Symptoms

Persistent low mood, tearfulness, a shorter fuse and loss of motivation that can feel unlike your usual self — and is easily mistaken for “just stress”.

Why it happens. Oestrogen helps regulate serotonin and dopamine. As levels fall and swing, this mood-stabilising support becomes erratic, directly affecting emotional regulation.

HOW TO FIND RELIEF

• HRT — replacing oestrogen often stabilises mood at the root cause.
• CBT or talking therapy tailored to menopause.
• Regular aerobic exercise, a reliable mood lifter.
• Antidepressants where clinically appropriate.
• Social connection and peer support groups.
• Protecting sleep and reducing stress (mindfulness).

Difficulty concentrating, losing your train of thought, word-finding trouble and forgetfulness that can feel alarming but is rarely a sign of anything more serious.

Why it happens. Oestrogen supports memory and processing in the brain. As it declines — and sleep and mood suffer — cognitive sharpness can dip. For most women it improves with time.

HOW TO FIND RELIEF

• HRT may improve clarity for some women.
• Prioritising quality sleep.
• Aerobic and resistance exercise.
• A Mediterranean-style diet rich in omega-3.
• Staying mentally engaged — learning, puzzles.
• Managing stress and treating poor sleep or low mood.

What it is. New or heightened worry, a racing mind, physical tension and sometimes panic — often appearing for the first time during perimenopause.

Why it happens. Falling oestrogen alters the stress response and lowers calming neurotransmitter activity, while disrupted sleep and hot flushes amplify the sense of unease.

HOW TO FIND RELIEF

• HRT to address the hormonal driver.
• CBT, proven for menopausal anxiety.
• Daily breathing or mindfulness practice.
• Cutting back caffeine and alcohol.
• Regular movement to discharge tension.
• SSRIs if symptoms are persistent or severe.

Trouble falling asleep, frequent waking (often drenched at 3am), and unrefreshing sleep that drains energy, mood and concentration the next day.

Why it happens. Lower progesterone removes a natural sedative effect, while night sweats and anxiety fragment sleep. The result is a self-reinforcing cycle of exhaustion.

HOW TO FIND RELIEF

• HRT, especially where night sweats wake you.
• CBT for insomnia (CBT-I) — the gold standard.
• A consistent schedule and cool, dark bedroom.
• Limiting screens, caffeine and alcohol late in the day.
• Daytime physical activity.
• Short-term sleep aids only under medical guidance.

Weight that creeps on — especially around the middle — despite no change in diet or activity, along with a slower metabolism and loss of muscle tone.

Why it happens. Lower oestrogen shifts fat storage toward the abdomen and reduces muscle mass, which lowers the rate at which the body burns energy. These changes are biological, not a failure of willpower.

HOW TO FIND RELIEF

• Strength training to preserve and rebuild muscle.
• A protein-forward, fibre-rich diet.
• Reducing ultra-processed foods and alcohol.
• Prioritising sleep, since poor sleep drives weight gain.
• HRT may help fat distribution (it is not a weight-loss drug).
• Managing stress to limit cortisol-driven storage.

A sudden wave of intense heat through the face, neck and chest, often with flushing, sweating and a pounding heart, lasting seconds to minutes.

Why it happens. Falling oestrogen narrows the brain’s “thermoneutral zone”, so tiny changes in temperature trigger an exaggerated cooling response — dilating blood vessels and sweating.

HOW TO FIND RELIEF

• HRT — the most effective treatment available.
• CBT, which reduces the impact of flushes.
• Identifying and avoiding triggers (alcohol, caffeine, spicy food).
• Light, breathable layers and cooling aids.
• SSRIs/SNRIs or newer non-hormonal options where HRT isn’t suitable.
• Regular exercise and a healthy weight.

Stiff, aching joints — often worse in the morning — together with the silent, symptomless loss of bone density that raises fracture risk later in life.

