Women's health

UNDERSTANDING MENOPAUSE

It’s one of the biggest biological changes every single woman will ever go through, yet it remains one of the least openly discussed. Menopause, often tiptoed around in conversation or dismissed as “just hot flushes”, is a complex, life-altering transition that affects every woman differently. At Numan, we’re changing this narrative.

THE BIG CHANGE

Despite being inevitable, menopause is still widely misunderstood and shrouded in stigma, with most people actually referring to the perimenopause as the ‘menopause’.¹ For many, the symptoms can be confusing, or even frightening. And for others, the silence around it leaves them feeling unprepared and unsupported. But menopause isn’t just about periods stopping. It touches every part of the body, from the brain and bones to the heart and skin, and its effects can last decades. With women spending up to 40% of their lives in the postmenopausal stage, understanding this transition becomes an act of empowerment.²

What is menopause?

Menopause marks the end of a woman’s reproductive years. It’s officially diagnosed after 12 consecutive months without a period, signalling that the ovaries have stopped releasing eggs and producing the hormone oestrogen at previous levels.² For most women, this natural transition happens between the ages of 45 and 55, with the average age in the UK being around 51.²

Menopause is more than just the end of periods; it’s a significant biological shift. However, this change doesn’t happen overnight. Many women experience symptoms for years before and after their final period. The lead-up to menopause, known as perimenopause, can begin in your 40s (or even earlier for some) and brings its own rollercoaster of hormonal fluctuations.² After menopause, you enter the postmenopausal phase, which continues for the rest of your life.

Menopause through your lifetime

While many people think of it as a single event, menopause actually unfolds in stages over several years, manifesting as one or more of over 34 symptoms. Understanding what happens at each phase can help you spot the signs and prepare for what’s to come.

Premenopause (usually up to the late 30s/early 40s)

Premenopause refers to the years between puberty and the first signs of menopausal change. During this time, reproductive hormones like oestrogen and progesterone fluctuate in a regular cycle, allowing for ovulation and menstruation.² Most people in this stage can conceive naturally and experience symptoms like PMS (premenstrual syndrome), including cramps, mood swings, breast tenderness, and fatigue.²

This stage is considered hormonally ‘normal’, but some may experience irregular periods, fertility difficulties, or medical conditions that bring on early menopause. For most, though, hormonal changes only begin to shift in the next stage.

Perimenopause (usually late 30s to mid-40s or early 50s)

Perimenopause is the transition period before menopause. It can last anywhere from a few months to over a decade.³ During this time, the ovaries begin producing less oestrogen, progesterone, and testosterone, resulting in noticeable shifts in the menstrual cycle. Periods may become irregular, lighter or heavier, or occur closer together. You may also experience symptoms typical of menopause.²

Despite these changes, it’s still possible to conceive naturally during perimenopause, so contraception is recommended until you’ve gone at least 12 months without a period (or two years if under 50).³

Menopause (usually around the early 50’s)

Menopause is diagnosed when you haven’t had a period for 12 consecutive months. At this point, the ovaries have significantly reduced hormone production and can no longer release eggs, meaning natural pregnancy is no longer possible.² The physical and emotional symptoms that began in perimenopause often continue into this stage.

Some people experience a reduction in symptoms, while for others, issues like mood changes and pain during sex persist.² For many, this stage marks the beginning of thinking seriously about long-term health, including bone density, heart health, and cognitive wellbeing, as well as a loss of libido and pain during sex.

Postmenopause (from 12+ months after final period)

Postmenopause is the stage that follows the official end of menopause, and it lasts for the rest of life. Hormone levels stabilise at their new, lower baseline, but the long-term effects of oestrogen deficiency begin to show.⁴ These include a higher risk of osteoporosis, cardiovascular disease, and urinary tract issues.

For some women, hot flushes and sleep disturbances fade after menopause, while for others, they persist for years. Symptom duration varies, highlighting the need for personalised management and health monitoring.

Why does menopause happen?

Menopause is a natural biological process, but that doesn’t mean it’s not complex and gradual. You don’t just wake up one day in menopause. At its core, menopause occurs because the ovaries, which are the organs responsible for producing eggs and key reproductive hormones like oestrogen, progesterone, and testosterone, run out of viable eggs.

But there’s more to it.

Everyone is born with a limited number of ovarian follicles (the tiny sacs that contain eggs). As you age, these follicles are gradually depleted. By the time menopause approaches, this supply is nearly gone.^2,5 In response, your hormone levels begin to fluctuate. In particular, follicle-stimulating hormone (FSH), rises in an attempt to stimulate the ovaries, but the ovaries start to become less responsive.²

As oestrogen levels drop, the brain’s capacity to regulate hormones, especially in the hypothalamus (the body’s thermostat and hormone control centre), starts to diminish.⁶

Eventually, when 12 consecutive months have passed without a period, the menopause is officially reached. From this point onwards, the ovaries no longer release eggs, hormone levels remain low, and natural pregnancy is no longer possible.

