Understanding menopause: what to expect and how to manage symptoms

Each year, around 1.5 million women in the UK go through the menopause transition. And yet, despite how common it is, many still feel unprepared for the physical and emotional changes it brings.¹ From hot flushes to mood swings, sleep disturbances to vaginal dryness, menopause can affect every part of your wellbeing.

But while the symptoms can be challenging, they’re not something you just have to put up with. With some guidance, many are manageable, and knowing what to expect is the first step.

The core four menopause symptoms

Although menopause affects every woman differently, there are four symptoms that crop up time and time again: vasomotor symptoms (like hot flushes), vaginal dryness, insomnia, and mood changes. Many women also report fatigue, joint pain, brain fog, or low libido, but the following four are the most closely linked to hormonal changes.¹

1. Hot flushes and night sweats

Hot flushes are one of the most recognisable symptoms of menopause. They’re caused by changes in the body’s thermoregulation system, likely due to falling oestrogen levels. Around 85% of women experience them, often beginning before their periods have stopped.¹

Flushes can come on suddenly, raising your body temperature, leaving you flushed or sweaty, and sometimes dizzy or anxious. They may last only a few minutes, but they can occur multiple times a day (and night). On average, they last for about five years, though some women have them for much longer.¹

Thankfully, treatments are available. Hormone replacement therapy (HRT) is considered the gold standard for the treatment of hot flushes, but there are non-hormonal options too.

2. Vaginal dryness and discomfort

After menopause, the body produces far less oestrogen, which can affect vaginal and urinary tissues. This can lead to dryness, itching, discomfort during sex (dyspareunia), and even urinary urgency or infections.¹

These symptoms often worsen over time if left untreated, but there are effective options available. Vaginal oestrogen (in creams, pessaries, or rings) is a low-dose, local treatment that’s very effective for dryness and generally safe for long-term use. Non-hormonal moisturisers and lubricants can also help, especially for women who can’t or prefer not to use hormone-based treatments.¹

3. Trouble sleeping

Many women find their sleep deteriorates during the menopause transition. Night sweats, anxiety, and mood changes can all contribute to disrupted sleep, and the knock-on effects of poor rest can be felt during the day too, with fatigue and difficulty concentrating.¹

Sleep problems can be frustrating, but they’re not uncommon. Lifestyle tweaks (like avoiding screens before bed, limiting caffeine, or keeping your bedroom cool) can make a big difference. For women with severe symptoms, HRT or other medications might help, particularly if hot flushes are the main culprit.¹

4. Mood changes 

While not every woman experiences depression during menopause, many report mood swings, anxiety, irritability, or even panic attacks. The link between hormones and mood is well established, and midlife can bring additional stress, whether from work, relationships, or caregiving roles.¹

If you’re struggling emotionally, know that it’s not “just in your head” and instead it’s valid, common, and treatable. Antidepressants, therapy, lifestyle changes, and HRT are all methods of treatment. The most important step is to speak to your GP or a healthcare provider and not to suffer in silence.¹

The other menopause symptoms

The menopause journey doesn’t stop with the core four. Many women report:¹

• Brain fog and forgetfulness

• Joint and muscle aches

• Weight gain and changes in body shape

• Fatigue and low energy

• Changes in sexual desire

Some of these symptoms may be more closely linked to ageing or lifestyle than to menopause directly, but they can still have a real impact on quality of life.

Treatment is more than just HRT

Hormone replacement therapy is often the first treatment that comes to mind, because it’s one of the most effective options for hot flushes, sleep problems, vaginal dryness, and even mood issues in some women. HRT typically includes oestrogen and, for women with a uterus, progestogen to protect the womb lining.

But HRT isn’t suitable for everyone. There are alternatives, such as:²

• Cognitive behavioural therapy (CBT) is helpful for managing anxiety, sleep issues, and mood swings.

• Lifestyle interventions such as regular exercise, a balanced diet, limiting alcohol, stopping smoking, and stress management.

• Complementary therapies including mindfulness and certain herbal remedies (though these aren’t always backed by strong evidence).

• Non-hormonal medications such as antidepressants for symptoms of depression and low mood.

The numan take

You don’t need to wait until your symptoms are severe to speak to a healthcare provider. If menopause is affecting your life, whether that’s physically, emotionally, or socially, help is available. It’s never too early (or too late) to start the conversation. With better awareness, open conversations, and access to treatment, more women are finding ways to manage their symptoms.

References

1. ^{Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinology and metabolism clinics of North America. 2015;44(3): 497–515.} 

2. ^{Al Wattar BH, Talaulikar V. Non-oestrogen-based and complementary therapies for menopause. Best practice & research. Clinical endocrinology & metabolism. 2024;38(1): 101819.}