Health Blog

World Menopause Day: Understanding Menopause Beyond the Hot Flushes

When we think about menopause, hot flushes and night sweats are often the first symptoms that come to mind.

But for many women, the changes are considerably broader than that.

Sleep may become disrupted. Concentration and memory can feel less reliable. Some women experience anxiety for the first time, or find that previously manageable worries suddenly feel overwhelming. Mood, energy levels and confidence may change. Others notice differences in their weight, body composition, joint health or ability to recover from exercise. Some experience symptoms they would never previously have associated with menopause.

And for some, the transition passes with relatively few difficulties.

World Menopause Day, held every year on 18 October, is an opportunity to look beyond the familiar symptoms and consider the wider implications of menopause for women’s health, both now and in the years ahead. [1]

Understanding menopause and perimenopause

Menopause is defined retrospectively as the point at which a woman has gone 12 consecutive months without a menstrual period, provided there is no other explanation for the absence of menstruation. In the UK, the average age of natural menopause is around 51. [2, 3]

However, the changes associated with menopause usually begin well before that point.

Perimenopause describes the transitional period during which hormone levels fluctuate and menstrual cycles may become irregular. It can begin several years before menopause and is often when symptoms first appear.

During this time, changes in oestrogen and progesterone can affect multiple systems throughout the body. [2, 3]

The experience is highly individual. Some women have relatively mild symptoms, while others experience changes that significantly affect their health, relationships, work and quality of life.

Menopause can also occur earlier than expected, either naturally or following certain medical treatments or surgery. [2]

Menopause doesn’t always look the way we expect

Although hot flushes and night sweats are well recognised, they are only part of the picture.

Women may experience a combination of physical, cognitive and emotional changes, including:

• Sleep disturbances: Difficulty falling asleep, waking frequently or feeling unrefreshed despite spending sufficient time in bed.
• Anxiety and changes in mood: New or worsening anxiety, feelings of unease, increased worry, irritability, low mood or feeling overwhelmed by situations that previously felt manageable. Some women experience heightened anxiety or episodes of panic during perimenopause, even without a previous history of anxiety. Hormonal changes, disrupted sleep and other life circumstances may all contribute.
• Memory and concentration: Forgetfulness, difficulty finding words or the experience commonly described as brain fog.
• Muscle and joint symptoms: Joint discomfort, stiffness, changes in muscle strength or slower recovery from physical activity.
• Changes in body composition: A tendency towards increased abdominal fat and changes in muscle mass, even without major changes in overall body weight.
• Genitourinary symptoms: Vaginal dryness, discomfort, urinary urgency or recurrent urinary tract infections.
• Changes in skin and hair: Increased skin dryness, changes in hair texture or thinning.

These symptoms are recognised in clinical guidance and research, although their frequency, severity and relationship to hormonal changes vary between individuals. [2, 4, 5]

Not every symptom experienced during midlife is necessarily caused by menopause. Thyroid disorders, nutritional deficiencies, sleep disorders and other health conditions can produce overlapping symptoms, making individual clinical assessment important.

Menopause and long-term health

Menopause is not simply about managing symptoms. The hormonal changes that occur during this period can also have implications for longer-term health.

Bone health: Oestrogen plays an important role in maintaining bone density. As oestrogen levels decline, bone loss can accelerate, increasing the risk of osteoporosis and fractures. Adequate calcium and vitamin D, resistance exercise and appropriate assessment of individual fracture risk are important considerations during and after menopause. [2, 6]

Muscle strength and physical function: Ageing is associated with gradual changes in muscle mass and strength, and the menopausal transition may contribute to these changes. Maintaining muscle strength becomes increasingly important for mobility, metabolic health, balance and long-term independence. Resistance exercise, sufficient dietary protein and regular physical activity can all contribute to maintaining muscle health. [2, 7]

Cardiovascular and metabolic health: The menopausal transition is associated with changes in fat distribution and blood lipids, while cardiovascular risk also increases with age. Midlife is therefore an important time to review blood pressure, cholesterol, blood glucose and other cardiovascular risk factors. Menopause is one part of this picture, alongside ageing, genetics, lifestyle and existing health conditions. [2, 7]

Sleep, anxiety and psychological wellbeing

Sleep disruption can be one of the most difficult aspects of perimenopause and menopause.