Hormones

At the heart of menopause is the shift in hormones, especially oestrogen and progesterone, which play a central role in regulating everything from your menstrual cycle to mood, metabolism, and temperature control. As the ovaries gradually stop producing these hormones, the body responds in a variety of ways, leading to the wide range of symptoms women experience during the menopause transition.

Oestrogen

Oestrogen is one of the main hormones that helps your body function at its best. It supports your periods, keeps your bones strong, helps protect your heart, and plays a big role in things like sleep, mood, memory, and sex drive.⁷

As you approach menopause, your oestrogen levels start to drop. Pain during sex, changes in libido, and an increased frequency in sleepless nights are some of the most commonly reported symptoms. Tissues throughout the body, including the brain, skin, bones, vagina, bladder, and blood vessels, all have oestrogen receptors and are affected when levels drop.^6,7

Oestrogen also influences neurotransmitters in the brain, such as serotonin, which can affect mood and sleep. In the urogenital tract, a reduction in oestrogen can lead to vaginal dryness, irritation, discomfort during sex, and urinary symptoms. And over the long term, low oestrogen can increase the risk of osteoporosis and heart disease.^6,7

Progesterone

Progesterone is a natural hormone that plays a vital role in the menstrual cycle, fertility, and pregnancy. After ovulation, the body produces progesterone to prepare the uterus for a possible pregnancy.⁸ It thickens the lining of the womb (the endometrium) to make it easier for a fertilised egg to implant. If pregnancy doesn’t occur, progesterone levels drop, triggering a period. If pregnancy does occur, progesterone continues to be produced, first by the ovaries and then by the placenta, to support the pregnancy and prevent the uterus from contracting too early.⁸

Progesterone also plays a part in other systems. It supports brain health and may have a calming effect on mood. It contributes to bone strength and helps regulate the immune system during pregnancy. It even plays a role in lung function and nerve repair.⁸

As menopause approaches, progesterone levels naturally decline.² This hormonal shift can lead to symptoms like irregular periods, mood swings, sleep problems, and heavier bleeding. Low progesterone can also leave the uterine lining unprotected against oestrogen, increasing the risk of endometrial thickening or, in rare cases, cancer.^2,8

Testosterone

Although often seen as a male hormone, testosterone is also produced in women and plays a key role in sexual function, mood, and bone health.⁹ Levels naturally decline with age, especially after menopause, and more so in cases of early or surgical menopause. Testosterone replacement isn’t recommended just because levels are low. Instead, it may be considered for women with a persistent lack of sexual desire that causes distress, after other potential causes have been ruled out.⁹

Symptoms of menopause

As menopause is driven by hormonal changes, especially a drop in oestrogen levels, it can affect nearly every part of the body. The symptoms of menopause are therefore wide-ranging and often overlap, but they are generally grouped into three key categories: vasomotor, psychological, and physical.⁹

Vasomotor

Vasomotor symptoms are among the most well-known signs of menopause. They’re caused by fluctuations in the body’s internal thermostat due to hormonal shifts, particularly falling oestrogen.9 These symptoms can significantly impact quality of life, especially sleep and overall comfort.

Common vasomotor symptoms include:

Physical symptoms

Menopause can bring about a range of physical changes due to the drop in oestrogen and other hormonal shifts. These symptoms often appear gradually and may affect multiple body systems, from skin and hair to joints and digestion.

Common physical symptoms:⁹

Psychological symptoms

Hormonal changes can also affect brain chemistry and emotional regulation. As a result, many women experience psychological symptoms during the menopause transition. These can vary in severity and may appear even in those with no prior history of mental health issues.

Common psychological symptoms:⁹

Diagnosing menopause

Diagnosing menopause at all stages can be notoriously difficult and complex; often due to the stigma surrounding it. Women with menopause struggle to be seen and heard, even by healthcare professionals.

Menopause is defined clinically as 12 consecutive months without a period due to the natural decline of ovarian function.² This “final menstrual period” is typically confirmed in hindsight, and symptoms often intensify during the first one to two years after this point. While most women begin the transition in their late 40s and reach menopause around age 50, the timeline and symptom burden can vary significantly.

