The menopause: what it is, what it’s like, and when it happens

Menopause

May 20

Last updated 20 May 2025

First off, some menopause context…

Menopause can affect anyone with ovaries, not just women who are cisgender (their gender matches the sex they were assigned at birth). This means some trans men, as well as non-binary and gender non-conforming folk may experience it. However, their menopausal journal – physically and emotionally – might be entirely different from that of a cis woman. They may describe what they’re going through differently too, in a way that fits their gender identity and hormonal journey.

This post focuses on how menopause shows up for cisgender women. If this isn’t you, visit queermenopause.com, a great resource for LGBTQIA+ folk.

Are you in a relationship with a menopausal partner – or likely to be?

Chances are you’ll feel the impact of menopause too. And often in the way that a hand grenade can have an impact.

If you value your sex life, intimacy, connection, and your relationship itself, keep reading.

What is the menopause?

The menopause is literally a moment in time.

Basically, if a woman goes for a full 12 months without having a period, she’s “reached the menopause”. The run-up to that moment is known as the perimenopause. Once that 12-month milestone has been reached, we’re in post-menopause territory.

The perimenopause usually starts in a woman’s 40s, but timelines can vary.

Perimenopause starts between 45 and 55 years.
Early menopause happens from 40 to 45.
Premature Ovarian Insufficiency (POI) starts in women under 40. The Daisy Network, a charity for women with POI, has lots of information about that. Premature menopause can be caused by certain genetic diseases as well as medical procedures including IVF, a hysterectomy or chemo.

What happens during menopause?

Two hormones make up a big part of the menopause conversation: oestrogen and progesterone. (There’s testosterone too, but more about that in another blog post!)

From puberty to the perimenopause, levels of both oestrogen and progesterone are pretty consistent, going up and down with the menstrual cycle (periods). Once perimenopause starts, levels of both hormones can swing wildly. Then as menopause approaches, they drop. During this time, periods might become irregular, get lighter or heavier, or disappear altogether, only to start again after a few months.

Stress, an unhealthy diet, smoking and a lack of exercise can also speed up this hormonal drop.

The whole journey, from the start of the perimenopause to the end of that period-free year, takes an average of five years – but it can last up to 15.

Important: Pregnancy is still possible during the perimenopause, even if periods become erratic.

What about post menopause?

Once women have reached the menopause, their body starts calming down and women often find a more grounded and settled version of themselves, although symptoms don’t disappear overnight.

There’s also an increased risk of certain conditions after menopause, include osteoporosis and dementia.

What are the symptoms of menopause?

Oestrogen plays a HUGE role in making a woman feel happy and healthy. There are oestrogen receptors in every part of the body. This is why, when levels drop, it can have a big impact in so many different ways.

While some women sail through the menopause without a hair out of place, for others it’s like being pulled through a hedge backwards. Around 75% of women experience menopause symptoms.

And depending on what the body does, symptoms can ripple out into your relationships, your sex life, professional and social life too.

Hot flushes get all the attention but there are other symptoms too. Lots of them.

Some symptoms are more common during the earlier stages of perimenopause; others crop up later in the journey. They fall roughly into four categories:

Emotional
Physical
Neurological
Sexual

Emotional symptoms

These are many and varied. From depression to plummeting confidence, menopause can wreak havoc. Throw in confusion, hypersensitivity, anxiety, overwhelm, a lack of motivation, and a general, non-specific rage or grief and you’ve got the stuff that hormonal horror movies are made of.

Mock it at your peril. This can feel like an emotional invasion of the body snatchers and often comes with a sense of having no control or being out of control. It’s horrible and many women feel disconnected from the person they used to be.

If there’s a history of mental health problems, they may well resurface or intensify too.

Menopause also means no more kids. It takes away your choice to have children in a very final way. For some women, this isn’t a problem. For others, it’s a loss or a reason to grieve deeply, even if they already have children and are happy with their lives.

And then of course we live in a world that favours youth and sex appeal, particularly in the form of beautiful (and highly photoshopped or filtered) young women. They’re everywhere: in magazines, on TV and on social media. In this context, dwindling fertility and an aging body are massive sucker-punches to the self-esteem and sense of self-worth. Women talk of feeling invisible as they age. Anecdotally, there’s plenty to support this.

External factors can also contribute to the emotional turmoil. For example, many women of a menopausal age often have teenage (aka hormonal) children AND aging parents to worry about too.

Neurological symptoms

Decreasing oestrogen levels also have a big impact on the brain. This leads to:

Brain fog – like wading through treacle, but in the mind
Cognitive drift (aka forgetting what you were going to say in the middle of a…)
Depression
Difficulty concentrating
Dizzy spells
Headaches and migraines
Less ability to deal with stress leading to overwhelm
Memory issues
Mood swings
Panic attacks
Trouble multi-tasking

Physical symptoms

This isn’t the full smorgasbord, but it’s some of the most common physical menopause symptoms.