Night sweats may interrupt sleep, but changes in sleep quality can also occur independently of vasomotor symptoms.

Poor sleep can affect concentration, mood, appetite, pain sensitivity and the ability to manage everyday responsibilities. [4]

Anxiety is another important, and sometimes overlooked, aspect of the menopausal transition.

Some women describe feeling unusually worried, tense or emotionally unsettled, even when there is no obvious reason for these feelings. Others find that situations they previously managed comfortably begin to provoke anxiety or that their usual ways of coping feel less effective.

Research has identified associations between the menopausal transition and psychological symptoms, including anxiety and depression. However, the relationship is complex, and the evidence does not establish that hormonal changes alone explain these experiences. Sleep disruption, physical symptoms, previous mental health difficulties and wider life circumstances may all play a role. [5]

For women already balancing work, family responsibilities, caring roles or other demands, these changes can have a considerable cumulative effect.

Psychological support, appropriate treatment of menopausal symptoms and attention to sleep routines may all be helpful. NICE recommends considering menopause-specific cognitive behavioural therapy (CBT) for certain menopause-related sleep difficulties and depressive symptoms, depending on individual circumstances. [2]

It is also important to recognise that menopause can coincide with other significant life changes. Not every difficulty experienced during this period is hormonal, and support should reflect the individual’s wider circumstances.

Supporting health through menopause

Menopause can affect many aspects of health, and managing these changes often benefits from looking at the bigger picture.

Nutrition and dietary changes, regular movement, maintaining muscle and bone strength, psychological support and appropriate medical treatment can all play important roles in managing symptoms and supporting longer-term health. The right combination will depend on the individual, their symptoms, medical history and personal circumstances. [2, 7]

At Springbank Clinic, our multidisciplinary team brings together expertise in specialist dietetics, clinical psychology, osteopathy, physiotherapy and other areas of healthcare. By working collaboratively, we can help women address different aspects of their health, from nutritional needs and physical changes to anxiety, sleep difficulties and emotional wellbeing.

This World Menopause Day, we’re encouraging women to recognise that support is available, that their concerns deserve to be taken seriously and that menopause care should be as individual as the women experiencing it.

If you’re experiencing changes during perimenopause or menopause and would like support, we encourage you to get in touch. Whether your concerns relate to nutrition, bone and muscle health, anxiety, sleep, joint discomfort or your general health, our team can help you identify which of our practitioners may be best placed to support you.

You don’t need to wait until symptoms become difficult to manage before seeking help. Taking the time to understand what’s changing and explore the support available can be an important first step.

Contact Springbank Clinic to speak with our team and find out how we can help.

Useful information and resources

For reliable information about menopause, symptoms, treatment and longer-term health, the following UK resources provide useful starting points.

• NHS — Menopause
  Information about perimenopause, menopause, symptoms, treatment options and when to seek medical support.
• NICE — Menopause: Identification and Management (NG23)
  National clinical guidance on recognising and managing menopause, including HRT and non-hormonal treatment options.
• Women’s Health Concern
  Patient information and evidence-based factsheets covering menopause and wider women’s health.
• British Menopause Society
  Specialist clinical information, educational resources and guidance relating to menopause.
• Royal Osteoporosis Society
  Information about bone health, osteoporosis prevention and maintaining strong bones throughout life.

References

1. International Menopause Society. (2026). World Menopause Day 2026: Chronic Pain at Midlife.International Menopause Society.
2. National Institute for Health and Care Excellence (NICE). (2015, updated 2026). Menopause: Identification and Management. NICE Guideline NG23. Read the guideline.
3. World Health Organization. (2024). Menopause. WHO Fact Sheet. Read the fact sheet.
4. British Menopause Society / Women’s Health Concern. (2025). Understanding and Managing Sleep Problems During the Menopause. Read the resource announcement.
5. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. (2023). Read the systematic review.
6. Royal Osteoporosis Society. (2021). What’s the Menopause Got to Do with Bone Health? Read the article. See also Vitamin D for Bones.
7. British Dietetic Association. (2025). Eating Well for the Perimenopause and Menopause. BDA Food Fact Sheet. Read the fact sheet.