is not the right first step.

The British Menopause Society hold a list of specialists, and Menopause Matters and the Daisy Network, for premature ovarian insufficiency, are both reliable.

Bleeding after the menopause always needs urgent investigation.