Aching joints / joint pain
Allergies – hayfever, asthma and prickly heat rash can get worse around this time, or new allergies may develop.
Bladder issues such as urge incontinence (a sudden, urgent need to go to the loo) and stress incontinence. This is because the muscles of the pelvic floor, which support the bladder, get weaker. It can lead to embarrassing leaks when you sneeze, cough or laugh. Which tends to make things less funny.

Breast tenderness
Brittle nails
Changes in body odour
Digestive issues – IBS, bloating, acid reflux, constipation, and nausea.
Fatigue

· Gum soreness and/or burning mouth – complete with ulcers on rare occasions.

Hair loss or thinning
Heavy periods – aka flooding, which speaks for itself.
Hot flushes – more than feeling ‘a bit warm’ this can involve being drenched in sweat and blushing bright red which isn’t good for the confidence, particular if it happens in a public space. It can also be accompanied by panicky feelings or anxiety. Although listed here under physical symptoms, hot flushes are actually triggered by the brain rather than the body. They can last for up to an hour.
Insomnia – and the resulting tiredness
Irregular heartbeat and palpitations
Itchy or dry skin
Night sweats – and waking up with the bed quite literally soaking.
Skin breakouts
Sleep disturbances and deprivation
Tinnitus
Weight gain

Take a quiet moment to reflect on that lot…

Sexual symptoms

I want to start this section with a Public Service Announcement…

The vagina is the *inside part* of a cis woman’s genitalia – a muscular internal canal. All the external parts – including her inner and outer labia (lips) and clitoris – are known as the vulva.

Now I’ve got that off my chest, here’s what you need to know about the impact of the menopause on your sex life…

Libido (sex drive) can go up and down during the perimenopause, but even if there’s a will, the way you go about things might have to change.

Some women experience a loss of sensation as hormones drop, so what used to turn her on doesn’t have the same effect. Different or more powerful stimulation may be needed

Alternatively, there may be an increase in sensation – but of the wrong kind.

Vaginal atrophy (horrid term) now also known as genitourinary syndrome of menopause (GSM) refers to the tissues of the vulva and the lining of the vagina becoming thinner and less elastic, stretchy and flexible. This results in a range of symptoms including:

Less wetness
Redness and itching around the genitals
Pain
A burning sensation inside the vagina
Discharge
Bleeding

Penetrative sex can become very painful due to the irritation and soreness that can happen inside, as well as less natural lubrication – which means more uncomfortable friction. Use lube. The more the better.

Important: Always get pain, unusual bleeding or discharged checked out by your GP or a healthcare specialist.

A drop in oestrogen can also affect the urinary system. This results in:

The need to pee more often or the urgent and sudden need to pee
Incontinence (stress incontinence or urge incontinence)
Having to get up more frequently in the night
Pain while peeing

As the tissue around the vulva and vagina gets thinner, it also makes infections like thrush and cystitis more likely – and if one of those happens, sex won’t be happening at all.

Want to find out more?

Check out the list below. But bear in mind that although it’s being more openly discussed than ever before, menopause is rarely talked about with diversity in mind. Much of the info in the public domain is aimed at cis-gendered women.

Ethnicity, social and cultural factors also have an impact, but there’s not much about how the global majority navigate menopause either. Hopefully that will change over time.

General menopause health/medical information:

Websites and podcasts:

Women’s Health Concern, the public-facing side of the British Menopause Society

The Menopause Charity – an educational site with a number of high-profile ambassadors

Balance Menopause – lots of practical advice from the team working alongside Louise Newson, a physician, menopause specialist and member of the UK Government’s Menopause Taskforce.

Menopause Whilst Black podcast - placing the experiences of primarily black, UK-based women front and centre.

queermenopause.com – created by therapist Tania Glyde specifically for LGBTQIA+ folk

NICE guidelines on menopause - for women, trans men, and non-binary people registered female at birth with menopause-associated symptoms, their families or carers, and the public.

Daisy Network – a charity for women experiencing early menopause

The Royal Osteoporosis Society – for info and support

Yes – the organic intimacy company

Menopause in the Workplace

Online talks and articles:

How menopause affects the brain

What really happens to your body during menopause

There will be blood

Menopause is something that almost all women go through — so why the silence?

My Queer Menopause – “Becoming knowledgeable and powerful and furious” (on LinkedIn)

Menopause around the world – from Mindset Health

Me and my menopause – from The Guardian