For women with regular cycles, early signs of the menopausal transition include changes in period frequency or duration. A cycle that suddenly becomes irregular by seven days or more often marks the early transition, while a gap of 60 days or more between periods typically signals the late transition, during which menopause is likely within the next four years.¹⁰

However, for women with conditions like fibroids, prior hysterectomy, long-standing irregular cycles, or those using hormonal contraception, diagnosing menopause based solely on bleeding patterns may not be possible. In these cases, biomarker testing can help.¹¹

Blood tests

Follicle-stimulating hormone (FSH)

Levels rise as ovarian reserve declines, but FSH fluctuates widely through the menstrual cycle, so it must be measured at specific times for reliable interpretation. It’s less useful when cycles are absent or irregular.¹²

Anti-Müllerian hormone (AMH)

Produced by early-stage ovarian follicles, AMH offers a more stable and direct estimate of ovarian reserve. Low or undetectable AMH levels suggest menopause is near or already complete. AMH can be especially helpful for women with unclear menstrual patterns or those making decisions about contraception, surgery, or hormone therapy.¹³

Hormones

You can check your hormone levels with a simple blood test. This test looks at key hormones like oestrogen, progesterone, testosterone, FSH, and LH (luteinising hormone) to see if you’re approaching or going through menopause. It’s a straightforward way to understand what’s happening with your body and can help guide the right support for managing symptoms.

Heart health

Keeping an eye on your heart health during menopause is important due to your possible increased risk of heart disease(s). A blood test can be used to measure your cholesterol levels, triglycerides, and markers of inflammation, all of which give insight into your heart health. It can also check your blood sugar levels to catch any signs of diabetes early.

Treating menopause

Managing menopause isn't about easing symptoms, but more about improving quality of life, protecting long-term health, and giving women the tools they need to navigate this transition confidently. Whether your symptoms are mild or disruptive, there are a range of treatment options available, from hormone therapy to lifestyle support, that can be tailored to your personal needs and health history.

Hormone therapy

Hormone therapy is the most effective treatment for managing common menopausal symptoms such as hot flushes, night sweats, mood swings, vaginal dryness, and disrupted sleep. By replacing the oestrogen your body stops producing during menopause, hormone therapy can offer rapid relief from vasomotor symptoms, improve sleep and mood, boost libido, and help protect against bone loss and osteoporosis.¹⁴ It’s especially beneficial for women under 60 or within 10 years of their last menstrual period, provided they have no history of breast cancer, stroke, or blood clots.¹⁴

Hormone therapy is available in several forms, including pills, patches, gels, sprays, and vaginal treatments.¹⁴ If you still have a uterus, it’s important to take a progestin alongside oestrogen to reduce the risk of endometrial cancer. While hormone therapy is generally safe for most women, there are some risks to be aware of, particularly a small increase in breast cancer risk with long-term use of combined hormone therapy, and a slightly higher risk of blood clots or stroke with oral forms. Transdermal options, such as patches or gels, tend to carry a lower risk and are often the preferred route.¹⁴

Local treatment

For those who can’t, or prefer not to take hormones, there are several non-hormonal options that can treat various symptoms of menopause. These range from antidepressants to blood pressure medications, each of which would be prescribed by a specialist practitioner depending on your symptoms.

Women experiencing genitourinary symptoms of menopause, such as vaginal dryness, discomfort during sex, or recurrent urinary tract infections, local treatments can be used to target symptoms directly.¹⁵ Low-dose vaginal oestrogen, available as creams, tablets, or rings, helps restore moisture and elasticity in the vaginal tissue and is considered safe for many women, even those who can’t take systemic oestrogen.^14,15 Other hormone-based gels and creams are also available depending on your symptoms and medicine availability.

Lifestyle and behaviour therapy

Lifestyle plays a big role in managing menopause symptoms and improving your long-term health. Small changes can make a big difference.¹⁶

Sleep and exercise: Regular movement improves sleep, mood, and bone strength. Weight-bearing exercises like walking or yoga are especially helpful. Regular sleep also helps alleviate fatigue and can improve overall health.
Nutrition: A diet rich in calcium, vitamin D, healthy fats, and fibre supports heart, bone, and gut health. Avoiding alcohol, caffeine, and spicy food may reduce hot flushes.
Weight management: Menopause can make it harder to lose weight, but even small changes can help. Keeping a food and symptom diary may reveal helpful patterns.
Smoking cessation: Smoking worsens hot flushes and increases risk of osteoporosis, cancer, and heart disease. Quitting brings significant health benefits.

Psychological treatment

Menopause can have a significant impact on mental wellbeing, self-confidence, and personal relationships, but supportive therapies can offer meaningful relief and guidance through this transition. Cognitive Behavioural Therapy (CBT) is a well-researched approach proven to help with insomnia, mood swings, and anxiety related to menopause.¹⁷ Practices like mindfulness and meditation can also reduce stress, enhance emotional regulation, and improve sleep quality.