Why it happens. Oestrogen has anti-inflammatory effects and helps maintain bone. As it falls, joints can become inflamed and painful, and bone is lost faster than it is replaced.

HOW TO FIND RELIEF

• HRT, which eases joint pain and protects bone.
• Weight-bearing and resistance exercise.
• Adequate calcium and vitamin D.
• Maintaining a healthy weight to reduce joint load.
• Stopping smoking and limiting alcohol.
• A bone-density (DEXA) scan if you are at higher risk.

Hot flushes that strike during sleep, leaving you soaked and waking repeatedly — one of the biggest drivers of menopausal exhaustion.

Why it happens. The same disrupted temperature control behind daytime flushes, now interrupting sleep. The wakings compound fatigue, mood and concentration problems.

HOW TO FIND RELIEF

• HRT to calm vasomotor symptoms overnight.
• A cool bedroom and moisture-wicking bedding and nightwear.
• Avoiding alcohol and caffeine before bed.
• A steady wind-down and sleep routine.
• SSRIs/SNRIs or gabapentin where appropriate.
• CBT to ease the knock-on effects on sleep.

Cycles that become shorter or longer, lighter or much heavier, skipping months then returning — usually the first sign of perimenopause.

Why it happens. Ovulation becomes erratic as ovarian function winds down, so oestrogen and progesterone rise and fall unpredictably, changing the timing and flow of bleeds.

HOW TO FIND RELIEF

• Tracking your cycles to spot patterns.
• Seeing a GP to rule out other causes if bleeding is very heavy or prolonged.
• Hormonal options such as the Mirena coil to manage bleeding.
• Iron-rich foods if periods are heavy.
• Tranexamic acid for heavy bleeding.
• HRT to help regulate symptoms during perimenopause.

A more urgent or frequent need to urinate, leaks when you cough or laugh, and repeated urinary tract infections.

Why it happens. Oestrogen maintains the tissue of the bladder, urethra and pelvic floor. As it declines these tissues weaken and the urinary environment changes, raising infection risk.

HOW TO FIND RELIEF

• Vaginal oestrogen, which reduces recurrent UTIs.
• Pelvic floor exercises.
• Staying well hydrated and bladder training.
• Reducing bladder irritants such as caffeine.
• Prompt treatment of any infection.
• Seeing a GP about incontinence options.

A noticeable drop in sexual desire, arousal or enjoyment that can affect confidence and relationships.

Why it happens. Falling oestrogen and testosterone reduce desire and arousal directly, while dryness, painful sex, fatigue and low mood all add to the effect.

HOW TO FIND RELIEF

• Treating any dryness or pain first.
• HRT to restore oestrogen.
• Testosterone supplementation where indicated, via a specialist.
• Psychosexual counselling.
• Open communication with your partner.
• Addressing fatigue, mood and stress.

Dryness, itching, soreness or a burning sensation in the vulva and vagina that can make daily life and intimacy uncomfortable.

Why it happens. Oestrogen keeps vaginal tissue thick, elastic and lubricated. As levels fall the tissue thins and produces less moisture — part of what clinicians call genitourinary syndrome of menopause.

HOW TO FIND RELIEF

• Local (vaginal) oestrogen — highly effective and safe for long-term use.
• Regular use of vaginal moisturisers.
• Lubricants for comfort during intimacy.
• Systemic HRT.
• Avoiding perfumed soaps and other irritants.
• Maintaining tissue health with regular sexual activity and pelvic floor care.

Discomfort, burning or pain during or after intercourse (dyspareunia), which can make intimacy something to dread rather than enjoy.

Why it happens. Thinner, drier and less elastic vaginal tissue is more easily irritated and torn. It is one of the most common — and most treatable — intimate symptoms.

HOW TO FIND RELIEF

• Local vaginal oestrogen.
• Lubricants and regular moisturisers.
• Vaginal dilators or pelvic floor physiotherapy.
• Systemic HRT.
• Allowing time for arousal and treating underlying dryness.
• Seeing a clinician to exclude other causes.