Relaunching menopause: are we really there yet?

When a woman comes to see me for the first time because she is struggling with menopause, I begin in the same place I begin with every client. I listen. I listen to how her symptoms affect her daily life. I listen to how her confidence has changed. I listen to how sleep has disappeared, how anxiety has crept in, how concentration has become difficult and how suddenly she no longer recognises herself.

And every single time, I find myself genuinely taken aback by the depth of the impact. Not because menopause is unusual, but because so many women have been left completely unprepared for it.

The menopause conversation

In recent years, beginning around 2018, there was a noticeable shift in public conversation. The media began discussing menopause as something that needed a relaunch. Women began speaking openly about their experiences, and suddenly thousands of others felt able to admit that they too were struggling. It was as if women and their partners had been peering out from behind a curtain of confusion and finally felt permitted to talk about what was happening to them. 

For the first time, many women realised they were not alone.

Menopause is a completely natural phase of life. Yet saying something is natural does not mean it should be endured without knowledge or support. Giving birth is natural. Dying is natural. But we still want education, information, care and dignity around those experiences.

So here we are, many years on, and in some cases, women still report feeling dismissed or misunderstood when seeking support for menopause. Research from the Fawcett Society highlights that many women experience delays in diagnosis and gaps in the information and support they receive. Some are told their symptoms are simply stress or depression, while others receive unclear or inconsistent advice about treatment options. Even now, there is a surprising amount of misinformation circulating.

Perhaps most concerning of all is that many women still feel embarrassed to talk about menopause and the impact it is having on their physical and mental health. That is not the successful rebrand we hoped for.

Menopause as the mirror of puberty

I often ask women to think about menopause as the mirror image of puberty.

When we were around twelve years old our bodies began changing. Hormones shifted. Our bodies developed. Weight distribution altered. Skin and hair changed. Our moods became unpredictable. We felt emotional, irritable, tired or overwhelmed without really understanding why.

What made that stage of life manageable was the fact that many other girls were going through the same thing and we talked about it. The experiences were not identical, but there was a shared understanding that something significant was happening.

Menopause is similar but in reverse.

Instead of beginning around the age of twelve, it often begins in our late thirties or early forties with perimenopause. The difference is that this stage arrives when we are often juggling the busiest years of our lives. Careers, children, ageing parents, relationships and responsibilities all compete for attention.

We rarely pause to analyse what we are feeling, because we simply do not have the time.

On top of this, many women are unaware that menopause can involve cognitive changes as well as physical symptoms. Memory lapses, difficulty concentrating and increased anxiety can all occur alongside hormonal fluctuations.

Without understanding the biological changes taking place, many women assume something is wrong with them personally.

A brief overview of menopause

Menopause is defined as the point at which a woman has not had a menstrual period for twelve consecutive months. The years leading up to this stage are known as perimenopause, when hormonal levels fluctuate significantly.

Common symptoms include:

• hot flushes and night sweats
• sleep disturbance
• mood changes and anxiety
• brain fog and difficulty concentrating
• fatigue
• joint pain
• changes in skin and hair
• irregular menstrual cycles

Not every woman experiences all of these symptoms, and the severity varies widely.

The psychological impact of menopause

While physical symptoms are widely discussed, the psychological impact often receives far less attention. Many women describe a sense of losing their emotional stability. 

They may feel anxious for no clear reason. Confidence can drop. Decision-making becomes harder. Small stresses suddenly feel overwhelming.

Sleep plays a significant role in this. When a woman has spent several nights waking repeatedly due to night sweats or hormonal shifts, her nervous system becomes exhausted. Poor sleep affects mood regulation, concentration and resilience. The brain becomes less able to process stress effectively, which can intensify feelings of anxiety or irritability.

Another important factor involves the interaction between hormones and stress chemicals. Oestrogen helps regulate many systems in the body, including temperature control and mood stability. During perimenopause, oestrogen levels fluctuate dramatically. At the same time, the body is producing stress hormones, such as cortisol and adrenaline, in response to daily pressures.

All of these chemical messengers are interacting within the same systems in the brain and body. When stress levels rise, the nervous system becomes more reactive. This heightened state can trigger or intensify hot flushes. Many women notice that stressful meetings, rushing around or emotional tension can make hot flushes appear suddenly or feel more intense.

This means that managing stress not only benefits mental well-being, but it can also help reduce the frequency or severity of hot flushes.

Supporting sleep and managing anxiety

Improving sleep can make a significant difference during menopause. Small adjustments can support the body’s natural rhythms.

Good sleep hygiene may include:

• keeping consistent sleep and waking times
• reducing screen use before bed
• creating a cool, comfortable sleeping environment
• limiting caffeine later in the day
• practising calming routines such as breathing exercises or gentle stretching before bed

Managing anxiety also becomes an important part of supporting overall well-being. Techniques that many women find helpful include mindfulness, grounding exercises, journaling, gentle movement such as walking or yoga and learning how to regulate the nervous system through slow breathing.

Therapeutic support can also provide a safe space to explore the emotional impact of menopause and rebuild confidence during a period of change.

Moving forward with understanding

Menopause does not need to be something women endure in silence. The more we normalise menopause, the less isolating it becomes. And perhaps then the relaunch we spoke about several years ago.