For women facing reduced libido or intimacy concerns, sex therapy can be particularly effective, especially when used alongside medical treatments, to rebuild connection and confidence.¹⁷

Bladder and pelvic treatment

Bladder issues, a feeling of pelvic heaviness, or vaginal changes during menopause can often be improved with targeted pelvic health support. Pelvic floor physiotherapy helps strengthen the muscles that support the bladder, bowel, and uterus, making it an effective option for managing symptoms like incontinence or prolapse.¹⁸

Pessaries, which are small devices inserted into the vagina, can also provide structural support for prolapsed organs. In addition, bladder training techniques, often combined with lifestyle adjustments and local oestrogen treatments, can help reduce urinary urgency and frequency, restoring comfort.¹⁹

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Free, discreet delivery

No names, no logos, no delivery fee.

Ongoing clinical support

Access expert clinicians and medical advice.

Pause or cancel any time

You're always in control of your treatment.

Innovative treatments

Advanced, clinically-proven medications.

Rated excellent on Trustpilot

4.6* from over 18,000 people like you.

Trusted

Regulated by the Care Quality Commission.

UK licensed

Medications and clinicians.

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Specialists in weight loss, nutrition, and behavioural science.

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Head of Medical

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I’m currently experiencing menopause, which has caused me to gain significant weight. I tried dieting and other medications with little or no effect.I can honestly say it’s the best thing I’ve ever done. I can see my weight steadily decreasing and my energy levels increasing. I’ve been so impressed with Numan’s service.

Johanna, 52

I went through menopause and gained a lot of weight during lockdown because of bad habits and hormonal changes. I walk whenever I can now. If there's an option between stairs and an escalator, I take the stairs. It's amazing because I'm 56 and I pass by 30-year-olds who go for the escalator. I’ve gone from focusing on what I can’t do, which was an ever-increasing list, to focusing on what I can do.

Philippa, 56

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KNOWLEDGE

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References

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Peacock K, Carlson K, Ketvertis KM. Menopause. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Santoro N. Perimenopause: From research to practice. Journal of women’s health (2002). 2016;25(4): 332–339.
Koothirezhi R, Ranganathan S. Postmenopausal syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Gosden R, Lee B. Portrait of an oocyte: our obscure origin. The journal of clinical investigation. 2010;120(4): 973–983.
McEwen BS, Akama KT, Spencer-Segal JL, Milner TA, Waters EM. Estrogen effects on the brain: actions beyond the hypothalamus via novel mechanisms. Behavioral neuroscience. 2012;126(1): 4–16.
Delgado BJ, Lopez-Ojeda W. Estrogen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Davis SR. Not just sex: other roles for testosterone in women. Climacteric: the journal of the International Menopause Society. 2025; 1–4.
Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: Signs, symptoms, and management options. The journal of clinical endocrinology and metabolism. 2021;106(1): 1–15.
Harlow SD, Paramsothy P. Menstruation and the menopausal transition. Obstetrics and gynecology clinics of North America. 2011;38(3): 595–607.
Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, et al. Abnormal uterine bleeding in perimenopausal women: The role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics (Basel, Switzerland). 2022;12(5): 1176.
Diagnosis of menopause and perimenopause. NICE. https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-menopause-perimenopause/ [Accessed 1st May 2025].
Moolhuijsen LME, Visser JA. Anti-müllerian hormone and ovarian reserve: Update on assessing ovarian function. The journal of clinical endocrinology and metabolism. 2020;105(11): 3361–3373.
Flores VA, Pal L, Manson JE. Hormone therapy in menopause: Concepts, controversies, and approach to treatment. Endocrine reviews. 2021;42(6): 720–752.
Carlson K, Nguyen H. Genitourinary syndrome of menopause. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, et al. The importance of nutrition in menopause and perimenopause-A review. Nutrients. 2023;16(1).
Hunter MS, Chilcot J. Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms? British journal of health psychology. 2021;26(3): 697–708.
Marcellou EG, Stasi S, Giannopapas V, Bø K, Bakalidou D, Konstadoulakis M, et al. Effect of pelvic floor muscle training on urinary incontinence symptoms in postmenopausal women: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology. 2025;304: 134–140.
Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane database of systematic reviews. 2013;(2): CD004010.

Women's health

UNDERSTANDING MENOPAUSE

THE BIG CHANGE

Menopause through your lifetime

Hormones

Symptoms of menopause

Vasomotor

Physical symptoms

Psychological symptoms

Diagnosing menopause

Blood tests

Treating menopause

Your health partner

UK DOCTORS AND CLINICIANS

REAL PEOPLE, REAL IMPACT

KNOWLEDGE

References